newsRCPCH

6In memory of June Lloyd

10Seeing things differently

13Child protection,paediatricians and thecourts – new trainingprogramme

12BPSU 20th Anniversary

RCPCH Vision and Values document enclosedAn outline of College activities today and strategies for the future.

AUTUMN 2006

Royal College of Paediatrics and Child Health

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Reading is to the mind what exercise is tothe body Sir Richard Steele

They say that doctors make the worst patients.So when I discovered I had high bloodpressure, I took the only possible course ofaction; I totally ignored the problem andcontinued doing the very things that hadprobably precipitated it in the first place.Eventually, when denial and avoidance failed,I was taken in hand by the College President,who duly dispatched me to consult my GPand join a health club.

I had a hazy concept of where and howto find the GP surgery, but a health club?! It was my brother-in-law who helpfullysuggested I should join Holmes Place in MillHill. My emphatic claims that there was noHolmes Place in Mill Hill evaporated when ittranspired that the very large building rightnext door to the Waitrose where I shop everyweek was indeed Holmes Place.

Selective blinkers are a great way ofavoiding seeing the things that are under ournoses – and maybe the College falls into thatbracket. The building at Hallam Street, the staffand the officers make up a component of theCollege…but ultimately, the College is themembership. The expertise of that membershipis incalculable, and it must be seen and heard.My concern as I write this column is that we’renot tapping into that expertise effectively.Currently we are asked to respond to abouttwo consultations per week, to provide inputinto national working parties, and to advise onlocal service issues. The majority of ourresponses and advice come from a tinyminority of our 9,000 strong membership. If our advice is to be valid, we need to formaliseand extend our base of respondents. To thisend, we are proposing to establish a CollegeConsultation Panel – and we need as many ofyou as possible to sign up.

How can I join the College Consultation Panel?Please use the form enclosed in this mailingpack. Further copies can be downloaded fromwww.rcpch.ac.uk/publications/recentpublications/consultationpanel.pdf This will giveus a cohort of people who are available torespond to consultations, give advice and/or tojoin short-life working groups. By telling us yourparticular interests and expertise, we can make

sure we use your knowledge to best effect.

What is the commitment?We would like you to stay on the panel for aminimum of one year – but like the gym youcan, of course, make a lifetime commitment.For each year you are a member, we will askyou to respond to 2-3 consultations or to joinone working group. In total, we are asking fora minimum commitment of 3 days per year,although we’d be delighted if you want to domore. We will, of course, continue to consultsome people who are not on the panel, butwill have a more formalised relationship withthose who are ‘signed up’.

What’s in it for me?I know that many of you will be happy tocontribute to this work without expecting anyparticular incentive. Nonetheless, it is nowcrucial that people’s work is acknowledgedand evidenced - and we will be supplyingregular documentation of your contributions,which you will be able to put in yourappraisal folder. This will also support ACCEAapplications which are dependent ondemonstrating work which is ‘over and above’normal commitments. Much of what we areasking of you will also have CPD value, andwe are planning to provide CPD certificationof relevant work.

When Pat told me to join a gym, I hoped thatthe pain of paying out the membership feeswas enough proof that I’d heeded aPresidential instruction. I now find that to getsome positive health gain, I actually have togo there and work up a sweat. The same istrue of College membership fees; the joining isnot enough. We will only get maximum healthgain for children if more people ‘go there’ –but unlike the gym you can do it from thecomfort of your own home. So I’m off to thegym right now. And you know what? I’mactually enjoying it!

Hilary CassRCPCH REGISTRAR

Editorials

From the Registrar

4News round-up

5PCAG: listening to others

6June Lloyd obituary

7Good practice for healthprofessionals

10Seeing things differently

11Trial of osteopathy forchildren with Cerebral Palsy

12BPSU Conference

13Child Protection and the courts

14Trainees Committee report

15Meetings

From the EditorsWith this issue of the RCPCH News, we begin theprocess of a gradual transformation of the newsletterinto a real ‘connecting medium’. To this end, we havechanged the format to enable a more interestingpresentation of issues of relevance to children andyoung people.

RCPCH as the professional organisation ofpaediatricians, has a major role to play in bothstrategic practical aspects involving healthcare forchidren and young people. In a supplement withthe current issue, Patricia Hamilton, RCPCHPresident, outlines a practical action plan for theCollege during the course of next three yearsYour comments on the document, and any otheritems of this issue, are most welcome.

In the next issue to be published in mid-December, we intend to focus on the issue ofchildhood obesity, so watch this space!

Rashmin Tamhne, Graham Sleight, Joanne Ball.

In the newsAutumn 2006

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I was talking to a 9 year old the other dayand asked her if she had any pets. Shereplied rather ruefully that she did not. Shetold me she had asked her parents if shecould have a gerbil but they said she couldnot. Some time later she asked if she couldhave a cat and again they said no. Later stillshe asked for a dog, but this too wasrefused. “What I’m working on now” sheconfided “is a horse”.

It is perhaps this spirit of hope overexperience that paediatricians will recognise.We have been asking for a better resourcedservice for many years. We had hoped thatthe national service frameworks in our fournations would result in changes but theserecommendations have not been resourcedor given the priority that is needed. Therecent Healthcare Commission reportshowed that whilst many hospitals areproviding good services under difficultcircumstances many were still marked as“weak”. There were particular difficulties inproviding child-friendly facilities in the A&Edepartments and there were also shortfalls inoutpatient services.

This is disappointing but not surprising.We have been drawing attention to theincreased stresses on paediatric A&Edepartments and in particular the rise inattendances due to changes in primary careand to parental expectations. Attendanceshave been matched by an increased numberof admissions. Hence we are having todevote a lot of our personnel and resourcesto the acute sector whilst plannedattendances both in and out of hospitalinevitably suffer. We have highlighted this tothe politicians we meet and are about to beinvolved in a pilot for practice basedcommissioning and in an initiative on urgentcare services.

If regulation is to mean anything then theresults of the Healthcare Commission’sreport ought to result in Chief Executives oftrusts being obliged to put their houses inorder. We will be pushing the Department ofHealth for this but local paediatriciansshould take their copy of the report andwave it at their trust board.

The Donaldson report Good doctors, saferpatients has recently been released. This haswide implications and I have sent out an

email asking for your response. There ispotentially a strong role for Colleges inproviding ways in which doctors canrecertify or credential their skills in theirspecialty. In theory we would support theimportance of doctors demonstrating theirability to continue to practise – but howshould this be done and what are thepenalties for failing to do this? How do wedefine an acceptable level of performance?Is it fair that a doctor’s livelihood shoulddepend on a civil rather than a criminalbalance of certainty? What warning shouldbe given that a doctor’s performance is notup to scratch and needs improvement? Ournext Council meeting will be dedicated todebating this so please make sure yourrepresentative knows your views.

Speaking of Council meetings, I havebeen going to some regional meetings and more are planned – thank you to thosehow have invited me. I am somewhathumbled by the general view that CollegeCouncil meetings can be boring. I’m trying to think of ways of being creative and having a debate on a substantial topicsuch as the Donaldson report in theafternoon is one of them. We do havestatutory business to conduct, and this must take priority.

One example of an item guaranteed tohave people suddenly have to leave toanswer their mobile phones is the budget.But this is crucial. In these changing dayswe have to think of how our statutoryfunctions – which are the ones for which wereceive considerable funding - are changingor indeed whether we will have anystatutory function at all in future. We willalways have a crucial role in settingstandards for service and education but thefinancial implications of – for example – thePMETB are considerable and we have to beaware of this.

You will find attached in this edition ofthe newsletter a copy of my vision for thefuture. This is a personal vision of how Iwould like things to be different for childrenand for paediatricians as a result of theCollege’s activities over the next three years.We have traditionally always had a budgetand workplan which relate to a strategy butwe have not articulated our vision and

values. The vision will determine thestrategy and workplan that the College, itsofficers and committees will follow toachieve our aims. My next column will detailthe ‘how’ of achieving this vision.

This July the GMC decided to put thelease on 44 Hallam Street (next door to us)up for sale. Over the years we have debatedwhether we would buy this 50-year leaseshould it become available. In many ways itseems very attractive to be able to occupythe premises next door to our currentbuilding in a good location. We haveoutgrown Number 50 and we are alreadyrenting space on two other sites. However,the GMC building has a large Councilchamber which we would not need inaddition to our existing one and lots ofrather small rooms. Importantly it isarchitecturally listed and neither WestminsterCouncil nor the freeholder permit anystructural changes. The price was initiallyvery good so we gave it considerablethought. However, the price gradually rose, secret bids were asked for, and theprospect of being left with two elegant butold fashioned buildings with inflexible space and a decreasing asset meant in theend we did not bid for it. We are stillactively looking for a modern freeholdbuilding that will be fit for purpose,attractive for staff to work in and useful to members. But we also need to be prudent and leave our successors financially secure.

The College is ten years old this October.We have achieved a great deal. The next tenyears will be even more challenging – but Ibelieve we will be very much in theforefront of determining the shape ofservices, of providing educational resourcesand of enabling paediatricians todemonstrate that they meet the professionalstandards to which we aspire. We may bewishing for a horse – but I hear the soundof hoof beats.

Patricia HamiltonRCPCH PRESIDENT

RCPCH newsEditorials

From the President

Many subjects have brought the College andthe media together over the past few months.

The BPSU celebrated its twentiethbirthday, and some of the health press choseto highlight current research such as the risein TB rates in London.

In late June, thirty paediatricians andvaccination experts wrote an open letter to themedia and health professionals to put a stop tothe doubts about the MMR vaccine. Co-ordinatedby the Science Media Centre, this generated lotsof coverage and comment. MMR was also themain focus of Patricia Hamilton’s Radio 5 Liveinterview with Simon Mayo in July in which shewas invited to talk about her role as President.

Paediatrics had its own speciality focus pagein Hospital Doctor in July. The College’s Vice-President for Training and Assessment, MaryMcGraw, and Workforce Planning Officer DavidShortland, gave the latest news from their areas.

Following the death of June Lloyd (BaronessLloyd of Highbury) in late June, the Guardianand the Times both carried her obituary andPatricia Hamilton spoke to Radio 4’s The LastWord about her impact on paediatrics and herinstrumental role in the College’s creation.

The journalist Jonathan Gornall, wrote anarticle about the College’s new ChildProtection Companion in the BMJ and sparkeddebate in July. Patricia Hamilton had theopportunity to state the College’s position onthe Today programme on the same day.

The new Press Panel has been workinghard too, for example with Dr Alan Stantonfrom Birmingham talking to The Scotsmanabout how children can live healthier livesand Professor David Field from Leicestertalking to The Guardian about how gas can beused to cut lung risk for premature babies.

Children and young people’s healthcontinues to be high on the media agenda, sowe will continue to comment and promoteour work where we can.

Claire BrunertHEAD OF MEDIA AFFAIRS

…call it what you like, it’s all about taking partand having your say in the things that affectyou. Involvement has become a profession inits own right with Participation Worker rolespopping up all over: even the RCPCH has one!

You may know that last year the Collegeconsulted with a group of over 70 children andyoung people about how they could be moreinvolved in its activities. The recommendationsthey made, published in the Coming Out OfThe Shadows* (COTS) document, were to formthe basis of a strategy of participation forRCPCH. Since joining the College as Children’sParticipation Manager in February 2006 I havebeen following up on group suggestions andputting words into action to create areas ofparticipatory work at the College.

In the near future you will see the youth-friendly branding for the College, which is beingdeveloped by young people in workshopsessions. This in turn will lead to the creation ofa website page for children and young people,the format and content of which will be decidedthrough consultation with and contributions fromyoung writers. Using the website, the College willbe able to engage daily with young people, askthem to join in consultations, gain their opinionand feedback and provide public healthinformation. In addition, I have been looking atthe potential for involving children in theassessment of candidates in the College’s ClinicalExams and how this might be best applied.

From the COTS report, one of the mainareas young people highlighted as an issuewas communication between them and theirpaediatrician. I will be assessing how this canbe improved, with the results being madeavailable to all members. I am also planningtraining and workshops for members at the2007 Spring Conference, details of which willbe in the next edition of the Newsletter.

As paediatricians, the recipients of yourservice are children and young people, and morewidely their families. What is generally acceptedfor children’s services is that, in the main, theyare adult-led. They are designed and managedby people whose job it is to do so, and most of

the time these services meet the requirementsand get the job done. However, what if the childwas involved? What if their suggestions werelistened to and the way in which they sawsomething was so different an adult would neverhave thought of it? Participation is not aboutrelinquishing control but about enhancing theeffectiveness and appropriateness of a service toensure it meets the needs of the child.

I am not going to go on about how positiveparticipation is or how much money or time itcan save. What I am going to do over the nextfew editions of the Newsletter is to shareprogress of the College’s participation projects,provide guidance on how you can increase thelevels of engagement with your patients, ask youto share examples in your own work and howyou did it, what the benefits were for both youand the young people.

So, if you would like further information,would like to get involved, or perhaps know a young person who may like to have theirsay, then for now (until the website is open forbusiness) email sophie.auckland@rcpch.ac.ukor call me on 020 7307 8018.

CYP Recommended Websites/Organisations:

www.cftrust.org.ukThe Cystic Fibrosis Trust website isrecommended for its interactive chat forumwhere young people can safely post theirquestions, share their experiences and providetips and suggestions to others. On the main pagego to Meeting Point and select forum ‘TALK.’www.youngaddaction.org.ukWith the recent reports of 1 in 5 eleven tosixteen year olds drinking alcohol at least once aweek, then services for alcohol abuse for youngpeople are a must. Addaction’s youth branchprovides online advice about alcohol and drugs,as well as a confidential service for finding localone-to-one services for more in-depth help.* http://www.rcpch.ac.uk/publications/y.html#young_people

Sophie AucklandCHILDREN AND YOUNG PEOPLE PARTICIPATION MANAGER

The media column

Participation, engagement,involvement, active listening…

News

Honorary editor: Rashmin Tahmne Managing editor: Graham Sleight Editor: Joanne Ball Email: newsletter@rcpch.ac.ukEditorial services: Chamberlain Dunn Associates Advertisements: British Medical Journal

Published by the Royal College of Paediatrics andChild Health, 50 Hallam Street, London W1W 6DE Tel: 020 7307 5600, Fax: 020 7307 5601 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.ukThe College is a registered charity: no. 1057744

© 2006 Royal College of Paediatrics and Child Health. The views expressed inthis newsletter do not necessarily reflect the official positions of the RCPCH.

RCPCH newsCopy deadline for next issue: 1 November 2006

Page 4

It is now 5 years since the College began aPatients’ and Carers’ Advisory Group(PCAG). Earlier this year I took over fromthe founder Chairman Carole Myer. LikeCarole, I care passionately about the qualityand appropriateness of health services forchildren. This results from my experiencesas a nurse (albeit long ago!), my involvementwith ‘Action for Sick Children’, and as aTrustee of ‘Transport for Sick Children’ inGreater Manchester – and more importantlyas a mother. But my experiences with a sickchild are personal and even differ from thoseof my children, the ‘patients!’

So the PCAG will try to persuade you ofthe value of each ‘personal’ experience.What is appropriate for one child and itsfamily is not always appropriate for anotherand by listening to others we increase ourability to be more responsive and createmore opportunities.

I believe the PCAG has an important role toplay. Our aims are: • to promote the participation of patients

and carers • to facilitate their access to information

about their health care • to inform and advise Council of the

public perspective of paediatrics andchild health.

During my three-year term of office I wantto encourage lay representation across theCollege. We support the exciting workSophie Auckland, the Children’s ParticipationManager, has started (see article opposite).The PCAG looks forward to seeing how wecan harness “participation, engagement,involvement and listening” to children andtheir families in order to help improve thepublic’s understanding of the College andmore importantly to help you in your workas paediatricians. We welcome your supportof the joint RCPCH/Contact a Family project“parents & paediatricians together”.

The one thing in life that is certain ischange! We should never presume that theway we are currently doing something isbest nor will we always get it right in thefuture. We must be looking for innovationand creativity to provide good health carefor our children and meet the challengesahead. I hope there will be opportunities tomeet you personally.

STOP PRESS: Please could you suggest a ‘good read’for budding paediatricians, and maybeeven ALL medical students?

The Sunday papers have wonderfulcolumns full of celebrities’ & authors’recommendations for a “good holiday read”and I’ve received a challenge from Dr SimonLenton, Vice President RCPCH, HealthServices Committee:

When a child goes into hospital, isdiagnosed with a serious illness or hasanother baby brother etc there’s a goodselection of preparation/ ‘how it was for me’books for children & parents to read.

Some are extremely helpful and some doaffect you enormously. (Memories of SusanHampshire’s struggle with her own dyslexiawhen my eldest’s mysterious problems werefinally identified!)

But if you aspire to become apaediatrician what should you read?

At a recent dinner with friends, an eminentretired Prof of Medical Oncology said thebook that had influenced him most was A.J.Cronin’s The Citadel.

Mine would be Margaret Drabble’s The Millstone (1965). I’m sure this bookinspired me in the early 70’s to become apaediatric nurse & get involved withNAWCH as it was called then! The staffthought they were doing the right thing &their best. But I didn’t really understandhow Rosamund, the main character, felt until many years later and the first dash tohospital with my own child.

So would you contribute a suggestion?Please make a maximum of fiverecommendations of your personal choice byemail to sophie.auckland@rcpch.ac.uk .Provide any explanation or reasons youwish. The College Registrar, Dr Hilary Casshas written a very good book called TheNHS Experience The ‘Snakes and Ladders’guide for patients and professionals, whichmight get a mention. The Trainees’Committee have agreed to be our ‘officialreaders’ before the PCAG publish the full listand our recommended Top 10 list!

Sally Sweeney-CarrollCHAIR, PCAG

PCAG: listening to others

News

Advocacy and the College

Dear Sir,

Advocating for Children was published bythe Royal College of Paediatrics and ChildHealth (RCPCH) in October 2000. It remindsus that it is our duty to speak up for theinterests of children everywhere. One of themain objectives stated is the promotion ofthe United Nations Convention on the Rightsof the Child. The United Nations InternationalChildren's Education Fund (UNICEF) asksthose involved in care of children to raiseawareness of the Convention and its OptionalProtocols, research and documentgovernmental actions and policies andinvolve communities in promoting andprotecting children’s rights. A respectedorganisation like the RCPCH is likely to bemuch more effective than individuals inpromoting positive change. We firmly believethere is a need for the college to take a morepolitical role in pressing the UK governmentwith regard to its policies affecting childrenwithin the UK and in the international arena.This will require less caution and a greatersense of urgency than is being shown atpresent whilst avoiding political bias by usingthe UN convention on the Rights of the Childas the bedrock of advocacy. We believe thefirst step in this would be for the college toemploy an officer with a political remit. If theRCPCH is to live up to its name as a Collegefor Child Health, a louder voice in the politicalsphere is critically important.

Yours sincerely,

RAMAN LAKSHMAN, N AHMAD, MALCOLM BATTIN,MALCOLM BAXTER, MITCH BLAIR, GRAHAM BRIARS,JACQUELINE BUCK, JOHN BRIDSON, HARIKUMAR

CHIDAMBARA, PAUL DAVIS, ZOE DUNHILL, BASIL

ELNAZIR, IAN EVANS, CARYS GRAHAM, RAJEEV

GUPTA, JANET HISLOP, RACHEL HOWELLS, SUSAN

IRELAND, LYDA JADRESIC, ANTHONY JOHN, GLYN

JONES, SARAH KELLY, WOLFGANG MULLER, RICHARD

NICHOLL, MARTINA NOONE, ALICE O'NEILL, RAJESH

PHATAK, UMESH PRABHU, RICHARD READING, VENKAT

REDDY, JUSTIN ROCHE, ROBERT SCOTT-JUPP, V.S.SANKAR, OLUGBEMIRO SODEINDE, NICHOLAS SPENCER,PRAKASH THIAGARAJAN, SUE THOMPSON,V.VIPULENDRAN, SUE ZEITLIN, PAM ZINKIN.

We welcome correspondence on this or othersubjects for publication in the Newsletter.Letters (ideally under 300 words) can besent by email to newsletter@rcpch.ac.uk

LETTER TO THE EDITOR

RCPCH news

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News

Page 6

Obituary

Powerful and PassionateAdvocate for Children’s Health

Whilst the College has been celebrating itstenth year, sadly, June Lloyd passed away on29 June. She played a crucial role in itsformation, was a leading paediatrician of herday and an inspiration to women in medicine.This is primarily commemorated by herdepiction on the College Coat of Arms.

June Lloyd and Otto Wolff produced apaper in 1977 on "The Case for a College ofPaediatrics," but when the proposal was put tothe membership in a 1978 referendum, it wasdefeated by a substantial margin. Undaunted,Lloyd and others continued to press the caseand a second referendum in 1987 produced aclear mandate to seek College status. Afterprotracted negotiations, this was eventuallyachieved and the new College of Paediatricsreceived its Royal Charter in 1996.

In the period running up to the formation,members were asked what they would like tosee on a coat of arms. Several suggestionscame forward that it should depict the family.Father was easy. Thomas Phaire was theauthor of the first book on paediatrics in theEnglish language in 1545. He holds scales,

which signify the role of the College insetting standards and professionalexaminations. He already appeared on theCoat of Arms of the Australian College ofPhysicians. The mother is a depiction ofJune Lloyd, in recognition of her role in theformation of the College and of her positionas first woman president of the BPA. She isholding a rod indicating the staff of Aesculapius.Instead of a serpent, it is intertwined with adouble helix representing the importance ofscience - of which June Lloyd was apowerful proponent. The baby on the crestwas taken from the Coat of Arms of theFoundling Hospital in Coram Fields. She wasa Paediatric Vice President of the RoyalCollege of Physicians of London and manyhad tipped her to be the first non-Physicianto be president of that ancient institution.

June Lloyd was born on New Year’s Day1928 in Gilgit, Kashmir, a wonderful mountainregion in India. The family returned toEngland when June was eight and she wasenrolled at the Royal School in Bath. She laterqualified with honours and a gold medal fromBristol in 1951 obtaining her MD in 1966. Shebecame one of the youngest female membersof the Royal College of Physicians in 1954. It was difficult for women to make their wayin a competitive man's environment and it wassuggested that she try Public Health. Sheundertook a course in South Shields and wasagain told that paediatrics was not for women.Being a stubborn character this just made hereven more determined to follow her chosencareer path. Further training in Bristol wasfollowed by a move to Birmingham where shebecame research assistant to Otto Wolff. Hereshe developed research interests in obesity,inherited disorders of fat metabolism andother metabolic diseases. Her maincontribution is probably the recognition of thefat-soluble vitamin deficiencies which occur inchildren with abetalipoproteinaemia.

She followed Otto Wolff to Great OrmondStreet and the Institute of Child Health in1965, becoming senior lecturer and here she

further developed her research interests.During this time she became very active inteaching, traveling widely to lecture and began to serve on major national committeesincluding the Medical Research Council.In 1975 she was appointed to establish a new Department of Paediatrics at St George’sHospital Medical School.

In 1985 she returned to Great OrmondStreet as Nuffield Professor of Child Health. Shealso continued to develop nationalresponsibilities and was the first womanpresident of the BPA from 1988 to 1991. She retired in 1992, but continued to work for the promotion of paediatrics and children’shealth. In 1990 she was made DBE and in1997, a Baroness. When informed that she wasto enter the House of Lords she was told thatshe had joined the best club in town. Herresponse was “but I am not a clubbable person.”

Shortly before she was due to beintroduced into the House of Lords shesuffered a stroke, which left her very disabledand unable to speak.

The College’s former President ProfessorSir Alan Craft described her as a remarkableindividual. He said: “She had a fiery temper,which perhaps goes with the red hair. She had a steely eye and was very shrewd.Attention to detail was impressed on all who worked for and they all had to keepmeticulous charts of every facet of a child'sexistence when a patient under her care.

“She always had an open door and wouldbe pleased to talk to anyone. She wasaffectionately known as Aunty June by staff andshe enjoyed being surrounded by bright youngmen, although women did not find her so easy.”

The College’s President, Patricia Hamilton,described June as “feisty” and that “she is anexample to us of what can be achieved. Sheshowed us that we should not accept that thehigher roles are not for women, because theycertainly are. She was highly respected andhad a very good, considered judgment.”

Baroness Lloyd of Highbury – June Lloyd

News RCPCH news

Page 7

William Cadogan Prize

The BSHPCH is offering a £250 prize for anoriginal essay of up to 3,000 words, on anyaspect of the history of paediatrics and childhealth, in any period of time or place. Theprize has been established in memory of Dr William Cadogan of Bristol (1711-1797) an eminent pioneer of child health care andfather of infant care in Britain.

As well as the prize, the winner will beinvited to give a presentation to the autumnmeeting of the Society. The closing date is 1 April 2007 and the winner will be notifiedin early July of that year.

Further enquiries (and submissions) shouldbe directed to the Secretary: Mr Robert Arnott,Director, Centre for the History of Medicine, The Medical School University of Birmingham,Birmingham B15 2TT. Email: r.g.arnott@bhanm.ac.uk

Good Practice for Health

Professionals when

communicating difficult news

British Society for the History ofPaediatrics and Child Health

Sharing news with parents about a child is achallenging task requiring great skill andsensitivity. Since the Right from the Start initiativeby Scope in June 1994 patient surveys suggestthere have been improvements in the waydiagnosis is being delivered. In one recentlycarried out by Unique, a charity that support rare disorders, 64% of the parents felt thepaediatricians delivering diagnosis did so with asensitive manner though only 32% of the parentsfelt they were given enough information. Amore recent survey carried out by the DownsSyndrome Association reflects a similar picturebut also raises concerns of how diagnosis is

delivered when the child is still in the womb.The Contact a Family Support Pack for

Health Professionals includes good practiceadvice on sharing news in differentcircumstances including prenatal settings,death in utero, neo-natal units and referral togenetics clinics. It has been written for allheath professionals working with childrenincluding ultrasonographers, obstetricians,neonatal nurses, midwives, neonatologists,paediatricians and specialist nurses.

The health support pack has recentlybeen updated to include information aboutthe Early Support programme which has been

developed by the government to support abetter co-ordinated family focused service fordisabled young children and their families.The Early Support material can be orderedfor free by any health professionals workingin England with children aged 0-5.

To order a free copy of the Contact aFamily Health Support Pack Telephone Sheila Davies, 020 7608 8773or email Sheila.Davies@cafamily.org.uk

A report of the Down’s Syndrome Associationsurvey can be obtained by emailingMarie.Benton@downs-syndrome.org.uk

Child Protection SpecialInterest Group (CPSIG)Call for nominations to ExecutiveCommittee

There are vacancies for two members of theCPSIG Executive Committee. Successfulcandidates should be available to start in January2007, to “shadow” Executive Committee meetingsprior to taking up position in June 2007. Eligible candidates must be members of CPSIG.

If you would like more information, please contact Jane Mitchell, e-mail: Jane.Mitchell@rcpch.ac.uk

Officers and staff at RCPCH recently spentMidsummer’s day together, getting to know a little more about each other’s work. Wetook the theme of seeing things differentlyand this provided me with the perfectprompt to sit down and write this piece. Ihave been struck in my time in the Collegeby comments paediatricians make about theirwork with children and by the differentperspectives they have from my own.

As a sick child in the 1950s, there wasnowhere for me to go, in the regional andcottage hospitals around my home, but intogeriatric wards. How awful, I have hearddoctors say, it is so much better now. But thatwas not my experience. The elderly womenwere kind to me, knitting me teddies andsitting and talking to me when they weremobile and I was not. I suppose theyreminded me of my grannies and these timesfelt safe and quiet and comfortable. Yes, therewere the nights when the curtains went roundthe bed and another patient had died. Butthese events affected me far less than the

bleakness and the cruelty of children Iencountered in the children’s wards of the 60s.

I can see this little girl standingbewildered and intimidated on her first dayin such a ward. Gangs of boys are tearingaround, crashing into people and screamingand shouting, toddlers are crying, standing atthe rails in their cots, and there are toys andbooks all over the floor. Too few nurses andauxiliaries are trying to calm things downand over all this chaos an enormous blackand white television is bellowing out thetheme from Popeye. For a tidy and quietchild the scene was disconcerting, to say theleast. Wherever I went in those days,televisions and their noise dominated thewards. There were too many children inthere and you could get no peace or privacy.That really mattered for me, as I wet the bedand desperately needed the other childrennot to notice, but of course they did and Iwas teased and bullied horribly for it,especially as I was by this time nine or tenand one of the older ones.

After that I graduated to Londonhospitals, both small specialist ones and thebig one. Paradoxically now the problemscame from small wards with a few childrentrapped in each other’s company. I supposein our way we were all trying to cope withpain, distress, loneliness, fear, boredom. Andbeing stuck in bed made things worse. Therewere horrible episodes of verbal abuse, ofsending one another to Coventry - the onlyway we could get at each other really. I wasconstantly criticised for my southern accent,for being posh in a ward of working-classchildren from London. The worst bullying Iexperienced was from a group who hadbeen in the ward for a while together. I wasan easy target as a new girl and they mademe very unhappy. One day they forced meto eat a whole packet of sweets, cajoling,threatening and by force. I don’t know nowwhether the sweets were off, or whether theywere just too much for a sick child to copewith, but I remember feeling terrible andwalking along long, bleak corridors looking

Seeing things differently

News

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Kim Brown in hospital in the 1960s.

for someone to help me, before I was hugelysick all over the floor of the kitchens.

Of course, there would be less scope forthis kind of behaviour now as ‘there arealways so many visitors and family andfriends around a child’s bed’. One of thedoctors I work with referred to this recentlyand it startled me. This was not myexperience. It was difficult for parents andfamilies to travel long distances to thesehospitals in London and long days andweeks went by with no visitors at all. No-onewould argue that this was good for a child,but nonetheless, I found visitors the biggeststrain of all when I was ill.

Somehow I felt I had to entertain them,and always felt a huge sense of relief, as wellas exhaustion when they left. I wonder ifanyone has asked children in hospital whatthey think about long visiting hours?

To end on another paradoxical note,there was a very positive side to theseexperiences - this is the adult writing inretrospect now and not the child. Far frombeing confined and limited by my time inhospital, it opened my world. For the firsttime I met working-class children, andchildren who were allowed to watch ITV,and read comics and have chewing gum. For the first time I met and was cared for byblack people. They washed me, and tookme for walks up the corridors and sangsongs to me and told me about their homes.In the 1950s and 60s in the south of Englandthat was a real privilege for a white middle-class child. By being stuck in hospital I discovered a wider and richer world than I would ever have encountered at home.

The college has recently appointedSophie Auckland in a new role as Children’sParticipation Manager. One of herresponsibilities is to bring the child’sperspective to the work we do. Perhaps thispiece might prompt other reflections onchildhood experiences of being ill, which, inturn, we can use to inform our training ofpaediatricians and our understanding of thebest interests of children in our care.

Kim BrownTraining and Assessment Advisor

News RCPCH news

Researchers from the Peninsula Medical School,the Institute of Child Health, University CollegeLondon and the Osteopathic Centre forChildren, London are carrying out a randomisedcontrolled trial to examine the effectiveness ofcranial osteopathy for children with cerebralpalsy. The trial is funded by Cerebra, thecharity for brain-injured children and youngpeople, as a direct response to their membersidentifying this as a priority for research.

The trial has been designed with extensiveinput from both parents of children with CP and osteopaths to determine the type ofchildren eligible, the choice of outcomemeasures and comparison arm. Cranialosteopathy is not a separate form of osteopathyfrom that used to alleviate problems in musclesand joints but is said to use subtler techniquesto “restore balance and release stresses in thebody” which some osteopaths have arguedmay be more appropriate for use with children.Osteopaths believe that this treatmentcomplements rather than interferes with otherforms of therapy, so the trial should notcompromise existing management.

Outline of trial150 children, aged between 5-12 years old,who have moderate to severe cerebral palsyand live in Devon (Exeter and Plymouthareas) or London (within the M25) will beinvited to take part. A researcher will visit thefamily at home to explain the trial and obtainconsent. Children will be randomly allocated

to either six sessions of osteopathic treatmentor to a waiting list. Children on the waiting listwill be repeatedly interviewed by researchersto provide at least a partial attention control,as well as providing an opportunity to collectqualitative data around life experiences andtreatment choices. Trial outcome data willinclude assessments of motor function (theprimary outcome assessed by independentphysiotherapists blind to treatment allocation),fit frequency, sleep and quality of lifemeasures for both parents and children.

Children allocated to the waiting list willbe given vouchers for six sessions ofosteopathic treatment after completing thefinal six month assessments: parents weconsulted had strong views that randomisationwas only acceptable if all participants wereoffered treatment at some point, and felt shamtreatments were unacceptable and unethical.The researchers believe that this design, withrandom allocation, use of an attention control,blind assessment of the primary outcomemeasure and outcome assessment after sixmonths offers the best opportunity for anunbiased assessment of effectiveness while stillhaving a good chance of engaging parents.

If you are responsible for a child who youthink may fit the inclusion criteria, or wouldlike to discuss any aspect of the trial, pleasecontact Stuart Logan stuart.logan@pms.ac.ukor Vanessa Edwardsvanessa.edwards@pms.ac.uk

Osteopathy for children with cerebral palsy

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News

Attended by over 140 delegates, the conferenceprovided an opportunity for college members,INoPSU (the International Network of PaediatricSurveillance Units) members, representativesfrom other national surveillance units andpatient support groups to come together andreflect upon 20 years of surveillanceundertaken by the BPSU. The conference

considered the role of paediatric surveillance todate as well as possibilities for the future.

Guest speakers were selected to representthe successful surveillance activities of theunit over the past 20 years. Presentationsincluded childhood inflammatory boweldisease by Professor Bhupinder Sandhu, thebiliary atresia story by Professor Deirdre Kellyand childhood tuberculosis by Dr DelaneShingadia. The special guest lecturer, a pastmedical coordinator of the BPSU, wasProfessor Angus Nicoll CBE, who delivered anentertaining and informative presentationabout pandemics and other emerginginfections. The two current recipients of theRCPCH Sir Peter Tizard Research Bursary, Dr Scott Williamson and Dr Shamez Ladhanipresented data from their studies onthyrotoxicosis and malaria respectively.

Several RCPCH Officers were involved inthe event including Dr Patricia Hamilton

(RCPCH President) who chaired themorning session and Dr Christopher Verityand Professor Neil McIntosh who chaired theafternoon sessions. Dr Sheila Shribman, theNational Clinical Director for Children, praisedthe work of the Unit and the commitment ofpaediatricians to the surveillance undertakenby the BPSU. If you would like copies of anyof the abstracts from this conference pleaseemail jennifer.ellinghaus@rcpch.ac.uk Formore information about the BPSU and itsactivities please visit the website atwww.bpsu.inopsu.com

The conference was followed by ameeting of the International Network ofSurveillance Units (INoPSU), which joins 14 diverse countries with the commonpurpose to conduct surveillance of uncommonconditions of childhood. Delegates enjoyedpresentations of studies by various unitscontributing to this network such as FoetalAlcohol Syndrome (Australia / New Zealand),Hypernatraemia (Netherlands / Canada / UK)and invasive Group B Streptococcal disease(Portugal) and shared ideas for futurecollaborative surveillance. For moreinformation about INoPSU please visit thewebsite at www.inopsu.com

Richard LynnBPSU SCIENTIFIC COORDINATOR

BPSU 20th AnniversaryConferenceIn June 2006 the BPSU completed 20 years of disease surveillance in the UK. A conference was held on Tuesday 30 May 2006 at the Institute of Child Health(London) to celebrate this momentous occasion, followed by a dinner at the RoyalInstitute of British Architects.

Dr Sheila Shribman, National Clinical Director forChildren and Professor Angus Nicoll CBE, past medicalcoordinator of the BPSU.

Dr Patrician Hamilton (RCPCH President) who chaired the morning session.

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News RCPCH news

Page 13

Over the last few years there has beenincreasing concern and interest aboutpaediatricians, child protection and the courts.No paediatrician can avoid the neglected orthe abused child. Part of the role in caringfor the child is to write reports and to attendcourt either in civil or criminal proceedings if required. Remember, we might think we are attending court as a professional witnessbut the moment we offer an opinion, thecourt will view us as an expert.

The courts are not always comfortableterritory for paediatricians and some way off our natural habitat.

The College is determined to dosomething about this and together with the Family Justice Council (chaired by the President of the Family Division andsponsored by The Department ofConstitutional Affairs) we are developing a training programme to help overcome some of these difficulties.

The programme is aimed at senior

trainees (SpR’s year 4 &5) and Consultants inthe early part of their career.

The programme has three parts:• A two-day course about family and

criminal law in England in Wales,evidence gathering, receiving instructions,report writing and preparing for court.There will be talks from experts in thelegal and health fields on a range ofcurrent problems in child protection andforensic medicine concentrating on theevidence base. On the second day therewill be an opportunity for every one totake part in a mock court exercise led by senior Barristers. This will involvereport-writing, examination in chief andcross-examination.

• Learning materials. These will bedeveloped along the same lines as therecently launched Safeguarding Children,Recognition and Response in ChildProtection Programme.

• Opportunities to observe the courts andthe judiciary at work. Around the countrythere is growing enthusiasm forpaediatricians to have the opportunity fora mini-pupillage, (time spent with abarrister or judge). We will publish goodpractice guidelines and ideas for yourportfolio.

The first course will be at The Royal Societyof Medicine, London on May 14th & 15th2007. The learning materials will follow andwe then plan to role the course out across the country. This is an exciting opportunityto be part of an important new trainingdevelopment and to help us get it right!

Are you interested? Please contact JuliaSharp: e-mail julia.sharp@rcpch.ac.uk

Rosalyn ProopsCONSULTANT COMMUNITY PAEDIATRICIAN NORWICH

MEMBER OF THE FAMILY JUSTICE COUNCIL

As I sit writing this with the sun shining in throughthe window I am reflecting on the opportunitiesthat are now open to SASG paediatricians whichweren’t available this time last year.

Firstly, the launch of PMETB means that we can have our experience as well as ourqualifications taken into account to have ournames placed on the Specialist Register. Thespeciality specific guidance for paediatrics isavailable on the PMETB website: www.pmetb.org.uk

Secondly associate specialists and SCMOswho were in post prior to April 2006 can now beelected as an Ordinary Member of the Collegeunder Bye-Law 11(i)(b).

If you are a UK-based Associate Specialist oran SCMO and have been in post prior to April2006 and you would like more information aboutthis please contact the membership section e-mail membership@rcpch.ac.uk or telephone 020 7307 5619.

So now thinking about the year ahead, theRCPCH annual information day for SASG doctorswill be held on Friday the 1st December. Please put this date in your diary.

Finally, we are waiting to hear the outcome of the negotiations of our new contract and arehoping this will reflect the commitment we showand hard work we do.

Natalie LythCHAIR OF THE SASG COMMITTEE

• The Royal College of Paediatrics andChild Health has been awarded thecontract to develop and implement theNNAP by the Healthcare Commission. A dataset of nine questions has beenagreed after consultation with theprofessionals involved through theBritish Association of PerinatalMedicine, the patient groups throughthe charity BLISS, and many others.

• A software provider, Clevermed Ltd, has been appointed to develop a web-based data collection audit tool.This company already provide aneonatal system which is in use in 70 units across the country.

• A carefully selected group of 30 units(covering a wide range of current datacollection systems) have now beenapproached to become Early Adopters.During the summer, the system will be implemented and fine-tuned withinthese units with their legacy systems,and in October we will be assessing the data and, soon afterwards, rollingthe programme out more widely.

If you would like any furtherinformation:Please contact the Project Manager, Louise Youle (louise.youle@rcpch.ac.uk)or Project Administrator, Kim Davis(kim.davis@rcpch.ac.uk).

Child Protection, Paediatricians and the Courts – A New Training Programme

The National Neonatal Audit Programme (NNAP) hasmade great strides in the past few months. The latestdevelopments are:

SASG NewsNational Neonatal AuditProgramme

Trainees

Night Shifts and on-call roomsThe night shift has become a very real part ofmost of our working lives. The Europeanworking time directive and a constant level ofpatient admission over a 24-hour period haveforced a move to a full-shift rota. This hasbeen coupled with the removal of on callrooms and appropriate rest facilities frommany departments. This is important, as nightshifts can be bad for the health of doctors andpatients alike.

The Junior Academy of the Medical Royal Colleges and the Junior Doctors’Committee of the British Medical Associationhave recently issued a joint position statement on the removal of on call rooms.(www.bma.org.uk/ap.nsf/Content/jntposstmtsleep). This has been supported bythe Trainees’ Committee.

Furthermore, there was a useful evidence-based guide to working the night shiftproduced earlier this year by a WorkingGroup led by Nicholas Horrocks and RoyPounder of the Royal College of Physicians (www.rcplondon.ac.uk/pubs/brochure.aspx?e=36). Despite our mention of this guide beforein this newsletter and talking to colleaguesabout it – few had heard of it and even fewerhad read it.

As a member of this Working Group anda relative newcomer to night shifts, I foundhearing the evidence from public health,industry and medics most enlightening.What is done before, during and after theshift has big consequences for the doctorand for the patients.

Brought up on 24-hour rotas, I hadbelieved that the pre-first-night day of a shiftrota was a bonus day off. In reality this day isfor rest and preparation for the forthcomingnight. It is clear that there is a duty to turn upadequately rested just as there is a duty to besober. This improves the quality of brainfunction. The more sleep deprived you are,the more attention fails, leading to clinicalerrors and incorrect diagnoses. Furthermore,being overtired prevents insight into the errorsthat are made.

In addition, fatigue limits learning, sostaying on for teaching after a night shift isoften futile. The key to combating fatigue is totry to take short naps during the night shiftand to minimise the sleep debt by getting tobed as soon as you get home. If you have a

long drive, think about getting a taxi orsleeping before driving.

Do try to read the guide – it containssome really useful pieces of advice andprovides referenced evidence for therecommendations.

Modernising Medical CareersThe move to transition is set for August 2007.Despite rumours of delaying transition, thistime is fixed. In 2007, National selection willonly apply to those going into SHO equivalentposts. (ST1-ST3). In paediatrics we estimatethat transition will not leave current SHOsunemployed despite recent concerns. SeniorSHOs will apply through their deaneries forRegsitrar equivalent posts (ST4 upwards).Current SpRs and SpRs appointed by autumn2006 will remain in the current system.Competencies for training and means ofassessment are being finalised.

PMETBWe hope that everyone has completed theirNational Trainees’ Survey for PMETB. Thesurvey has been established to identifystrengths and deficits in regional training. Theresults are currently being analysed and willbe reported later this year.

PMETB will continue to visit deaneries toquality assure programmes. The board arelooking for trainees who are willing tobecome trained ‘visitors’ to deaneries andprogrammes. The trainee would form avaluable part of the team involved in deaneryassessment. This would ensure a balancedtrainee perspective. In practical terms, it wouldinvolve two days’ training and then a few daysper visit, which could be taken as professionalleave. Please contact one of us if you wouldbe interested in pursuing this.

International Medical GraduatesThe Trainees’ Committee supports the RCPCH,The Academy of the Medical Royal Collegesand the BMA in the dismay over the changesto the home office regulations for permit freetraining – in particular, the speed ofimplementation of the changes withoutappropriate consultation. There still remains alot of confusion over the implementation ofthese regulations, especially as they maychange with the forthcoming change to the

run-through grade. The current advice to IMGsis to register under the Highly Skilled MigrantProgramme, allowing 2 years training with apossible additional 3 years.

AssessmentMany trainees should now be familiar withSPRAT. This form of assessment is currentlyundergoing a pilot study with a view to moveto eSPRAT. This is the online version of thistype of assessment. The plan is to try and rollthis out nationally next year.

Academic TrainingThe UKCRC/MMC Clinical Fellowships arecurrently being advertised locally, afternational advertisement a few months ago.Those eligible to apply at present are SHOswanting to partake in an MD or PhD.However, ultimately, trainees will apply forthese fellowships following foundationtraining, in application for an academicNTN. Clinical Lectureships are also beingadvertised for post-doctorate traineeswanting to pursue a career in academicmedicine.

College BusinessWe have decided to hold a Trainees’ dinnerat the Spring Meeting next year – probablyon the Wednesday. It should be a goodsocial evening.

The exams committees are looking formore questions – any budding questionwriters out there can contact their local groupsor us and we will forward your details.

Please contact us if you would like to getinvolved in any of the above issues or if youhave any questions.

Trainees’ Committee Report

Martha Wyles Marthawyles@nhs.net

Paul Dimitri pauldimitri@hotmail.com

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Meetings RCPCH news

UK meetings

9-10 November 2006The Welsh Paediatric Society inassociation with The Royal College ofPaediatrics and Child Health in WalesAutumn Meeting 2006Venue: The Hilton Newport Hotel Tel: 02920 455414 Fax: 02920 455416 E-mail: Siobhan.Conway@rcpch.ac.uk

17 November 2006International Child Health Group (ICHG) Winter meeting 2006: How to teach - effectivelyVenue: Partnership for Child Development, Imperial College School of Medicine (St. Mary’s Campus),Paddington, LondonContact: Julia Sharpe, RCPCH, 50 Hallam Street, London W1W 6DE Tel: 020 7307 5600 ext 308 E-mail: Julia.Sharp@rcpch.ac.uk

17-18 November 2006Court Skills Training for ConsultantPaediatricians and Senior TraineesVenue: Mackenzie Building and Parliament House High Street,EdinburghContact: carol.irvine@rcpch.ac.uk

18-20 November 2006Behavioural Signs of Autism in InfantsVenue: School of Infant Mental HealthContact: Sophie Miles, SIMH, 27 Frognal,NW3 6 ARTel: 44 (0)207 433 3112 E-mail: simh2000@aol.comWeb: www.infantmentalhealth.com, www.ipan-infant-autism.org

24 November 2006The 17th Graham & Jenny Watson Study DayVenue: Newcastle General Hospital,Newcastle upon Tyne, NE4 6BE Contact: Dr A R Gennery, Paediatric Immunology & InfectiousDiseases Unit Tel: 0191 2563099 E-mail: a.r.gennery@ncl.ac.uk

24 November 2006St Andrew's Day Symposium and AnnualGeneral Meeting A Joint Event of RCPCH, RCPE, RCPSG, SPS & SACCH.Royal College of Physicians and Surgeons of Glasgow Contact: Jacqueline TaitTel: 0141 227 3240E-mail: jacqueline.tait@rcpch.ac.uk

27-30 November 200617th Annual Course in PaediatricGastroenterology and 9th Masterclass inModern Paediatric EndoscopyVenue: The Atrium, Royal Free Hospital, LondonContact: Mrs Rivka PersoffTel: 0207 830 2779

27 November-1 December 2006Neonatal Update 2006 – The Science ofNewborn CareVenue: Imperial College London, Hammersmith Hospital, LondonContact: Judy GowingTel: 0207 594 2150

28 November 2006Child Health Surveillance UpdateOrganised by: Dr Mitch Blair. Venue: Himsworth Hall, Northwick ParkHospital, Harrow, North West LondonContact: Course Admin ServiceTel: 020 8869 2254/2251E-mail: casnph@nwlh.nhs.uk

30 November 2006Child Project – current issues in child abuse and neglectVenue NSPCC - National Training Centre, 3 Gilmour Close, Beaumont Leys, Leicester, LE4 1EZTel: 08700 416 215, E-mail: info@medupdate.co.ukWeb: www.medupdate.co.uk

12 December 2006 How to be a success as a new consultant Venue: The Royal College of Physicians,London Tel: 020 7935 1174 ext 252, Fax: 020 7224 0719, E-mail: conferences@rcplondon.ac.ukwww.rcplondon.ac.uk/event/details.aspx?e=243

9 January 2007Neonatal Cranial Ultrasound Course – 4 full day modulesVenue: Birmingham Women’s Hospital, EdgbastonContact: Sharon KerrTel: 0121 623 6893 E-mail: sharon.kerr@bwhct.nhs.uk

Worldwide meetings1-3 November 2006Paediatric Society of New Zealand 58thAnnual Scientific Meetings Location: Nelson, New Zealand Contact: Convenor, Dr Paul G Taylor E-mail: paul.taylor@nmhs.govt.nzWeb: www.confer.co.nz/Paediatrics2006

11-14 January 2007Pedicon 2007Venue: Renaissance Mumbai Hotel & Convention Centre, IndiaWeb: www.iapindia.org/pedicon2007.cfm

22-26 January 2007 21st Annual San Diego InternationalConference on Child and Family MaltreatmentLocation: Town and Country Resort & Convention Center, 500 Hotel Circle N, San Diego, CA, 92108 Tel: 858-966-4972 Fax: 858-966-8018E-mail: sdconference@chsd.orgWeb: www.chadwickcenter.org

25-30 August 200725th International Congress of PaediatricsLocation: Athens, GreeceTel: 02-2-106-889-100 Fax: 30-2-106-844-777E-mail: icp2007@cnc.gr Web: www.icp2007.gr

RCPCH meetings

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26-29 March 2007RCPCH Annual Spring MeetingVenue: University of York Contact: Aaron BarhamTel: 020 7307 5633E-mail: aaron.Barham@rcpch.ac.ukWeb: www.rcpch.ac.ukAbstract submission: to make asubmission please go to our websitewww.rcpch.ac.uk/events/rcpch_spring_meeting.htmlClosing date: 5pm, 1 December 2006