Jonathan Cushing, Project Manager of Paediatrics 2040, introduces us to the College’s flagship project in designing health and healthcare for future generations.

Without innovation our ability to prevent, diagnose, and treat illness in children would look radically different. Innovation is core to our work, and new technologies will mean that the delivery of paediatric care in the future will look different to how it does at present. The last 20 years have seen major changes, for instance, patients now have easy access to medical information from a variety of sources, and going forward the current Secretary of State for Health and Social Care has ambitious plans to use technology to transform the NHS.

It is also clear that there are substantial challenges in ensuring adoption of new technologies. The NHS has a chequered

history in the adoption, and scale up of innovation. Slow and fragmented adoption has all too often led to new technologies not being taken up universally, meaning that only a few, and not the many, benefit from innovation.

We will need to ensure that technologies developed are suitable for CYP, and that paediatricians and healthcare systems are able to work with increasingly complex and rapidly changing technologies.

The College’s Paediatrics 2040 project is in the process of developing a vision for the future of paediatrics. As part of this we are looking at the role innovation will play in the delivery of paediatric care 20 years from now, and working to develop a vision for how we can ensure that new innovations and technologies are beneficial to providers of care and children and young people. We will look

at the impact of innovation on domains of care, and consider how specific innovations e.g. digitalisation, or genomics, may impact on the way in which we work and provide care.

The project will run until October 2020, and we are working with 100 members on the project, across four workstreams.

These workstreams aim to:

Develop predictions of CYP health outcomes, and develop business cases for investment in child health.

Develop an understanding of how innovation and technology will shape the delivery of paediatric services.

Propose new models of care that ensure the health needs of CYP are properly served across the four nations.

Develop strategies to ensure we continue to attract and retain personnel who are well equipped to provide the best possible services to CYP populations.

FEATURING

6 Fostering a culture of support

7 Students and trainees

8-9 RCPCH Conference 2019

12 IPA Congress Panama City

14 It all starts with rights!

15 Achieving consensus

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Focus

www.rcpch.ac.uk/paediatrics-2040

Launching Paediatrics 2040

“We need to ensure that new technologies do not increase inequalities in healthcare provision ”

Professor Russell Viner

In May, paediatricians of all ages and from all corners of the UK and overseas, met for the College’s Annual Conference. It was an inspiring three days – filled with a mixture of practical sessions, research presentations and of course some fun along the way.

I felt that the Annual Conference was fantastic – a great mix of inspiring plenaries, educational clinical sessions and networking opportunities, plus time to honour our great and good through the PAFTA awards, College prizes and honorary fellowships. It’s particularly a time to inspire medical students and early trainees to come into paediatrics, but also to refresh and revitalise those in the thick of working lives.

And I think the Conference did all those jobs. A huge thanks to Camilla Kingdon our VP for Education and Professional Development, and the College team led by Jo Howe. Camilla had been keen to focus the last day on the future of paediatrics – and this was a great highlight, particularly the plenary by our RCPCH &Us young people.

Since I last wrote in Focus, Camilla, our Chief Executive, Jo Revill and I attended the International Pediatric Association (IPA) Congress in Panama. The IPA brings together over one million paediatricians from over 150 countries around the world – so it’s an exciting and interesting meeting. We attended in force as we are hosting the next IPA in Glasgow in August 2021. This will be one of the most exciting things the College will do over the next couple of years so I hope you

will be able to be part of the meeting in some way. Camilla is leading the Scientific Committee for this with an IPA colleague, and is already lining up an amazing slate of speakers. So keep late August 2021 free in your diary to join us in Glasgow.

Last month we also had the news that The Medical Practitioners Tribunal Service (MPTS) ruled Dr Hadiza Bawa-Garba can return to work. I know that Dr Bawa Garba’s case touched many members and in this edition there’s a short summary of the case and the resources available to help doctors with reflective practice and reducing errors in healthcare.

“One of the most rewarding aspects of paediatrics is helping a child return to full health and sharing that journey with understandably anxious parents”

For me, one of the most rewarding aspects of paediatrics is helping a child return to full health and sharing that journey with understandably anxious parents. On the flip side, what can be most challenging is having those difficult conversations with parents when their child’s condition is not straightforward and there are potentially different treatment options – or indeed we feel as healthcare professionals that it’s in the best interest of the child not to continue treatment. Thankfully, conflict with parents in these cases is rare. But when doctors and parents do disagree, as we know from high profile cases such as Charlie Gard and Alfie Evans, the consequences for all involved can be catastrophic. Last month, the College launched advice for paediatricians on ‘Achieving Consensus’ – which is designed to support paediatricians. It was well received in the media, and I hope you will find it useful as practitioners.

Whilst there are many wonderful aspects of being a paediatrician, there are also real challenges – with increasing demands on services coupled

with serious rota gaps. The onus is on the College to be both ambitious and practical in how we meet this challenge.

That’s why in February we launched Paediatrics 2040, a two-year project to look ahead to 2040 and try to work out where our profession will be in that time. It’s an ambitious project that I hope every College member will get involved with. It entails starting with data to identify our best guesses as to how many children and young people there will be and what type of conditions they will suffer from. We will use data from the Global Burden of Disease study plus a range of other data sources, looking at which conditions have increased over the past decade and which conditions are going away, and project these trends out to 2030 and 2040. We will also look at innovations that will transform our practice, and then use this information on data and innovations to inform projections of the models of care. This in turn will inform how we train paediatricians for 2040 and how we as a College support them across their working life.

We’re also developing a Paediatrics Careers Campaign to look at retention and recruitment. The success of this will again be dependent on the input of members – we want to hear about what attracted you to paediatrics, what you find most rewarding, and what might put others off joining.

Whilst external events are largely beyond our control, the future of paediatrics is in our hands. Please do get involved in these projects as little or as much as you feel able. And don’t forget to get in touch with suggestions for articles for future Focus editions!

PROFESSOR RUSSELL VINER president@rcpch.ac.uk 020 7092 6077

Follow me on Twitter: @RCPCHpresident

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President’s Welcome

President

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First International RCPCH Conference

Focus is a quarterly magazine, mailed to all RCPCH members.

We would love to hear from you. If you have any suggestions of what you would like to see or indeed write a piece for Focus, we’re open to hearing them all. Please do let us know at focus@rcpch.focus@rcpch.ac.uk

Editors: Aisling Sheehan and Joshua Deane

Published by: The Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH

RCPCH is a registered charity: no. 1057744 and registered in Scotland as SC038299.

Notes About Focus

Celebrating improvementsin Sierra Leone

Global

Dr Sebastian Taylor, Head of International Operations, tells us about a recent event held to celebrate the success of the College’s global programme in Sierra Leone.

For many years, Sierra Leone has been a kind of shorthand for very poor countries struggling at the bottom of the global league tables of human development and child health.

The problem with this shorthand is that it can obscure real strengths, and real achievements in Sierra Leone’s national story.

This March, the College was honoured to welcome Her Royal Highness, Princess Anne and His Excellency John Sylvanus Tamba Lamina, Sierra Leone’s High Commissioner to the United Kingdom, amongst a host of senior UK health policy makers, College fellows, members and trainees, INGO practitioners, academics and researchers, to an event celebrating improvements in child health in Sierra Leone in the years following the outbreak of Ebola.

Through a series of short presentations, we heard about how the College’s Global Programme has been working in low-

income countries, including Sierra Leone, to improve child health by strengthening secondary (district hospital-level) care, and about how the College’s unique value – its highly skilled UK and international membership – provides an important and cost-efficient partner in some of the most resource poor parts of the world.

We heard directly from Sierra Leonean nurse-mentors, via video, about how partnership with the College enabled them to learn, change practice, build confidence and improve their ability to stabilise and save critically-ill children. We saw some impressive statistics showing how paediatric mortality in Sierra Leone’s hospitals has fallen over the last couple of years, by more than 50%, as the College’s use of the World Health Organisation’s Emergency Triage Assessment and Treatment (ETAT) protocol has been rolled out from a pilot in Freetown to a full national programme.

Princess Anne’s address showed her long-standing interest in and

commitment to improving the lives of children in Sierra Leone. She was delighted, she said, to see such positive results coming out of a national programme, in spite of the many challenges. But she was equally insistent that the value of UK paediatric clinicians working in low income settings be recognised within the UK’s NHS. It was incumbent on the College and our partners, she concluded, to show how experience in highly challenging parts of the world helps shape new generations of clinical leaders here at home.

This event was a great chance for the College to showcase how it contributes to the enormous challenges of global child health improvement. But it was also a moment to stop and reflect on how, through quite simple and economical approaches to international partnership, doctors and nurses in one of the world’s most challenging environments have been able to lead a process of improving clinical care for children and, in so doing, make a significant impact on children’s life chances.

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Our officers from around the UK give insight into the latest College activities in their nations.

Scotland

View from the nations

Officers have a three year term of office with the option of a two year extension. I have passed the three year mark and recently accepted an invitation to extend my stay. Here are somereflections on the last three years and ambitions for the next two years and beyond.

What has gone well? Members are generally in good spirits in Scotland and engaging with the College. We have three applicants for each training post and the majority of trainees want to stay in Scotland when they get their CCT. Meetings where the College is

involved are sold out and all posts on the Scottish committee are filled. A 100% return on the College’s 2017 workforce census directly lead to eight additional paediatric ST training posts in 2019. We meet regularly with politicians from all parties at Holyrood and key civil servants, and are an active partner in the Child and Adolescent Health and Wellbeing Action Plan (a ten year strategy).

What needs to go better? Holes in rotas are not getting smaller and the College’s Facing the Future: standards for acute general paediatric services are far from touching distance for most centres in Scotland. Referrals to outpatients and assessment units continue to rise. Some child health outcomes such as obesity, mental health conditions and suicides are rising. More paediatricians may help in the short term, but the College’s

Paediatrics 2040 project can be expected to predict a situation which will necessitate substantial changes to how we work in 2020. The child health community will need to work with parents, carers and children to address the question “When should I worry?” Members will be working with colleagues in RCGP and RCN to provide the community based general paediatric service all these colleges aspired to in Facing the Future.

So how do we get from where we are to where we want to be? It all boils down to good communication, data, common sense and hard work. I finish by thanking my friends and colleagues in hospitals up and down the country and the College’s offices in London and Edinburgh.

Professor Steve TurnerOfficer for Scotland

Wales

The Nations

One of our highlights as members in Wales is our St David’s Day Conference. This year, we looked at a hot topic for paediatricians: mental health. In the time that I have been a doctor, the profile of this issue and its implications for paediatricians has exploded. Our speakers explored the latest thinking in early attachment, adverse childhood experiences and the challenges faced by adolescents. Common themes emerged. We need to put resources into early intervention and prevention, building resilience and ensuring that our workforce is trained to spot the signs of mental ill health and support children. The mental health and wellbeing of children remains a priority for us as paediatricians and we must ensure that it does for government and decision makers.

Healthy weight means a healthy Wales. Children in Wales are the heaviest in

the UK, with 26% overweight or obese by the time they start primary school. This compares to 22% in Scotland and in England.

The Welsh Government has consulted on a strategy, with proposals from the Healthy Weight: Healthy Wales report including support for limiting unhealthy food and drink promotion, calorie labelling in the out of home sector, encouraging local authorities to promote active travel options and banning the sale of energy drinks to children. I have welcomed these proposals, but called for further action, such as reducing the number of fast food outlets near schools.

We must also see action to deliver services for children and young people already overweight or obese. Members in Wales told us that they are reluctant to open conversations about weight

because of a lack of services and referral options.

I want to see children in Wales given the best possible start in life. As advocates for child health, we support the Welsh Government’s Healthy Weight: Healthy Wales proposals and want them to be delivered in full - urgently.

Dr David TuthillOfficer for Wales

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Dates for the diary

MRCPCH Theory exam preparation course - theory and science (TAS)12 September, London

Effective educational supervision23 September, Manchetser

Emotional and behavioural problems in community paediatrics4 October, London

Advance palliative care planning in children and young people14 October, London

Module 4 - Core skills in a paediatric environment15 October, London

Dates correct at time of going to press. Limited places available. Access eLearning courses anytime on Compass at rcpch.learningpool.com

www.rcpch.ac.uk/courses

Dermatology17 October, Birmingham

Ireland

The Nations

The State of Child Health in Northern Ireland falls short in many ways when compared to child health outcomes elsewhere in the UK and in Europe. The uncertainty of Brexit makes it difficult to predict and plan for the future, and in Northern Ireland the absence of a functioning Executive and Assembly for well over two years compounds the problem. Our strength is our knowledge and expertise. As the Officer for Ireland one of my priorities is to increase our engagement with members in Ireland, to determine how the College can continue to improve member support and discuss how they can get involved in College work.

In Northern Ireland we have a role to influence and shape child health policy

and legislation. By creating a stronger paediatric voice and extending the breadth of our engagement with key decision makers, I believe there is much that we can achieve.

In recent times we have been working closely with the Department for Health, the Public Health Agency, and the Children’s Commissioner to help influence and shape children’s physical and mental health services. Children make up a quarter of the population and their needs are provided for by a wide range of professionals. This prompts us to work more closely with medical Royal Colleges and child health professionals so that we can all work together to improve child health outcomes. For instance, the Review of Emergency and Urgent Care has to date a focus on adult services and we have worked to ensure that paediatrics will be better considered and appropriately represented in this work. We are encouraged by the establishment of the Child Health Partnership and of multi-disciplinary

teams in primary care, and we look forward to supporting these initiatives as they continue to develop. With two major children’s hospitals under development in Ireland, an uncertain Brexit, and services operating on a cross border basis, I look forward to continuing our engagement with the Royal College of Physicians in Ireland through the All Ireland Paediatric Committee, a joint body established to consider paediatrics and child health across all of Ireland.

Over this coming year I will be arranging discussions with members across Northern Ireland to inform and shape our approach to this work. I very much look forward to collaborating with you and the wider workforce to secure better health outcomes for our children and young people, and to build comprehensive resilience for emotional, mental and physical wellbeing, and equally for all.

Dr Ray NethercottOfficer for Ireland

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“Our members are committed to delivering high-quality, safe care for children and avoiding errors; but when one-off errors do happen, doctors are owed a duty of care and support, not blame”

Professor Russell Viner

Fostering a culture of support

Timeline of events

February 2011: Jack Adcock dies

December 2014: Dr Bawa-Garba charged with gross negligence manslaughter

November 2015: Dr Bawa-Garba convicted of gross negligence manslaughter

June 2017: The Medical Practitioners Tribunal Service suspend Dr Bawa-Garba from the medical register for a year – which was extended to 18 months. GMC appeals against the decision

January 2018: Dr Bawa-Garba removed from the medical register following GMC appeal

August 2018: Dr Bawa-Garba wins appeal to work again and is reinstated to the medical register by the Court of Appeal

April 2019: Medical Practitioners Tribunal Service rules that Dr Bawa-Garba can return to work under close supervision

February 2020: Dr Bawa-Garba due to return to work

Dr James Dearden, writing on behalf of the Trainees Committee, discusses the case of Dr Hadiza Bawa-Garba and its impact on fellow trainees.

In February 2011 a paediatric trainee was involved in a series of individual and systemic errors. As a consequence, a six year old boy called Jack Adcock died from an overwhelming bacterial infection.

Three years later she was charged and subsequently convicted of gross negligence manslaughter. She was suspended from the medical register and later removed entirely from the register following an appeal from the General Medical Council.

One of the most prolonged and high-profile cases of medical negligence in living memory came to a close in April 2019 as trainee paediatrician Dr Hadiza Bawa-Garba won her appeal to be reinstated to the medical register.

The impact of this case on the profession cannot be understated. Reading the accounts of systemic errors, short staffing, IT issues and questionable supervision of this trainee that contributed to the tragic death of Jack, I am sure that I am not alone in thinking “There but for the grace of God, go I”.

The anxiety that has surrounded this case over the last eight years is that each and every one of us has experienced “that shift” or “that patient” that could so easily have ended in disaster.

The anger that has followed the decisions made against Dr Bawa-Garba is rooted in our, possibly optimistic, view that the NHS has moved away from a “blame culture” and has a more

enlightened view on how risk, error and safety systems work.

The death of a child is the most eviscerating and desolating event imaginable for a family, but the trauma also deeply affects those who have looked after a child who has died. Part of dealing with our own grief and self-recrimination is through reflection. Only then can we learn and evolve as clinicians.

The College is wholly committed to fostering a culture of supporting doctors to learn from their mistakes. The training services team have worked with the Trainees Committee to publish Looking After Yourself – Good Practice for Trainee Paediatricians, where we try to address some of the many questions raised by this particular case. This is freely available on the College’s website. I would also strongly encourage you all to read the recent independent review conducted by Leslie Hamilton into gross negligence manslaughter, which is both sympathetic and balanced in its analysis, and was commissioned in direct response to this particular case.

As Dr Bawa-Garba prepares to return to her paediatric training it is important that each and every one of us reflects and ask ourselves, personally: “What steps am I taking to support my colleagues and my trainees? What am I doing to address the system errors in my department? How am I encouraging open and non-judgemental discussion of errors to enhance the care of children like Jack?”

www.rcpch.ac.uk/looking-after-yourself

Members

A bit of social

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Paediatrics is a career with limitless possibilities, showing me opportunities which I have not found in other areas. My love of paediatrics grew whilst in medical school and volunteering with the Teddy Bear Hospital, an organisation that goes into local schools teaching children the basics of first aid, healthy eating and the health service.

This sparked my interest in pursuing a career in paediatrics, which was confirmed during my placements at Alder Hey Children’s Hospital and an elective in Vancouver as part of the

NICU team. Paediatrics is a career that allows me to be me, building on my natural curiosity, pursuing my academic aspirations, all whilst working in an enjoyable and challenging environment.

During my time at medical school, I began to learn more about a career in paediatrics, and how I could help to inspire other students to become equally passionate. This led me to discovering the United Kingdom Aspiring Paediatricians Society (UKAPS).

My work with UKAPS, first as their secretary and currently as their President, has only grown my interest in paediatrics. I have met and worked with incredibly talented people in all areas of paediatrics and they have all driven me even more to helpcreate a specialty where all are welcome, the workforce is supported and matters of the child are at the forefront of our actions. Through my years in UKAPS our work with the College has grown. We have started running new events and look forward to ourAnnual Conference this October at Birmingham University.

My medical school career would not have been as amazing and rewarding without the work I do with UKAPS or without my passion for paediatrics to drive me through the past six years.

It was my great pleasure to host for the first time the Trainees Committee Spring Meeting in Belfast. The committee was also invited to attend the Royal Belfast Hospital for Sick Children Annual Lecture and the Ulster Paediatric Society Conference Day at Riddel Hall.

Our meeting was action packed, with updates on various ongoing projects. We were delighted to have talks from members about the role of the committee and Progress curriculum updates. Members have been involved in generating resource packs for each of the Progress Curriculum Domains (‘Domain of the Month’) to assist trainees andtrainers in achieving their personal goals.

Following on from the ‘Looking After Yourself’ guidance document produced last year, further valuable resources including the Trainee Charter and Toolkit are now in circulation. We are hoping to have a joint meeting with the Heads of School to further discuss how we integrate these resources and ensure it is meaningful for all. Other key topics discussed, ranged from multi source feedback and recruitment, to shape of training, exit interviews and PAFTAs.

I enjoy my role as Northern Ireland Trainee Rep as it gives me the unique opportunity to ensure the voices of trainees in Northern Ireland are heard at College level. I have also had the opportunity to be involved in the creation of College resources, providing an opportunity for sharing good practice between deaneries, andpromoting equitable training for trainees. Senior representatives from the College also attend meetings to ensure information received is up to date.

I feel the committee received a true Irish welcome and the visit was overall a great success. Hopefully they will grace these shores again for future meetings.

Trainees

Students Medical student Charlotte King tells us why she will be pursuing a career in paediatrics.

Dr Julie-Ann Collins updates us on the the recent Trainees Committee meeting in Belfast.

Members

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RCPCH Conference 2019

RCPCH &Us had a fantastic Conference 2019 experience, from opening plenary with their patient stories, to giving presentations in workshops on their projects. The 30 plus patient and family volunteers certainly made their mark! The stand was the biggest yet, with over 700 people visiting it over the three days to get advice and information on CYP voice and engagement, picking up the latest resources designed by RCPCH &Us volunteers.

Tiger said of the Conference “Thank you for giving me the opportunity to come. It was amazing, I had so many interesting converversations with doctors about our project.”

Day 1 - Using evidence to underpin innovation

1527 of the finest paediatricians and child health professionals in attendance

Delegates came from around the world, representing 31 countries

512 motivating posters

6 captivating keynote speakers

Inspiring delegates were 36 workshops and 27 speciality symposia

Keeping the conversation going was over 5,000 cups of tea and coffee

26 early risers running a 5k and 13 yoga goers

14 children chilling in the crèche

1 RCPCH Conference to remember!

Conference in Numbers

Held in Birmingham, the theme for this year’s Conference was Paediatrics: pathways to a brighter future, with each individual day having its own sub theme representing the widevariety of programmes on offer.

Welcoming everyone at the first plenary was the College’s President Professor Russell Viner. This was followed by Finn, Demi, McKenzy and Tiger giving excellent talks on behalf of RCPCH &US. In absentia, Tiger awarded Dr Michael Farquhar the Children’s and Young People’s Voice Champion of the Year 2019. Chosen by young people for his work on the Rainbow NHS badge and working with the Central Youth Voice on the Rainbow Youth Supporters Pack.

The first keynote speaker, Professor Sonia Saxena, discussed using data and evidence- based rigour to improve child health. While Dr Pierre Barker looked at how QI can help with

solutions for quality of care. A number of prizes were awarded to standout paediatricians, amongst them four PAFTA winners for Best Junior and Senior Trainees and Best Educational Supervisor.

After plenary there was a range of workshops and seminars, allowing attendees a choice of sessions on subjects that matter most to them. The afternoon was composed of specialty and special interest groups, which included abstract presentations and invited lectures. On display throughout the Conference, were a whole host of posters, representing the wide breadth of themes in paediatrics and child health. The day was rounded off by a drinks reception, affording members an opportunity to network with the College’s officers and exhibitors to discuss the day’s events.

Conference

RCPCH Conference 2019

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Day 3 - The future paediatrician

Day 2 - Investing in our future Kicking off day two at the early hour of 7am, VP for Training and Assessment Dr David Evans led the way on a 5k run along Birmingham’s canal path. A number of delegates also got involved in some early morning yoga, priming themselves for a full day of events.

In addition to key speakers at plenary, delegates were treated to a presentation of five of this year’s top scoring abstracts. Given in the PechaKucha style, presenters showed 20 slides, and had 20 seconds to comment on each. This session certainly set the scene for the diverse programmes on offer that day. From preparing for winter pressures, cost of caring and digital health, to working with children with perplexing presentations.

The prestigious James Spence Medal was awarded to Professor Alan Emond, one of the most distinguished UK researchers into issues around paediatrics in the community. Also celebrated were visiting fellows and honorary fellows, amongst them Professor Aye Maung Han, a founding member of the Myanmar Paediatrics Society.

That evening, the Conference dinner was held, where delegates could chat and digest the activities of the day, whilst also getting their photo taken at the RCPCH &US photobooth.

Dr Michael Farquhar opened the day’s proceedings with an insightful talk on growing up LGBT+ and how paediatricians can offer support. Three more of the top scoring abstracts were presented, again in the new fast paced style. Next a programme of workshops and seminars were delivered, which included topics on inspiring the workforce, burnout and transitional care.

This led into a lunch for senior members and fellows, before the afternoon agenda kicked into gear. Among the groups represented were trainees and paediatricians with expertise in cardiology. Further sessions explored topics on child oral health and editorial advice, giving tips on how to get papers published.

As the Conference drew to a close, we were presented with the first ever ‘On the Sofa with RCPCH &Us’ chat show event, exploring what matters to young people today. They even had the pleasure of inter-viewing VP Dr Camilla Kingdon and asked some very amusing ques-tions!

Closing the Conference, Sarah-Jane Marsh, Chief Executive Officer of Birmingham Women’s and Children’s Hospital delivered a talk entitled ‘From Better Births to Changing Childhoods’, which capped off a hugely successful few days in Birmingham.

Conference

Paediatrics: pathways to a brighter future

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Have you ever thought that there could be a better way to deliver paediatric care, or felt that there was an area of unmet need that urgently needs addressing? As we advance through a rapidly developing era of technological change, new opportunities are arising to develop new solutions to longstanding problems. New modes of technology provide novel ways to diagnose, investigate and manage the children and young people we look after. These technologies include artificial intelligence (AI), augmented and ambient intelligence, virtual and augmented reality, novel materials, 3D printing, digital platforms, sensor technologies

and novel in-vitro point of care testing.

The National TITCH (Technology Innovation Transforming Child Health) Network was established in 2014 with an aim of bringing together Specialist Children’s Units, District General Hospitals and relevant partners to focus on the coordinated development of technology specifically developed for paediatric healthcare. By working with funders, the TITCH Network has supported over £6 million of funding and has brought a national focus to child health technology development. Following this in 2018, the first National Institute for Health Research (NIHR) Children & Young People MedTech Cooperative was launched, bringing together seven Specialist Children’s Centres to focus on the development of child health technology in seven thematic

areas based upon high disease burden potentially amenable to technology solutions.

Looking forward, technology will provide new and exciting ways to train our future paediatricians. Understanding the incredible opportunities to work with academics and industry to align clinical needs with technology solutions will ensure that we get the best care for children. The greatest of all the challenges is to ensure that we can deliver innovative care that is safe and effective to allow children and young people the best opportunity for the future.

www.cypmedtech.nihr.ac.uk

Professor Paul Dimitri Director, NIHR Children & Young People MedTech Cooperative

Coming together to collaborate on neonatal care

Technology - a chance to enhance the future of paediatrics

Dr Julie-Clare Becher and Dr Colin Peters, both Consultant Neonatologists in Scotland and members of the NNAP governance group, report on the NNAP/NDAU Collaborators’ Meeting.

The morning had a great kick off from NNAP Lead, Sam Oddie, who highlighted future directions of the organisation including new collaborative QI work with BAPM in improving NNAP measures. Then followed a number of presentations showcasing collaborative efforts in improving outcomes including the PRECEPT study, the OPTI-PREM study and Optisurf. The remit of the Getting it Right First Time (GIRFT) neonatal work stream was illustrated by the Clinical Lead, Eleri Adams, again supporting change to deliver better care and overcome barriers to change at local and national levels by using data wisely.

What was really heartening was hearing of the engagement of local clinicians in delivering change in their own units, in a series of presentations, using data and process mapping to understand best

how to effect improvement. Of particular note was a presentation from Sankara Narayanan from West Hertfordshire on reducing mother and baby separation through provision of Transitional Care, as well as the introduction of FiCare and a daily educational package to support parents presented by Aniko Deieri from Imperial College London, which resulted in a reduction in length of stay for babies. Rachel Corry on behalf of the NNAP parent representatives showed us “What does ‘good’ look like?” for families in neonatal units and inspired us to take examples of good practice back to our units to make sure we get it right.

While improvements in neonatal and maternity care were widely celebrated, there was a sobering presentation from Chris Gale, using data to show the poorer neurological outcomes of extreme preterm infants who undergo postnatal transfer to a tertiary centre, reminding us how important network pathways and cross specialty liaison is in ensuring delivery in the right place for these

babies. The higher risk of severe brain injury compared to those in non-tertiary units who do not undergo transfer raises much concern about the adverse effects of postnatal transportation on the preterm brain. The results of a national survey on nitric oxide use in the preterm infant, presented by Nim Subedhar was interesting: despite no evidence of benefit, 55% of all UK infants who receive nitric oxide are less than 34 weeks gestation. Further work in understanding why this occurs and establishing a greater evidence base for use or otherwise is essential.

As usual coffee and lunch were opportune moments for networking and reading posters, and there was a great turnout from senior neonatologists to junior trainees as well as enthusiastic representation from nursing and the devolved nations.

With such engagement from all attendees we look forward to the next meeting, and the continued collaboration between NNAP, NDAU and those processing data, undertaking QI projects and carrying out research in neonatal units across Britain.

College News

A bit of social

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From the Annals of Paediatrics

Annual Conferences have been held almost every year since 1928 and began with the purpose of being a time doctors who worked in all parts of the UK could meet others in the same specialty and discuss the causes, prevention and treatment of childhood diseases. In the early years, the meeting was the only contact members would have with other members and the Association itself. Just 40 attended the first Conference in 1928.

The Conferences usually followed the same structure of lasting for two days and being a mixture of scientific presentations and social events. Early members strongly agreed that “Scientific communications should be spoken, not read”, although the presentations at meetings held during the war were frequently interrupted by air raids and blackouts.

It wasn’t all work though - it was also a chance for members to relax and socialise away from their work. Social activities included dinners, boating, fishing and competing for the Ulster Golf Trophy. In 1935, it even led to two members applying for licenses to sell alcohol to other attendees due to the strict licensing laws of Ulster at the time - the minutes of the meeting emphasised that this practice would not be encouraged!

Over 90 years later, the Conference is still an opportunity for paediatricians to get together to discuss, promote and further paediatrics, staying true to the original aim of the British Paediatric Association: to advance the study of paediatrics and promote friendship amongst paediatricians.

Kate Veale Archivist & Records Administrator

There is a wealth of material in the ADC pipeline for all the journals, from original research and global health to trails and clinical problem solving. Featured also is health policy, and quality improvement.

You may already have noticed the current research and ethics papers which will be followed and complemented by a statistics in paediatrics series from the Institute of Child Health. More can be found on the ADC website such as recent editor’s choices and the most widely read articles (do check out the current paper on anaphylaxis myths).

Developing fast is the podcast series, which covers a range of child health issues from the ADC suite of journals, including Fetal & Neonatal and Education & Practice. The podcasts are a regular rotation of editor highlights, coverage of specific articles, as well as interviews with authors and specialists. There are new recordings released every week ranging from the ‘Atoms’ editorial column and the new ‘spotlight’ advocacy and global health series. Nick Brown Archives of Disease in Childhood Editor-in-Chief

BMJ Paediatrics Open (BMJ PO) is now two years old. It has established itself as a paediatric journal with inclusion in PubMed Central, Google Scholar and the Directory of Open Access Journals. We have published over 200 papers from 35 different countries. The topics covered have ranged across most paediatric specialties, child health and wellbeing.

Downloads and citations are excellent for a new journal. Some of the most popular articles have covered antacid therapy for gastro-oesophageal reflux in neonates; perpetrators of child abuse; acute appendicitis; mental health issues; core outcomes in neonates and chronic fatigue syndrome. We are fortunate to have an editorial board that has members from around the world, including Australia, China, Singapore and the USA, as well as the UK and other European countries.

BMJ PO is open access. The advantage of this is that anyone who has internet access can read the papers in full. It also does not judge scientific papers on their importance. If they are clinically relevant to child health, and ethically and scientifically sound then we will try to publish the paper. All papers are peer reviewed and the process is transparent – you can read reviews online once the paper is published.

BMJ PO aims to be an advocate for children worldwide. Many children are deprived of their rights, be it access to healthcare, medicines, education, food or water. Health professionals have a responsibility to speak up on behalf of disadvantaged children. Imti Choonara BMJ Paediatrics Open Editor-in-Chief

BMJ Paediatrics Open

Archives of Disease in Childhood

Members

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A day in the life of a paediatrician

IPA 2019 Congress Panama City

Dr Camilla Kingdon, VP for Education and Professional Development shares her thoughts on Panama and looks forward to hosting in Glasgow in 2021.

Russell Viner, Jo Revill and I attended the International Paediatric Association (IPA) four day congress held in Panama this March. The IPA is a global organisation representing a million paediatricians and RCPCH is a member of the IPA thus making all College members part of the IPA too.

The congress was a very interesting experience with a strong showing of South Americans in the audience, but there were paediatricians from far and wide. So it was a great opportunity for meeting and connecting with colleagues with a wide range of interests and expertise.

The chief reason for Jo, Russell and I attending is that in August 2021 the UK will be hosting the IPA Congress in Glasgow and RCPCH is responsible for arranging that meeting. This gives us a very exciting opportunity to develop an inspiring congress programme. I am co-chairing the Scientific Committee, where I am joined by a number of UK paediatricians. Together we are going to produce an amazing conference programme showcasing the very best of British, European and international paediatric expertise, innovation, research and enthusiasm. In addition to some top class plenary sessions, we will have subspecialty symposia too. We are also hoping to have sub themes for the congress focussing on medical education, technology and innovation, workforce development and many other ideas. There should be something for everyone, including a brilliant social programme too!

Panama was a great experience and sets the scene for an exciting congress in Glasgow.

Dr Seb Gray provides an insight into his experiences of congress, where paediatricians gathered from around the world.

To be selected for the inaugural IPA LEAD Child Health Emerging Leaders Programme felt like a huge honour when I received the invite. However, arriving in Panama and meeting my 13 co-LEADers exaggerated my imposter syndrome to new heights. Over an intense few days we received an enlightening, invigorating and inspirational crash course in leadership from the enigmatic Yale Global Health team, guided by Linda Arnold, scheme creater and everything we aspire to be. We had been selected from 140 candidates from across the globe and I still can’t decide who was more awe-inspiring. On one hand were the incredible emerging leaders from around the world. On the other, established leaders and esteemed faculty, engaged and interested in nurturing the rooms potential.

None of the LEADers would have been there without the support from their societies. My support came from one of the College’s VPs, Dr David Evans. I heard of the programme 72 hours before the deadline and received a response with a supporting letter within 24 hours. This responsiveness, support and positive encouragement embodied

by David is what I’ve become accustomed to during my time as the College’s Trainees Committee Vice Chair. I’d always admired his ability to harness the energy and enthusiasm into productivity and he was therefore an obvious choice.

Paediatrics varies across the world – culture, resources, facilities and diseases all vary. What doesn’t vary is the nature of a paediatrician; the drive to make things better for the child in front of you.

You may have heard the story of the child on the beach who sees hundreds and hundreds of starfish washed up, who starts throwing them back one by one into the sea. An elder comes along, looks around at all the starfish washed up and asks the child, “Why are you doing this? You will never be able to make a difference.” The child picks up a starfish, throws it back in the sea and turns to the elder, “I made a difference to that one.” I never want to lose the mentality of trying to make things better for each and every child in front of me.

However, my take-home message from Panama was that to make a wider impact sometimes it is necessary to take a step back and look at the bigger picture. The IPA LEAD programme has created a community of practice to share seamlessly and steal shamelessly excellence from across the globe and I’ll be forever grateful for the support of our College for giving me the opportunity to truly make a difference.

Members

A bit of social

13

Dr Rakhee Shah is an ST5 Paediatric Registrar at North Middlesex University Hospital, London, and also works as a Research Associate at the Association for Young People’s Health. With the College, she is a Clinical Advisor on the State of Child Health project, and presented at this year’s Conference on bullying.

A day in the life of a paediatrician

My role currently involves being on a community paediatric placement and seeing a wide range of children and young people (some very vulnerable) in a clinic setting. During my on-call shifts in the hospital I am responsible for overseeing the care of all children and young people for the clinical area that I’m covering, which could be the neonatal unit, the paediatric assessment unit or the children’s ward. Other roles include teaching, taking the lead, ensuring the team is ok and have taken breaks and helping with logistics about where best to place certain patients.

As a research associate my role is to undertake research which can be used by policy makers and commissioners in making cases for investment.

I became a paediatrician because I really enjoyed my paediatric placement during medical school and children do say the funniest things! I rely a lot on my instincts and even though I didn’t have a paediatric placement during my foundation years I had a good ‘vibe’ that paediatrics is the right speciality for me – and I haven’t been proven wrong.

My typical working day involves lots of variation. I enjoy this particularly in my community placement, where I could either have a clinic in the morning, or

be attending a child protection case conference or having a multi-disciplinary team meeting. The days I work for the Association for Young People’s health doing policy work are also varied and this is something I really enjoy.

The most difficult part of my job is having to deal with the pressures in hospital, when the waiting time to see a paediatric doctor is three hours, parents are angry, and you’re trying to do your best with the resources that you have. It is frustrating because some of these pressures could be relieved by making better use of different people’s skills and through different ways of working involving new models of care.

I also used to feel a bit helpless about addressing the more social determinants of health such as poverty and this quote by Michael Marmot sums up the feeling “What good does it do to treat people’s illnesses, then send them back to the conditions that made them sick?” Being involved in projects such as The State of Child Health have made me feel like I’m making a small difference.

The best part of the job, aside from working with children and young people, is working within a very supportive team and passing off watching cartoons such as Rasta Mouse as continuous

professional development! Being able to have a portfolio career combining policy work with clinical work has been very enriching.

My most memorable moment, although there’s certainly been a few, was recently on a night shift I had a giggle when a 12 year old boy told me “Doctor can you please switch off the (muted) TV as it’s inappropriate” I was mortified to see Naked Attraction mistakenly playing when I turned around – at least the young person and his mother had a good sense of humour.

When I’m finished work, I normally cook with my other half and watch mindless TV shows such as Made in Chelsea! I normally catch up on my twitter feed whilst watching Newsnight and read a chapter of a book before going to bed at 11:30pm.

I joined the College in November 2015, and am responsible for overseeing the delivery of the extensive College events calendar. This includes the flagship Conference, new member admission ceremonies, presidential dinners, royal visits, and developing new event programmes such as the exciting Adolescent Health Conference coming up in Ascot this September. I also support the delivery of core College activity such as the CPD course portfolio and national audits.

The Annual Conference is a huge part of what I do, as I essentially work as a conduit between the many contributors who make up the event; the organising committee, delegates, speakers, exhibitors and College staff, and it is my role to take every idea from conception through to delivery.

I thoroughly enjoy working alongside our VP for Education and Professional Development Dr Camilla Kingdon and the clinicians on the

Conference committee to work year-round to put together the academic programme. This includes the management of a comprehensive abstract submission process, where I liaise with the committee and our specialty groups to adjudicate and allocate abstracts. I really love to see such a huge event gradually come together throughout the year and enjoy being involved in every aspect of the College’s flagship event which attracts around 1500 delegates each year.

One of the best bits of my job is the face to face time that I get with members and College officers, and getting the opportunity to understand their work.

In my spare time I enjoy road cycling, and getting out in the countryside for weekend rides, and to the French Alps and Mallorca for cycling breaks. I also have a keen interest in wine education and tasting, and plan to enrol in a course later this year.

Staff SpotlightJo Howe is the Events Manager working in the Membership and Development division.

Members Members

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College News

RCPCH &Us members talk about what their involvment has meant to them, and the importance of a rights-based approach.

“How many of you have heard of the United Nations Convention on the Rights of the Child (UNCRC)? How many of you can name at least 10 of the articles and why they are important for children and young people?”

“Before I joined RCPCH &Us, I was very isolated, quiet and mildly depressed. Joining the network really made me feel for the first time that I had power in my own life. I felt that my voice and experience was important and could affect change.”

“Feel far more empowered, valued through new ways of engaging with governance at RCPCH. Feel that it is far more impactful and we get more achieved. It’s all about what gets done rather than what we just talk about! Results! Not just hot air.”

“Really upholds principal of going to where young people are and collecting feedback/voice at a time that is right for them and in a place they would be anyway.”

As we approach children’s rights week this July, Emma Sparrow CYP Engagement Manager outlines the importance of The United Nations Convention on the Rights of the Child (UNCRC).

The UNCRC covers all aspects of a child’s life and sets out the civil, political, economic, social and cultural rights that children everywhere are entitled to. The 54 articles focus on children and young people’s development, protection, and participation in social life, being part of UK law since 1992. The UK now sits at 173rd out of 182 rated countries for upholding children’s rights. Improvements are needed in mental health support, tackling obesity and tooth decay, air pollution, use of restraint and low rates of breastfeeding.

RCPCH &Us has a rights-based approach where we take seriously our role in supporting children and young people’s dignity, participation, development, non-discrimination and best interests within strategic voice in health. RCPCH &Us members have identified key UNCRC articles for us to refer to in our work, these are:

Article 12 – Right to be involved in decisions that affect you, from individual care decisions through to shaping health services that you might use.

Article 23 – Infants, children and young people with disabilities have the right to be involved, which includes having appropriate communication support within healthcare appointments and engagement work.

Article 24 – The right to the best healthcare possible, thinking here about child and youth friendly health services.

Article 31 – The right to rest, relax and play. To include support for parents of children with complex health needs, to think about how to engage in social activities, and to provide services that support socialising with their peers (clinic times).

RCPCH &Us - It all starts with rights!

RCPCH &Us

RCPCH Child Protection CompanionNow available on PCO UK also as an app

Every paediatrician has a responsibility to safeguard children and protect their rights

www.pcouk.org/companion RCPCH

A bit of social

15

Achieving consensus

Editor Alan Emond welcomes the release of the 5th edition of Health for All Children and explains its importance.

Health for all Children was originally published in 1989 as a report of a multidisciplinary working party chaired by David Hall, and the book subsequently became known as the ‘Hall Report’. The original report reviewed the evidence for screening and health surveillance of children and made evidence-based recommendations for a universal child health surveillance programme.

A new edition of this important reference book was overdue. In the last 13 years, the evidence base to support clinical practice in child health surveillance and health promotion has expanded, and the range of professionals engaged in delivering care to young children has widened. What is different about this 5th edition is that the review of evidence starts in pregnancy and runs until age seven. The book takes account

of different government policies and different models of delivery of the child health programme in the different UK administrations. Evidence from all over the world is critically appraised, but referenced to UK policy and practice, using an approach based on ‘proportionate universalism’.

This book summarises evidence about ‘why’ and ‘what works’ in health promotion and health surveillance with children and families, and where possible gives guidance on ‘how’ to implement and quality assure a programme and the competencies needed – but does not conclude on ‘who’ should provide the service. Each chapter includes learning links to online training materials and e-learning for health, or to resources freely available to practitioners.

Recommendations are made for commissioners of child health services, provider organisations, trusts, and practitioners. Each recommendation is on the basis of evidence, and a weighting of the strength of that evidence is

attached to each recommendation.

The editors and authors are not receiving fees, all royalties will go to RCPCH, to be invested in future updates of Health for all Children, so hopefully we won’t have to wait over a decade for the next edition!

Health for all children

College News

Emily Arkell, co-author of Achieving Consensus gives some key highlights of the recently published advice on managing conflict in paediatrics.

The College has published new advice which seeks to prevent parent/doctor conflict in paediatrics. Although disagreement with the management of a child’s healthcare is rare, when it does happen it can have profound effects on the child, their family and health professionals.

The number of children living with complex and/or life limiting conditions continues to rise as advanced forms of life sustaining treatment become available. There is also a large amount of information online about innovative but unproven treatments for serious illnesses which increases the likelihood of conflict in paediatric practice.

‘Achieving Consensus: advice for paediatricians and other health professionals on prevention, recognition and management of conflict in paediatric practice’ suggests practices which aim to support professionals to identify and reduce disharmony whilst maintaining the child’s best interest.

The new document brings together practices covering prevention, recognition and management of situations where conflict exists, to support healthcare professionals either prevent disharmony, or manage it. It suggests:

Preventative management

• Avoiding giving inappropriate expectations to families.

• Using palliative care teams early, not just for end of life care but when treatment options are being discussed.

• Providing access to psychological support to families but also health professionals involved with the child’s care.

• Assigning a Lead Clinician to be responsible for the overall care of the child, including to act as a liaison between family and medical teams, to help ensure messages given to families are clear and consistent, and acknowledging a family’s understanding and expectations and if misunderstanding develops.

Identifying conflict

• Clinical teams must be able to spot the early signs of conflict including: communication breakdown, parents and health professionals avoiding each other, parents feeling they need to oversee or review every aspect of care.

Early management

• Seeking expert ethical and legal advice and considering early involvement of mediation services.

https://adc.bmj.com/content/104/5/413

ISBN: 978 0 85711 338 2 • September 2018 • 1640pp • 210 x 148mm • £57.50

Guiding health professionals on all aspects of paediatric drug therapy

BNF for Children 2018-2019

About the BNF for Children (BNFC) The BNFC provides essential, practical information to all healthcare professionals involved in the prescribing, dispensing, monitoring and administration of medicines to children.

Significant new content updates to the 2018-2019 edition include: ■ Updated guidance on chronic asthma, cystic fibrosis,

prescribing in multimorbidity and deprescribing, andurinary tract infections.

■ New drug monographs including daptomycin,emtricitabine with tenofovir disoproxil, ipilimumab,ledipasvir with sofosbuvir, nilotinib, sofosbuvir, andtenofovir alafenamide.

■ New safety information on head lice eradicationproducts and the risk of serious burns if treated hair isexposed to open flames or other sources of ignition andvalproate medicines now contraindicated in womenand girls of childbearing potential unless conditions ofPregnancy Prevention Programme are met.

and more...

www.bnf.org

Pharmaceutical Press is the publishing arm of the Royal Pharmaceutical Society

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