INSIDE SPRING 2020 The magazine of the Royal College of Paediatrics and Child Health Child and Paediatrics of College Royal the of magazine The paediatrics beyond 16? beyond paediatrics Coming of age of Coming Should we extend Page 12 Page STATE OF CHILD HEALTH The 2020 update explores the health of UK children

Dr Richard Purvis recounts Richard Purvis Dr Changing practice Changing his 50-year career 50-year his Page 14 Page REPORT Page 16 Page Members give theirMembers NHS pensions pensions NHS perspectives Page 21 Page

Wellbeing best practice practice Wellbeing best Happy &healthy to prevent stress prevent to Page 28 Page

Contact We’d love to hear from you – get in touch at milestones@ Contents rcpch.ac.uk Spring 2020

Welcome

THIS WILL BE AN important year for the College. The launch of the State of Child Health 2020 report looks at more 14 than 20 indicators of health. While 22 there has been some progress, much of the news is concerning and shows how much work there is to do, with the report shaping our public health policy 20 PIER Network 20 priorities for the next few years. Best practice in Wessex We’ll use the State of Child Health as an opportunity to engage with key 21 NHS pensions Recent survey responses decision makers, not least the new government. The political outlook is more stable than when I introduced EVERY ISSUE the winter edition of Milestones and it seems certain that the new 4 Update RCPCH in the news, diary dates government will serve a full term. We’ve THIS ISSUE social media updates and more written to ministers calling for action 12 Debate on our manifesto priorities, including When do children become adults 11 RCPCH &Us urgent investment in public health in the eyes of the NHS? The Children and Young People’s programmes, the NHS Long Term Plan, Engagement Team and the workforce crisis. 14 Paediatrics and me Several other big projects will A refl ection on a long and varied 22 Members dominate the College’s workplan for the international career News and views from members fi rst part of the year. The 2020 paediatric census is now underway – the results 16 Landmark report 27 International will give us a vital picture of services State of Child Health 2020 The challenges and rewards of paediatrics in Hong Kong and staffi ng across the UK. We’ve 18 Redthread advice also got an exciting agenda for April’s Youth workers’ guidance on 28 Wellbeing conference, taking place in Liverpool working with young people The benefi ts of mindfulness; basic – I look forward to seeing you there. ways to prevent burnout 19 Development and Best wishes, collaboration 30 A Day in the Life Russell Viner The Children and Young People’s Paediatric Registrar Dr Rakesh @RCPCHPresident Health Partnership model Tailor on his community work

Copyright of the Royal College of Paediatrics and Child Health. All rights reserved; no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical, photocopying, recording, or otherwise – without prior permission of the publishers. The views, opinions and policies expressed in Milestones do not necessarily reflect those of the College. While all reasonable efforts have been made to ensure the accuracy of the contents of this publication, no responsibility can be accepted for any error, inconsistency or omission. Products and services advertised in Milestones are also not recommended or endorsed by the College. Readers should exercise their own discretion and, where necessary, obtain appropriate independent advice about their suitability. Royal College of Paediatrics and Child Health is a registered charity in England and Wales (1057744) and in Scotland (SC038299). Registered address: 5-11 Theobalds Road, Holborn, London WC1X 8SH. Head of Design: Simon Goddard Project manager: Lizzie Hufton Publisher: James Houston. Milestones is published four times per year on behalf of the Royal College of Paediatrics and Child Health by James Pembroke Media, 90 Walcot Street, Bath, BA1 5BG. T: 01225 337777. Advertising: Alex Brown, Head of Corporate Partnerships [email protected]

EDITORIAL Managing editor: Aisling Beecher @AislingBeecher Editorial board: Dr Seb Gray @SebJGray Dr Hannah Baynes @HLB27 Dr James Dearden @drjamesdearden Dr Dita Aswani @DrDita

KEEP IN TOUCH @RCPCHTweets @RCPCH @RCPCH [email protected]

Milestones SPRING 2020 3 PATIENT CARE NEW SEIZURE SAFETY NET ADVICE The latest news and views I don’t think you ever get used to seeing a child having an epileptic seizure. Whether it is subtle or dramatic, there is something about a seizure that is always distressing. What makes it even more diffi cult is when it is your child, you are not completely sure what it was, why it happened and when and whether it will happen again. It is easy for families and professionals to give vague, incomplete information, to overreact Integrated Care Systems or underreact. However, it is possible, will facilitate after an appropriate assessment for much-needed collaboration families, to be given clear, informed, measured information, proportionate ENGAGEMENT safety-netting advice, and also be given clarity about follow-up and where to fi nd good advice in the meantime. The Launch of our information given can set the tone for the care and pathway that follows. Ambassadors Network A group of us, representing several perspectives and experiences, set out THERE IS NOTHING did cover the crucial policy elements of to provide an information resource quite like a gathering the English health service. Dr Nic Jay for those assessing children after of the enthusiastic and updated us on the challenges faced by our a fi rst seizure – for example, in an committed. This is current workforce. While we have more ED or GP setting. We consulted especially true when consultants and more doctors in training, existing materials, undertook an you are mixing with because of the way we are now working, audit examining family’s experience Dr Simon paediatricians who are it feels like we have lost sta ng numbers. of information after a fi rst seizure, Clark an optimistic bunch; Dr Lisa Kaufmann educated us on the drafted a leafl et, consulted families on VP for Health working with children role of community paediatricians, and its content and then went through a makes every day an adventure. why they are ideally placed to help with process of consultation and revision. We are the fi rst of the Royal Colleges this more local engagement as much The result is our ‘First seizure, First to develop a programme of localised of their work interdigitates with local safety-net’ leafl et for parents and engagement. With the policy shift authorities. carers. Information covers fi rst towards integrated working, it is vital that Our Children and Young People’s epileptic, non-epileptic or uncertain the voices of children and young people Engagement team taught us how to episode where there is are heard. In the push for collaboration canvass the opinion of the youth of today no associated fever. It has providers in England are coming together in a meaningful, collaborative manner. been endorsed by BACCH, in Integrated Care Systems. Each system Whilst it felt like play, the product at the BPNA, RCGP, RCEM, as will have a Local Workforce Action end was something that could be taken well as Epilepsy Action and Board. Decisions made here will feed into to local, regional and even national policy Young Epilepsy. We are national strate . Thus, it is crucial that makers. We also ran an entertaining Dr Colin now working on a young we get paediatricians engaged, otherwise workshop to practice talking to chief Dunkley person-facing version, children will continue to fall through the executives, commissioners and others. Consultant which we plan to launch cracks of the health service. The message from this was, ask, but have Paediatrician later this year. Sherwood We had a welcome chat from Professor data to back up that ask! Forest Hospitals Download the leafl et at Russell Viner, El Presidente. I followed To become an Ambassador, visit @drcolin www.rcpch.ac.uk/fi rst- with some holiday slides from Tonga but www.rcpch.ac.uk/ambassadors dunkley seizure-information

04 SPRING 2020 Milestones UNITED KINGDOM UPDATE Pension-related tax bills RCPCH FACTS “I hope the Government will tackle the pension crisis with the same urgency as ‘getting Brexit done’”

P21 63%

NEW PROGRAMME COLLEGE MEMBERS BASED IN ENGLAND “Time EQIP pilot success to act” THE EPILEPSY when it is safe to PUBLIC AFFAIRS QUALITY discharge a child, IMPROVEMENT and how we can 3% WAVES IN PROGRAMME ensure that the (EQIP) puts service process is equitable WESTMINSTER teams in the driver’s to all children and seat of their own Dr Vandna young people. COLLEGE MEMBERS YOU DON’T need us to tell local improvement Gandhi I tremendously BASED IN WALES you that the previous few interventions. Consultant enjoyed the years in UK politics have Paediatrician, Imagine a weekend and Luton and been characterised by programme of Dunstable left with an uncertainty and instability. content that kicks University Hospital understanding Post-election, the o with a two-day about what we can Government has an training residential allowing do better for children with opportunity to enact a paediatric epilepsy service epilepsy. We all are responsible longer-term strategy, and sta to network and learn for children with seizures 6% deliver programmes set tools and techniques while and epilepsy and see young out in their manifesto and having fun with tennis ball people struggling with school, the months before. There COLLEGE MEMBERS and skittles exercises. Then, as friendships and academics. BASED IN SCOTLAND have been commitments if by magic, each team leaves We all felt part of a bigger team to address funding, quality with an action plan, new sense over the weekend and it was of care and workforce of drive and team spirit. great to network with teams pressures. With a majority, We, as a team in Luton, from across the country. the Government now has the were truly grateful to have the We are in the midst of bandwidth to make good on opportunity to participate in developing our integrated its promises. the EQIP pilot project. QI is seizure care pathway and 2% Over the coming months not anything new, but the tools are happy to share our QI the College will press to embed QI within the NHS initiatives with colleagues. I COLLEGE MEMBERS Ministers on the urgent BASED IN NORTHERN were new to us. As a team we am hoping that the project will IRELAND delivery of the NHS Long are eager to improve in areas bring us closer to prioritising Term Plan, publication of where we recognise there are epilepsy nationally. the People Plan in full, and di culties, ie taking a good Read more at a defi nitive solution to the seizure history, knowing www.rcpch.ac.uk/eqip TOP pensions issue penalising senior doctors. A new programme will While we lost a number support children with epilepsy and seizures of our key parliamentary supporters in the election, State of Child Health 2020 offers us an exciting UK5 CITIES WITH MOST COLLEGE opportunity and basis upon MEMBERS which to engage and build 1 LONDON relationships with newly 2 BIRMINGHAM 3 GLASGOW elected MPs. 4 SHEFFIELD 5 MANCHESTER

Milestones SPRING 2020 05 What is the UPDATE KEEP IN TOUCH number one reason We’d love to hear from you, children under 5 get in touch through our channels end up in A&E? Turn to page Twitter @RCPCHTweets 23 to fi nd out Facebook @RCPCH Instagram @RCPCH [email protected]

Attendees at the recent conference discussing all things perinatal

CONFERENCE Evidence and Excellence in Perinatal Care

HOW DO I provide an eloquent lecture on the use of reading the papers isn’t enough, excellent perinatal the ‘number needed to treat’ and we all need to appraise, criticise, care to the babies the importance of remembering the disseminate and discuss in national and families in my baseline risk of each disease within and international sessions facilitated unit? Having spent individual populations. by modern connectivity and social three days at the Innovation was celebrated in media. It seemed as if every attendee Dr Cliodhna British Association sessions describing pioneering work was tweeting on each session! Godden of Perinatal Medicine in artifi cial gestation, human genome I can’t wait until next June when Neonatal Grid (BAPM) and Evidence- mapping and understanding the infant BAPM will join forces with the Neonatal Registrar, Royal Hospital for Based Neonatolo microbiome. Established practices were Society and British Maternal and Fetal Children, Glasgow (EBNEO) conference, challenged on transfusion of platelets in Medicine Society in London at Perinatal

@cliodhna67 I’m inspired, informed neonates, and in the Founder’s lecture 2020. I’ll be booking my place ASAP! and invigorated. surprising data was uncovered within For more information, visit The conference ‘normal’ neonatal blood sugars. A www.bapm.org kicked o with a thought-provoking clarion call to extend duty of candour presentation by Professor Harish to the world of academia was delivered Kirpalani on sustained infl ation, by Professor Martin Elliott. The long- followed by a taster of the 2018 lasting implications of prematurity National Neonatal Audit Programme upon both infant and family were also (NNAP) highlighting for the fi rst explored, and echoed by a free paper time huge variation in mortality on the TIGAR project monitoring and morbidity among our national impact of gestational age on childhood networks. Another internationally hospitalisations. respected researcher, Professor Workshops throughout the three Barbara Schmidt, helped us place days helped us develop our research these fi gures into perspective with and critical appraisal skills. Simply

06 SPRING 2020 Milestones UPDATE State of Child Health 2020 “We want to help you to improve matters for the children and young people you see in clinical settings”

P16

I’VE BEEN AT the College for two pathway. As well as that, we inform State years, and last year I stepped up into the of Child Health, Paediatrics 2040, the Workforce team lead role. Our aim is to #ChoosePaediatrics campaign and the ensure that every unwell child is seen by recent pensions issue. the right person, in the right place at the There is no quick fi x to the crisis we’re right time. currently facing, so we need to be creative. I previously worked at Public Health Luckily, paediatrics has always been at England researching how EU nations could the forefront of multidisciplinary working, collaborate to stockpile vaccines in case of forward thinking and collaboration. People an epidemic. I handed in my report to the are the foundation of paediatrics, it’s European Commission just a week before really just about making things better for the referendum! Prior to that I completed healthcare professionals. Staff my PhD in experimental psycholo . In my own time, I love to read (preferably Workforce is the defi ning issue for the feminist) sci fi . I fi nd cooking meditative Spotlight College, the NHS and politicians. My team and I consider Salt Fat Acid Heat (by Samin collects data that feed into a wide array Nosrat) my bible. Marie Rogers of work. For example, we are currently See the College’s latest resources Workforce Manager conducting modelling to look at the on workforce and service design @Marie_R_Rogers impact of Shape of Training on the trainee www.rcpch.ac.uk/workforce

RESEARCH CATCh-uS AS WE FALL: TRANSITION FOR YOUNG PEOPLE WITH ADHD Professor IDEAL TRANSITIONAL care Child and Adolescent Psychiatry adult services. This Tamsin Ford from services aimed at children Surveillance Service, I led a team that work suggests that Professor to those aimed at adults should studied transition in young people while transition was of Child and Adolescent be a planned process that supports with ADHD called CATCh-uS. supported by a good Psychiatry the medical, psychological and We measured how many young handover, there were University of Cambridge educational or vocational needs people with ADHD, who needed and gaps in care as many of the young person. wanted to continue their medication patients thought Young people who have ADHD but were within six months of the age ADHD medication was only needed experience huge diffi culties in at which the reporting consultant’s for school, and GPs were left to controlling impulses and emotions, service would have to stop seeing fi ll gaps in care. Many services are focusing attention and organising them. This work suggests that two focussed around medication so themselves. Some will fi nd thirds were accepted by adult mental stopping medication often means medication helps, while others would health services, but only one fi fth losing health service support. like psychological support to help attended their fi rst appointment and The fi nal strand of work was to them cope better. About two thirds 6% experienced optimal transition. produce a map of ADHD services will still experience diffi culties related We then interviewed young for adults. to ADHD in adulthood. people before and after transition, For more information about the Working with the British Paediatric as well as parents, carers and study see medicine.exeter.ac.uk/ Surveillance Unit (BPSU) and the practitioners working in child or catchus

Milestones SPRING 2020 07 In 2019 there UPDATE were 200 online articles about the State of Child Health JOURNAL RCPCH BMJ PAEDIATRICS OPEN ALONGSIDE ORIGINAL research in the news articles, we are now publishing research letters, with abstracts of 100 words, they are useful for CLIMATE NEONATAL CARE PubMed, and allow researchers and readers to scan the contents. AIR POLLUTION NATIONAL Imti Child health in Scotland and the NEONATAL Choonara contrasting approaches of the Child health has been at the top AUDIT BMJ British and Scottish Governments Paediatrics Open of the news agenda over the last PROGRAMME Editor-in-Chief are highlighted in an editorial by couple of months, with stories @BMJ_PO Professor Steve Turner and Dr Samir relating to gender identity, Our neonatal audit report Ahmed. The Scottish Government nutrition and diabetes, among revealed a stark regional appears to take a more holistic others, hitting the headlines. variation in mortality rates view of child health and wellbeing eg banning Most recently, the College’s for sick newborns. The report smacking and promoting healthy behaviours. Prevention Vision, a bold covered exclusively in The BMJ Paediatrics Open continues to make concept that outlines priorities Independent cited a shortage progress and is now recognised as a welcome for the Government’s green of nearly 600 neonatal unit addition to the list of paediatric journals with paper on the prevention of ill nurses. The report found its inclusion in PubMed Central, Scopus and health, was reported widely. almost 70% of nursing shifts Embase as well as Google Scholar. In a move that would transform did not have enough qualifi ed the health and wellbeing of nurses, while more than a third children and young people of shifts lacked enough general JOURNAL in the UK, the College nurses to meet NHS England’s proposed mandatory limits guidelines. ADC JOURNAL UPDATE on the amount of free sugar used in baby foods, banning THE RANGE of article types advertising for all formula OBESITY available makes it hard to know milks (babies under one) and where to start, but, in the spirit of placing a “moratorium” on WHO REPORT sparking discussion and change, Government-imposed public I recommend you look out for the health funding cuts. The We were widely quoted for our following: College’s Assistant O cer for response to a World Health Nick Podcasts: Traditional broths Health Promotion, Professor Organisation report that Brown and antimalarial properties; racial Mary Fewtrell, was widely warned of a ‘global epidemic Archives disparities in preterm birth; quoted across key outlets of childhood obesity’. We of Disease parents’ views on brain tumour in Childhood including BBC News, the said children who are more Editor-in-Chief follow-up MRIs. Daily Mail, The Guardian, active have better health and @ADC_BMJ Articles: ‘Votes for a better The Scotsman, the Belfast wellbeing and generally do future’ – Neena Modi; ‘Complexities Telegraph and The Sun. better in school. Our response and challenges...’ for us all as was covered by the BBC and in paediatricians – Hilary Cass. The Guardian, The Telegraph, Original research and policy: Medical Read more and The Daily Mail. devices: loopholes in EU law and over the Discover details counter pharmacy; Should family members be of our latest present at resuscitation?; Vitamin K defi ciency campaigns and successes online bleeding in Australia. at www.rcpch. Global: Intimate partner violence and child ac.uk health in Cambodia; TB in China; Anthropometry in low birth weight detection in Ethiopia.

08 SPRING 2020 Milestones UPDATE

PAEDIATRIC TWEETS

I recently had a really tough experience with Dr Geoff a preterm baby that for Burnhill a little while made me ST6 PICM, Evelina London consider what I was doing Children’s with my future. Today, the Hospital mum sought me out and thanked me for my role at that time. I honestly nearly cried. Occasional reminders of why we do the job are @ccdaniels65

The Patients’ Choice award gives patients the opportunity to nominate the individual they think is exceptional. This year’s BUSINESS winner is Dr Dennis Grigoratos in paediatrics #KingsStars Clinical entrepreneur @KingsCollegeNHS

AS WELL AS a paediatric intensivist, Bumble profi les (disclaimer: this Why do I love my job? I I’m also fortunate enough to be an NHS doesn’t help) but the real value is in the asked a seven-year-old Clinical Entrepreneurship Fellow. Sure, support and teaching you receive. The which sticker he wanted. it’s hard to pronounce (and to spell!) but cornerstone of the programme is the He picked one and gave it what actually is it? ‘pit-stops’ – regular get-togethers where to his sister. I let him pick The programme was developed to you mingle with likeminded healthcare another for behing so kind make it easier for clinicians to grow their workers, investors, NHS stakeholders, and he gave it to me! ideas into businesses without having to government o cials and well, you #neverwanttogrowup sacrifi ce their clinical careers. It is open name it… At these events there is also #innerchild to all kinds of health professionals with dedicated teaching on ‘businessy’ topics @lucnahabedian all kinds of di erent innovative ideas, as well as insightful talks from previous ranging from artifi cial intelligence apps fellows. Plus, there are opportunities to pediatrician: I need help to physical devices and podcasts. meet the health secretary, tour massive ortho: of course All you need to get in is the drive to companies or travel the world. peds: I have a super-cute innovate and a few ideas as to how you As for me, it’s allowed me to form little girl with a forearm might want to do that. Each year there a medical analytics start-up, which is fracture is an application process in which you helping to join together and integrate ortho: I need a better pitch your idea (and, more importantly, health and social care data across whole description yourself!) to the team in the form of an geographical areas (yup, that stu is peds: she’s got pigtails online application and an interview. I actually coming – watch this space!). If and a wonder woman pitched a few tech solutions I’d knocked innovation is your kind of thing, I can’t cape together, smiled enthusiastically, and it recommend it more. ortho: seemed to do the trick! peds: I mean can you Once you’re in you get the prestigious For more information, visit stand it?! title of NHS Clinical Entrepreneurship www.england.nhs.uk/clinical- @DocAroundThClok Fellow, which you can stick on your entrepreneur

Milestones SPRING 2020 09 In a typical UPDATE classroom of 30, 9 children Redthread are living in “We use the ‘teachable moment’ in the aftermath of a health crisis poverty to help improve their lives”

Read more p18 Find more dates at www.rcpch. ac.uk/courses www.rcpch. WEBINARS ac.uk/events Diary RECORDED WEBINAR Transitional care for young Dates adults with ADHD Presenting results of the fi rst Courses and events taking place in the coming in-depth study of the transition months to aid professional development of UK ADHD patients from child to adult. COURSES RECORDED WEBINAR 09 MARCH 22 APRIL 21 MAY Mentoring peer support Effective Educational Statement and Effective Educational Set up and deliver a mentoring Supervision Report Writing Supervision programme for paediatricians. London (Safeguarding Birmingham Level 3) RECORDED WEBINAR 13 MARCH Edinburgh 22 MAY DCH Clinical exam Effective Educational Returning to paediatric preparation course 04 MAY Supervision Plus: training series London How to Manage: Supervised Learning Essentials to ensure a successful Gastroenterology Events return to work following a break 26 MARCH London Birmingham from clinical practice. Disability Matters Relaunch Event 05 MAY 09 JUNE RECORDED WEBINAR London MRCPCH Clinical How to Manage: Exam preparation Recognising Facing the Future: 3 APRIL course (two days) neuromuscular Paediatric Standards Effective Educational London disorders Introducing a suite of service Supervision London standards and highlighting best London 15 MAY practice examples. Progressing 11 JUNE 20 APRIL Paediatrics: Mentoring Skills MRCPCH Theory Childhood epilepsies Stirling and Science exam London See more Free and accessible educational updates preparation course www.rcpch.ac.uk/webinars London

10 SPRING 2020 Milestones 1,791 children and young people were consulted for the State of Child Health 2020 report We’re different but that’s OK! RCPCH &US Following a national survey, the ICYP Engagement Committee got a group of young people together to talk about... rights

THE UNITED NATIONS Convention on the Rights of the Child (UNCRC) article 12 is about respecting the views of the child in decision making. In autumn 2019, 1,791 children and young people from across the UK took part in a survey to voice their thoughts on what makes the best health service. Of these, 77% identifi ed 499 said we need help to stay three priorities for helping them to keep ‘healthy, healthy, happy and well happy and well’. Think about how you can use their views to infl uence your decision making.

We need help to be healthy, happy and well. 1 Tell us about things like sleep, diet, exercise and where to get help and advice. Increase our awareness of health conditions. 407 2 Tell us about diabetes, epilepsy, asthma and other said we need youth- conditions so we can help our friends and siblings. friendly and youth- aware services Create youth-friendly and youth-aware services. Young 3 Think about di erent groups of children and young people and what they might need when they see you. people said...

Following the survey, 17 young people, plus carers, and Being you is your parents met for the Infants Children & Young People superpower (ICYP) Engagement Committee. We talked about why voice We’re not defi ned by and rights matter and looked at what the RCPCH &Us our conditions members had said. They used their article 12 right to help Believe in yourself us understand what help they need when it comes to health. 464 said we need help to You can use their responses to inform your services. fi nd out more about I have a life outside the conditions our friends consultation room Brought to you by Phoebe, Nicola, Michael, and siblings might have Coz I’m di erent, Lynn, Carmen, Ali, McKenzy, Adam, Demi, don’t judge me Camilla, Laura, Tiffany, Viv, Ishaan, Rosie and Mac I will continue to fi ght

Still normal and still me Read more at our page www.rcpch.ac.uk/ rightsmatter See me not my illness

ABOUT

RCPCH &Us: The Children and Young People’s Engagement Team delivers projects and programmes across the UK to support patients, siblings, families and under 25s, and gives them a voice in shaping services, health policy and practice. RCPCH &Us is a network of young voices who work with the College, providing information and advice on children’s rights and engagement.

KEEP IN TOUCH @RCPCH_and_Us @rcpch_and_us @RCPCHandUs [email protected]

Milestones SPRING 2020 11 FEATURE

YOUNG PEOPLE

TWEET US! You’ve heard their views but what do you think? Let us know using THE DEBATE: #MilestonesDebate @RCPCHtweets WHEN DO CHILDREN BECOME ADULTS IN THE EYES OF THE NHS?

EFFECTIVELY TRANSITIONING FROM CHILDREN TO ADULT HEALTH SERVICES CAN BE DIFFICULT. MEMBERS FROM THE YOUNG PEOPLE’S HEALTH SPECIAL INTEREST GROUP YPHSIG DEBATE FOR AND AGAINST EXTENDING PAEDIATRIC CARE BEYOND 16 YEARS OLD

AGAINST PAEDIATRICS GOING BEYOND 16 YEARS

THE HEART MAY say “Yes, the upper age of context is providing ‘medical’ care during pregnancy. Would paediatrics should be higher than 16 years”. Fine, we take over management of a sexually transmitted disease? but how high should the age ceiling be? Are we Even a simple condition such as asthma can be di erent talking about 18 years old? Or 25? Here are four in an 18 year old compared to a 14 year old, since di erent reasons why my head says, “We cannot safely aetiologies, eg occupational exposures, become important. change from 16 years old in the near future”. There is a long list of adult chronic conditions, which Professor Firstly, we do not currently have the sta to paediatricians sometimes glimpse in 14 and 15 year olds before Steve Turner provide care for individuals aged 16 years old and handing on to adult physicians. Our wonderful colleagues Officer for over. You may have noticed that our workforce in adult medical, surgical and obstetric specialties provide a Scotland, struggles to provide emergency and scheduled care perfectly e cient service for individuals aged over 15 years. Consultant in general and for the population aged under 16 years. Most centres fail Why do we think we can do better? acute medical to meet the College’s Facing the Future standards. How Thirdly, we currently do not have the accommodation to paediatrics, Royal Aberdeen can we accommodate more patients? There is a perception provide scheduled and unscheduled care for patients over 15 Children’s that there would only be a small increase in workload by years. Our ward and outpatient spaces are already often full Hospital increasing the age limit of paediatrics by a few years. This to capacity. We often have boys and girls in small four-bedded is wrong. Young people have a considerable healthcare wards, but this would not be acceptable in the context of over demand. For example, there are more hospital admissions for 16 year olds. We are still a long way from providing a teenage- 10–19 year olds than 1–9 year olds. Any increase in age limit friendly environment in our hospitals, can we do it better with must consider the required expansion in the multidisciplinary more teenagers to care for? Have I mentioned the small question workforce required to provide high-class healthcare. It takes of o ce accommodation for the additional front line and support at least three years to train a nurse and seven years to train a sta required to look after an expanded paediatric population? consultant (on average more than 10 years). Finally, and most importantly, has anyone asked children and “We are still a A further consideration is, would our young people what they want? My experience is that 15 year olds colleagues in adult specialties who currently feel very uncomfortable in the paediatric inpatient setting. long way from care for the over 15 year olds be happy to A move to expanding the upper age limit to 18, 21 or 25 years providing a lose sta in light of their falling workload? (or even beyond) has some attractions but would require a whole teenage-friendly Secondly, our current workforce is system rethink. Any change must be patient centred, and ideally not trained in providing care for many be community-facing. I embrace change, but there are some environment in conditions in individuals aged over 16 years inconvenient practical obstacles to increasing the upper age limit. our hospitals” old. One obvious example of a novel clinical Let’s get it better in the 0–15 year olds fi rst.

12 SPRING 2020 Milestones FEATURE At what age does a child really become an adult? FOR PAEDIATRICS GOING BEYOND 16 YEARS

WHAT IS MAGICAL about the age of 16? Does something happen the day a 15 year old turns 16 that logically supports a paediatric referral being rediverted to adult medicine? There are areas in the UK where 16 and 17 year olds fall outside paediatric criteria but not yet into adult criteria hence they fall Dr Janet into a gap and do not receive specialist healthcare. McDonagh Changes occur during adolescence and young Clinical Senior adulthood (AYA) that vary in timing and duration Lecturer in Paediatric and between individuals and are poorly related to age. Adolescent At 16, these changes are all ongoing! The pre- Rheumatology, frontal cortex so integral to complex thought and University of Manchester planning, will not mature until the mid-twenties. It children – the young people of tomorrow. How can we let such an is not just about their brains. Their di erent social investment opportunity be passed by? environments with multiple transitions (social, You could argue that the focus on transitional care in recent vocational and health) infl uence the decisions, risks years explains the limited progress in universal implementation and opportunities young people actually take. of developmentally appropriate healthcare (DAH) provision. The law is of no help. It is not static and varies DAH by defi nition is focussed on young people’s development. It over time and across geographical and political is in the less-studied third phase of health transition, which takes boundaries. Just take the laws on purchasing alcohol, place in adult settings after transfer, when at least half of health Dr Terry Segal medical use of cannabis, sale of tobacco, the right to management skills are acquired. YPHSIG Convenor, Consultant vote and the age of consent. The law will be guided Let’s look at research. It has identifi ed that the older the young Adolescent by society. Having a strict cut-o at 16 in healthcare person when transfer takes place, the better the health outcomes. Paediatrician, UCLH makes no sense! Not just that, a later transfer is developmentally appropriate but Medical advances have meant a lot for young needs to be coordinated with the other life transitions during this people with childhood onset disease, having increased survival and life-stage eg vocational. therefore need transfer to adult services. What better way for adult Training gaps continue in both paediatrics and adult services to become familiar with such conditions than to collaborate medicine, and this will have an e ect on delivery. We need to with their paediatric colleagues. Similarly, young people develop gain momentum and invest in expertise that already exists. We adult conditions, eg mental health disorders and cancer, and again propose truly meaningful support is extended at organisational will benefi t from such shared expertise. and national levels to paediatricians and adult physicians with an We wholly agree with the lifecourse approach being called for interest in adolescent medicine. This could lead to an adolescent in the NHS Long Term Plan, which acknowledges the di erent life and young adult workforce similar to that being recognised in stages. We have to acknowledge that there are many more young Australia. While we are at it, the College could lead the way and people aged 10 to 24 years old (now 18% of the population) than the undergo transition itself by rebranding as the Royal College of limited traditional paediatric 10–15 years old age group. Paediatrics and Young People’s Health! Investing in the health of young people has a triple dividend of Find more about resources for transitioning to adult better health for them, better adult health, and better health of their services www.rcpch.ac.uk/transition-adult

Young People’s Health Special Interest Group

THE YPHSIG IS an association Membership is open to adolescent health, formal appointed trainee and student of the College. Its aim is to healthcare professionals and informal mentoring, a representatives who drive and raise the profi le of young working with young people monthly academic update support initiatives including people’s health and promote (10–24 years old). Members and opportunity to contribute our recently launched annual the development of high benefi t from access to a lively to policy and guidelines student essay prize and quality health services for network of professionals affecting young people at a interactive training evenings. young people in the UK. with a shared interest in national level. We have newly Visit www.yphsig.org.uk

Milestones SPRING 2020 13 FEATURE

EXPERIENCE Paediatrics and me RICHARD RECOUNTS THE BEGINNING OF HIS LONG CAREER IN PAEDIATRICS AND THE MANY CHANGES HE HAS SEEN

had no option but to follow a career in paediatrics after my baptism into children’s medicine in the tropics when I was a student at University College Hospital Ibadan in Nigeria in 1963. The hundreds of children brought there daily revealed such a wide range of Dr Richard conditions, most of which were treatable and Purvis eventually preventable, however advanced Retired Consultant I they seemed when we fi rst saw them. Time Paediatrician, Dorchester spent with these children and their families was over vast distances, and always at the mercy of the exciting and never dull. It also compared favourably weather. Making diagnoses and suggesting treatments with my previous experience of sick children to our nurses over a crackling radio telephone system separated from their parents in huge dreary provided unique challenges too, especially as these Nightingale wards during a harsh Scottish winter. conversations containing such personal intimate My clear intention was to return to Nigeria, after details were avidly listened to by many households up taking the DCH (London) and MRCP (Edinburgh) and down the Labrador! in 1967. However, this was thwarted by the outbreak of the civil war in Biafra (where starvation was Changing challenges employed as a deliberate tactic of warfare – remember Throughout my career, I’ve seen a lot of changes the young children shown around the world with a in paediatrics. A young doctor starting out in a ‘Biafra belly’?). I soon discovered another adventure paediatrics career in the 1960s could expect to spend in paediatrics when I became the fi rst paediatrician many long hours doing exchange transfusions in the Top: Dr Peter Johnston and Dr Richard Purvis appointed by the International Grenfell Association newborn nursery. Each of these procedures for the dressed as Wombles in to organise the services for the children in Northern treatment of rhesus haemolytic disease, was carried out the seventies Newfoundland and Labrador, including the Innuit by cannulating the umbilical vein and required hours Middle: Staff and children patients in the paediatric (Eskimo) and Innu (North American Indian) children of concentration by the nurse and doctor team using a ward, StUnder, through in their established communities there. This meant “10ml out… 10ml in… slowly…” approach, which could the years Bottom: Richard with his my fl ying in single-engine planes to the outports take several hours to complete and was often scheduled book (see opposite page) where the children lived close to our nursing stations, into the “wee sma’ oors”. For many of us it showed how

14 SPRING 2020 Milestones FEATURE

“We often had Career to resort to daily ventricular Highlights taps, before 1960s Nigeria the invention 1 Richard found working as a student doctor in of the Rickham Ibadan exciting. Although reservoir” the volume of patients was large, the conditions were mostly treatable. real teamwork could determine Indigenous children the successful outcome of such 2 Richard’s role as a major procedure – a lesson the fi rst paediatrician learned repeatedly in the years for Innuit and Innu to follow. communities in Canada Another theme was the active saw him fl ying in single- surgical management of spina bifi da, which or when it became known that HIV was being engine planes (above) and followed the introduction of the Spitz-Holter valve transmitted to patients with haemophilia when consulting over crackling to control the hydrocephalus associated with the treated with Factor 8 (1984), or the revelations radio phone systems. Arnold-Chiari malformation. For the doctors about excess deaths in neonatal cardiac surgery in Service developments this resulted in a whole industry of treating the Bristol in 1992. 3 In West Dorset complications of blocked and infected valves. We However, there was a much more solid Richard led the often had to resort to daily ventricular taps before response from our peers to the paper published development of a the invention of the Rickham reservoir gave us in The Lancet in 1998, which attempted to link comprehensive, self- access to the CSF circulation. the MMR vaccine to the development of autism. managed, child health All of this had to be carried out against a media Paradoxically, the increased attention it brought directorate involving all background, which cast doubt on our endeavors to paediatricians and the public alike provided the professionals who and concentrated on wild speculation about a strong stimulus to our profession to recognise worked with children in the causes of spina bifi da. The wildest theory and understand autism spectrum disorders as the NHS Trust. reckoned that since this congenital malformation commonly hindering a child or young person’s Autism research was more frequent in the west side of Scotland and healthy progress in life. 4 The publication Ireland, that it surely must be due to the mothers Working in paediatrics has never lacked of a paper attempting eating potatoes a ected by blight! excitement: whether dealing with children to link autism with the individually, or making adaptations to our MMR vaccine brought Managing the media practices, adopting the many clinical advances paediatricians’ attention In subsequent decades we have become that have taken place in the past 50 years – such as to autism. Richard’s most accustomed to this scenario of working to ventilating premature newborns, huge advances fascinating work has been assimilate vital developments in our practice in laboratory services and the introduction of new helping to make children that have grabbed the attention of the media who scanning techniques. For me the most fascinating with autism’s integration interpreted them in their own inimitable way. development in the last 20 years has been my into society easier. While understandable, this can lead on to the involvement in delineating the nature and ‘blame game’ where colleagues have been targeted prevalence of children on the autism spectrum, unfairly from time to time. and their integration into normal society. Examples of these have been the responses to the Thalidomide tragedy (1961), Kempe’s ‘Battered Richard has published a child syndrome’ (1962), and Ca ey’s ‘Whiplash comprehensive account shaken infant syndrome’ (1973). On the other of his journey through hand, it wasn’t easy to unequivocally support our paediatrics: A History of peers when they were involved in scandals such Dorchester Paediatrics is as the Cleveland child sexual abuse scenario (1981) available now on eBay

Milestones SPRING 2020 15 FEATURE Adam Gale Adam Illustration: State of Child Health 2020 HOW HEALTHY ARE CHILDREN IN THE UK? A NEW UPDATE OF OUR LANDMARK REPORT EXPLORES THE ISSUES

E ARE PUBLISHING an violence, young carers and the CYP workforce – to updated edition of our refl ect the changing trends, priorities and evolving Dr Rakhee Shah ground-breaking State of challenges faced by paediatricians. Clinical Advisor of the State of Child Child Health report, three Overall, the report demonstrates considerable Health Project Board years on from its original progress made in child health over the past 30 years. @shahrakhee Wpublication in 2017. The report provides a Although, worryingly, positive trends have stalled in snapshot of infant, children and young people’s many key areas since 2017 and, in some areas, things health in 2020, pulling together available data are getting worse for children and young people. We across the UK. are particularly concerned by negative trends in infant It covers physical and mental health, alongside mortality (which has risen for the fi rst time in England wider determinants of health, such as the since 1999) and immunisations (the UK lost our WHO relationship between poverty, housing, education ‘measles free’ status in 2019). Additionally, we know and child health. The 2020 edition includes new that mental health concerns are seen repeatedly in areas – looked-after children, mental health, youth practice by paediatricians and the data confi rms

16 SPRING 2020 Milestones FEATURE

“Children from deprived ACTION POINTS backgrounds are more likely to have worse WHAT CAN YOU DO? health outcomes than WHILE THE REPORT the support that they are entitled to. wealthier counterparts” will retain the focus on infl uencing Advocate for local children, that prevalence is rising; young men are three national policy as 3 young people and their times as likely to commit suicide than women. successfully as before, families We hope that shining a light on these areas will we really want this Use available data (including the prove a focus for decision-makers to help drive Dr Ronny report to be just as State of Child Health report) to improvements in outcomes for CYP. Cheung relevant to practising articulate the needs of your local It’s not all bad news, as the report celebrates Chair of the paediatricians just like population, and make sure you State of Child positive trends for long-term conditions, as A&E Health Project us. For each indicator, give them a voice by advocating attendance for CYP with diabetes and epilepsy Board there will be practical for their wellbeing to local decision is decreasing year on year, suggesting that there @Cheung advice, guidance makers and commissioners / is improved self-management and care in the Ronny and resources that service planners. community. We hope these positive trends will individuals or teams continue through delivery and recommendations can take. We want to Take an active role in from both the National Paediatric Diabetes Audit help you, as clinicians, to improve 4 supporting child health (NPDA) and Epilepsy12 audit programmes. matters for the children and young research and data collection people that you see in clinical Without high quality data, it is The changing context settings, as well as helping you to impossible to know how healthy Importantly, the report highlights the impact advocate locally for the children and your local population is nor of poverty on child health – across the board, young people for whom your service persuasively argue for resources for children from deprived backgrounds are more is responsible. children and young people in your likely to have worse health outcomes than their Much of the advice relates to a area. Professionals should remember wealthier counterparts. It is projected that by particular topic, but there are some that taking a full and active role in 2022, 5.2 million children will be living in relative themes that emerge: research and improving local data is poverty, marking a record high for child poverty a vital part of their work. The more rates in the UK. Making every contact count clinicians use data, the better the Since 2017, the political landscape across 1 Children and young people data quality becomes too. the UK has changed considerably, which has may see an encounter with a impacted upon the way care for CYP can be trusted health professional as an Make child health a joyful delivered by paediatricians and the wider child opportunity to discuss issues beyond 5 place to work health workforce. It is important for State of Child their immediate, physical complaint. There are simply not enough Health to recognise and respond to these changes. Professionals should actively explore doctors, nurses or other Within England, the NHS Long Term Plan other issues with which the child, professionals in the child health provides a clear vision for future care, recognising young person or family may be workforce to deliver high quality, a shift towards integrated and community care. struggling (whether relating to other equitable healthcare for all children Services are increasingly provided outside of physical or mental health problems, and young people in the UK. When the NHS, within Local Authority remit, which or with their social and family we are all under increasing pressure has been impacted by funding cuts. In Scotland circumstances). to deliver more with less, it is easy and Wales, there has been increased devolved to forget that each of us has a power over health matters, while the Executive Signpost disadvantaged critical role to play in recruiting and in Northern Ireland has only recently resumed 2 children, young people and retaining much-needed colleagues following a three-year suspension. And of course, their families to sources of support to work in child health services – there is the unknown impact of our departure Our focus may be on health, but by creating an atmosphere in our from the European Union. Workforce continues to we know the health of children workplace, every day, that celebrates be a challenge across the UK and, by bringing this and young people is affected by the joy of working in child health. indicator into State of Child Health, we hope to factors beyond healthcare alone. demonstrate that wholesale improvements in child Make it your responsibility to know For more information on the health cannot be improved without resourcing what local services exist for your State of Child Health 2020 visit the workforce and empowering them to provide disadvantaged children and young www.rcpch.ac.uk/state-of-child- health promotion advice. people, and direct them to access health

Milestones SPRING 2020 17 Young people are vulnerable FEATURE and deserve our curiosity

YOUTH WORK Redthread Working with young people: practical advice from health- based youth workers

“We use the ‘teachable E ALL KNOW moment’ in adolescence is present and without judgement. Remember W a vulnerable the immediate that exploitation is often at play and those who transition, but tailored aftermath of a are committing violence are likely to have been approaches for this cohort are health crisis to victims of it themselves at another time. still an emerging fi eld. John Poyton At Redthread, we specialise help improve Remember looks can be deceiving CEO of Youth in working with this group. their lives” Just because a young person is behaving in an Work Charity Our youth workers support adult way, needs an adult dosage and looks like Redthread people aged 11 to 25, alongside an adult, doesn’t mean they are. We see patients @Redthread youth clinicians in emergency as young as 14 ‘aged up’ and treated like adults, departments, on the wards and when after a short conversation it becomes very in GP surgeries. The majority of those we work Consider adverse apparent that they’re actually a very scared child. with have experienced violence or exploitation, childhood experiences Accepted research around brain development and we use the ‘teachable moment’ in the (ACEs) now recognises full brain maturity doesn’t happen immediate aftermath of a health crisis to help Being informed about trauma until around the age of 25, far beyond the 16-18 improve their lives. Every day our sta see what isn’t just about considering the transition to adult services. We simply can’t make social intervention of the most vulnerable young incident that brought a patient to assumptions about a young person’s abilities. patients in hospitals need to recover. hospital, and unfortunately lots of the young people we all see have Be curious, always Stay trauma-informed experienced numerous traumas or One thing every young person deserves from For clinicians, the word trauma probably brings ACEs throughout their young lives. professionals they come into contact with is to mind a severe injury. But at Redthread, Recognised ACEs include having curiosity. We owe it to adolescents to be curious although we’re often there during or immediately a parent in prison, witnessing about the causes of their injuries, the reality after this work, the trauma we’re primarily domestic abuse or being the of their lives and about what they might need concerned with has deeper roots and longer victim of abuse or neglect. These support with. Though we may be trained to deal lasting impact. Although the incident that brought experiences have a signifi cant only with the presenting complaint and not open them to hospital may well have been traumatic, impact on their ability to think, up Pandora’s box, we need to ‘make every contact we often see young people who’ve experienced interact with others and on learning. count’ and ensure we explore the wider needs of multiple and cumulative emotional trauma young people during this vulnerable period. throughout their childhood. Remember that if Be careful not to label a young person comes in as a result of violence, When dealing with youth violence, Find out more about the work medical interventions may feel like a continuation victim and perpetrator aren’t Redthread do at www.redthread.org.uk of the trauma they’ve just experienced. phrases that are easily applicable Explaining everything that’s happening is or helpful – the beauty of working even more important than usual. Behaviour is within a healthcare setting is communication – what are they telling you? that we get to meet people as they

18 SPRING 2020 Milestones FEATURE

“We use pre-assessment information to be responsive to the whole child and not just their condition” BEST PRACTICE Health for the whole child: practising paediatrics Development is key to improving “Many children the UK’s child health outcomes with long term conditions have poorly managed ANY OF THE A biopsychosocial pre-assessment, completed most worrying online through the portal, enables us to deliver symptoms, often M child health tailored care for body, mind, and social context. accompanied by outcomes are related to anxiety and other poverty, and the social, Joined-up care political, environmental, and A multidisciplinary team provides joined-up problems. We Dr Ingrid Wolfe commercial determinants care around the child. Our teams include GPs, need to look at Consultant of health. Every day we children’s nurses, general paediatricians, and the whole child Paediatric see the e ect of poverty in mental health workers linked to the emerging Population and family” Medicine, Evelina the children we provide primary care networks, and working closely with London Children’s care for. What can we do as local authorities. Each local area has a linked Hospital paediatricians to provide care paediatrician working closely with GPs delivering @ingrid johanna66 for the whole child? care together, forming close supportive working In South London, based at relationships, and holding lunch-and-learn Can the CYPHP approach be Evelina London Children’s Hospital, Children sessions together. replicated? One of the most and Young People’s Health Partnership (CYPHP) Early results show encouraging impact: important reasons we’re evaluating is testing new ways of delivering better care for improved health outcomes, better quality of care, so carefully and thoroughly is the whole child. Our health system strengthening and reduced emergency department contacts and to ensure we can reliably share programme has developed a new model of admissions that save enough for the service to pay learning. We will soon be making care with several important attributes: early for itself and deliver moderate savings too. We’re available our Evelina London intervention, biopsychosocial care, and health achieving these results by looking after the whole CYPHP manual for health system promotion with supported self-management. child, and not just their disease. Our approach is strengthening, telling you all about We have built a Population Health Management reaching children most in need, helping to reduce implementing and delivering system that enables case fi ndings to detect early inequalities in care. a population health and health intervention and improves equity of access to care systems approach to improving for children with long term conditions. We’ve What have we learned? Child health can be services for children. We hope found that 60% of children with asthma in the improved by strengthening health systems. that others will benefi t from the community have poorly controlled symptoms Our clinical-academic partnership e ectively evidence we’ve generated, and adopt that are above the threshold for needing care, combines NHS system transformation and a population-approach to improving so picking them up early is especially quality improvement with research to build healthcare for children. And in the important. And around a third the evidence base for children’s meantime, we’re always happy to also have high levels of mental health. A population approach to share ongoing learning, so do get health needs. Self-referral biopsychosocial care can improve in touch. through a patient portal 1 in 15 early intervention and care for Find out more about CYPHP’s also helps improve access parents do not children, and thereby improve work and those involved in the and empower parents. always have health and equity. partnership at www.cyphp.org suffi cient food for their children Milestones SPRING 2020 19 FEATURE The PIER Network conference brings teams together INITIATIVE PIER Network Multidisciplinary health professionals working to improve the care of children and young people

HO WOULDN’T WANT to be to start all over again. part of a vibrant network of child Surely there was a more W health professionals working joined-up approach? PIER collaboratively to improve outcomes for children A lead clinician, and young people? The Paediatric Innovation nurse or allied health Network Education & Research (PIER) network in professional from each trust across the region outcomes Wessex aims to do just that. came together for an initial meeting. They were The initial spark was the use of a quality asked what they wanted from the network. This Multi-professional improvement approach to improve outcomes refreshing approach was gladly received, as most educational for children and young people in the region had assumed they were going to be told what to do. programmes across su ering severe trauma. This utilised multi- Since this initial meeting in 2014 the network has paediatric specialties. professional team-based education and fl ourished. PIER’s ethos is that everyone involved The development of standardisation of approaches, which resulted in child health should be empowered to realise the over 67 regionally in impressive outcomes. Following this, there value of their contribution to healthcare teams. agreed guidelines was a desire to bring educational opportunities We challenge traditional ways of training and and tools. together to maximise improvements and support promote a culture of continuous improvement. We The UK’s fi rst regionally sustainability. The idea of PIER was born! work with specialty networks, the clinical research delivered neonatal It was proposed that if child health departments network and the Wessex and Thames Valley and child health around the region shared skills, knowledge and operational delivery networks in paediatric critical nurse preceptorship experience in innovation, education and research, care, cardiac, neurosciences and neonatal care. programmes. this would lead to a reduction in variation and Wessex ranked second- avoid duplication of work Connecting teams highest nationally for contributing to improved The PIER conference has become a highly recruitment to research health outcomes for children successful annual two-day event that brings studies in 2018-19. and young people. Trainees together professionals to learn and build A Child Health were enthusiastic and had communities. It is truly multi-professional and Information & Leafl et plenty of ener ! Their initial innovative in its delivery, with tickets kept at low Directory facilitating request was for standardisation prices to enable the whole team to attend. easy access to up- Dr Kate Pryde of guidelines. Trainees were PIER is essentially multi-professional in to-date resources for PIER Innovation frustrated with being asked to everything it does, transcending boundaries clinicians, patients Lead, Consultant Paediatrician, create guidelines – devoting between healthcare professions, hospitals and and families. Southampton signifi cant time and ener , specialties. Involving everyone in all key activities Children’s Hospital taking almost the whole length ensures they feel valued and committed to the @pier_network of a training post (if they were projects. We believe that through inspiring and lucky!) for the guideline to supporting sta to contribute and develop their be agreed and go through ideas into practice PIER has helped to see Wessex governance – only for them to rated as the best place to train in England! move to the next training post in a di erent hospital and be asked Visit www.piernetwork.org

The PIER team: Dr James Edelman (Education) Dr Kate Pryde (Innovation) Dr Katrina Cathie (Research) 20 SPRING 2020 Milestones FEATURE WORKFORCE NHS pensions: Does work pay? Following our recent survey on pension-related tax bills, two members give their perspectives

LIKE MANY OF us, I had never worried I’VE RECENTLY RETIRED, what a relief! I’ve too much about my NHS pension. I believed pretty much escaped the issues around pension the pension scheme was reasonable, I was tax and annual accruals. contributing and that was it. However, the last Actually, not strictly true, as I’ve returned to few months have seen the rise of an unexpected work, and am still anxious I may have got my sums pension crisis. Consultants across the country wrong and be in for a shock! As someone who Dr Arun have been struck with staggeringly large tax Dr Sian Harris worked eight sessions for many years, I thought I Ramachandran bills following changes to pension rules. Consultant would be safe, but after seeing an accountant I fi nd Paediatrician, Consultant More senior colleagues are considering early I will have some additional tax to pay for exceeding Neonatologist, Royal Cornwall Swansea Bay retirement and the College’s pension survey Hospital the lifetime allowance. It’s not easy to understand University Health refl ects this trend across the UK. the fi nances, especially when you get inaccurate Board Here is a summary of what I learnt: We have information from the pension agency. I had a letter saying my tax a £40,000 per year tax-free allowance for our accrual was three times my salary for one year. This was wrong, pension. This is averaged over three years. We also have a lifetime but it took several phone calls before I got someone to admit it. The allowance of around £1 million. If your total annual income crosses responsibility lies with you to get your tax correct. £110,000, the annual limit is tapered until only £10,000 is left. In I’ve just completed job planning for my department; no one wants addition to your monthly contribution plus the NHS contribution, to do extra work. That includes the additional clinics needed and key an additional amount is added to your pension pot based on growth lead roles. In fact, three consultants want to make drastic reductions from previous years. Currently, there are limited options to predict in their job plans due to tax pressures. Although this potentially this growth and adjust your contributions based on it. You might releases money, it doesn’t fund a full post and getting extra funding not be automatically informed if you cross the annual allowance. from one’s trust is a challenge. Plus, if funding is agreed it may In England and Wales the Government has proposed a temporary take over a year, and then one needs to fi nd someone to fi ll the post. solution for the 2019/20 tax year. You can ask NHS pensions to Pensions changes have come along at the same time of increasing pay the bill with the ‘scheme pays’ option. The promise is that this demand and public expectation and pressures on the consultant will be repaid when you retire by the NHS so that you are not out workforce are immense, making retirement or working part-time the of pocket. I am no expert though. It is best to take fi nancial advice only sane options to staying healthy and having life outside of work. for your individual circumstances as the whole thing is incredibly The solution is to reverse the tax changes before too many complicated. experienced doctors are lost. If we don’t, the sta ng crisis we already The NHS faces many challenges. The pension crisis has hit morale. face will widen further and we will see departments becoming A clear manageable system is the fi rst step to a solution. The NHS unsafe and unattractive to recruit to. was a big election issue and I hope the Government will tackle the Read about the key fi ndings from the College’s survey pension crisis with the same urgency as ‘getting Brexit done’. www.rcpch.ac.uk/nhs-pensions

Milestones SPRING 2020 21 KEEP IN TOUCH We’d love to hear from you, get in touch through our channels Twitter @RCPCHTweets Facebook @RCPCH The latest member news and views Instagram @RCPCH [email protected]

TRAINEES TRAINING: MORE FLEXIBLE THAN YOU THINK

I WAS A FEW months into training when I applied for Exams will my fi rst Out of Programme make you a better Experience (OOPE). Having paediatrician spent 12 months as a clinical leadership fellow, an GUIDANCE opportunity came up that was too good to miss. Since then I’ve made a habit of seeking Tips for MRCPCH fl exibility within training. Following my fi rst inter- Theory Exams deanery transfer from Wales to England, after only 18 months, I Seeing these exams as a learning opportunity wanted to move again (to follow can help you remain calm and focussed my non-medical partner’s job), and so I made a second move to a different English region. THE THEORY 5. Keep calm in the exam. The In my new region, I took 10 examinations are a questions and answer stems will be months out to be a teaching useful and reliable given in a random order. Try to resist fellow and completed a second test of knowledge. For the urge to read the answer options postgraduate certifi cate. As I many paediatricians, before reading the question. This became more involved with they are a signifi cant introduces bias and reduces your the College and the BMA, I Dr Will high point in their chance of success. applied to return to training Carroll learning. Here 6. Seek advice from your supervisor working Less Than Full Time Assistant are some tips for and College tutor. This is particularly Training (LTFT) at 80% under Officer for candidates that I important if you are undertaking a category 2. It’s fantastic to Examinations @heretolearnkids hope can help. particular examination for the third (or see that all trainees now have 1. Look at the sample more) time. the opportunity to papers. 7. If you are fi nding the Theory and apply for LTFT under 2. Use the recommended resources. Science examination di cult, consider category 3. These include the ‘Clinical Cases’ series attending the MRCPCH Theory and Now in my ST5 year, and The Science of Paediatrics textbook. Science taught course, or accessing the I’m about to take a 3. Form a study group. Write questions online content. third period out. With for each other. 8. Do not despair. I have worked with the planned Shape Dr Emma 4. Plan your revision and stick to it. The brilliant paediatricians who have found of Training changes, Coombe theory examinations will require 600- the theory examinations a hurdle. Most Trainee there’s no predicting 700 hours of personal study for the have failed one or more parts. Representative where I will go next! for Recruitment average candidate. Some will need to Find out more at www.rcpch.ac.uk/ @dr_emma devote more time to a particular exam. www.rcpch.ac.uk/theory-exams coombe shape-of-training

22 SPRING 2020 Milestones 3,062 MEMBERS admissions out of 42,749 were due to objects being stuck in body parts

FILM

The Trainees Committee is calling FROZEN II for more trainees to get involved IT’S THE BLOCKBUSTER fi lm release we’ve all been waiting for. Frozen has been distracting Dr Sally hot, snotty Henderson children in waiting ST6 Paediatric rooms across the Trainee, Bristol country since 2013 Royal Hospital – it’s impossible to for Children be a paediatrician and know nothing about it. If you’re not keen to sit through the whole two hours of Frozen II, here’s a summary to help you fool any 5 year old with your knowledge of Anna TRAINEES and Elsa’s latest adventures: Elsa is queen and can still turn Trainees Committee News anything to ice and snow with a sassy sweep of her hand. Dr Hannah Jacob explains the role of the The Kingdom of Arendelle is under threat, and it’s up to Elsa Trainees Committe and reveals what’s on and Anna to save it. the agenda this year The whole crew – including snowman Olaf, loyal and lovable reindeer Sven, and good looking BEFORE I JOINED the Trainees Future plans but gormless ice hacker Kristoff Committee, I didn’t really have We’ll be continuing – enter the ‘enchanted forest’ to much of an idea about what it did. to proactively confront four creepy spirits and So, in case you were wondering, it’s work with the unearth previously hidden family made up of elected representatives College on the secrets. (Spoiler alert!) Not all of from each region in the UK and a #ChoosePaediatrics them leave the forest, leaving handful of subject representatives. campaign, Dr Hannah countless parents shocked and We’re all trainees and meet three particularly Jacob Trainees surprising themselves by sobbing to four times a year with plenty of supporting Committee Chair into their popcorn. messaging in between. foundation @HannahCJacob There are 80s We are focused on all issues doctor events, rock ballads, a related to training, including exams, and are always on the lookout for proposal, feminist curriculum, recruitment and trainee enthusiastic trainees to help out girl power, climate wellbeing. We’re keen to involve and promote paediatrics. And, of change references more trainees, and so this year there course, we’re all looking forward and tears. will be an opportunity for up to three to the annual Conference this year, But, it’s mostly a trainee observers to attend each where regional winners will be put happy ever after, meeting. Do get in touch with your forward for the national PAFTAs. although not regional rep if you would like to join See you there! in the standard us for a fun day out full of topical www.rcpch.ac.uk/ Disney way. trainee discussions! trainees-committee Frozen II: coming to your waiting room soon

Milestones SPRING 2020 23 MEMBERS

Dr Shilpa Shah Dr Robert Boon Dr Tessa Davis Consultant Consultant in Consultant in Paediatrician, General Paediatrics, Paediatric Emergency Craigavon Area Royal Manchester Medicine, Royal Hospital Children’s London Hosptial @drshilpashah @robboon69 @TessaRDavis

BOOKS BOOKS PODCAST THIS IS GOING ADMISSIONS: DON’T FORGET TO HURT A Life in Brain THE BUBBLES by Adam Kay Surgery by Henry Marsh DON’T FORGET THE BUBBLES (DFTB) THIS BOOK IS hilarious. I caught began life in 2013 as a blog run by four myself chuckling throughout, mostly ADMISSIONS IS friends, and has rapidly grown into to my own dismay! The exquisite use THE follow up one of the world’s leading websites for of medical jargon with witty footnotes to 2014’s Do No paediatric Free Open Access Medical is pure genius! But that’s as far as I Harm – Stories of Education (FOAMEd) and knowledge can praise. Life, Death and translation. The back catalogue of Adam uses ludicrously unprofessional Brain Surgery. podcasts, available for free on iTunes refl ections as a junior doctor for the While the latter and Spotify, initially consisted of sole purpose of misrepresenting recounted the recordings of talks given at the three the NHS. His general idea is that day-to-day work annual DFTB Conferences in Brisbane, the health service disregards junior of a neurosurgeon Melbourne and London. In late 2019, doctors who are the most underpaid in thrilling detail, Admissions takes a we launched a new podcast bringing and overworked individuals. Authors more philosophical retrospective view original content from a collaborative of are entitled to a licence, but when of his incredible life. Having spent podcasters based in the UK. Original he compares the celibacy and toil of a career battling against death, he episodes are released fortnightly. Shaolin Grandmasters to the existence realises time is running out for him Subjects range from conversations of junior doctors in the NHS, it stretches as he approaches retirement and the with published authors about their the licence. unknowns of what old age will bring. original research, to discussing clinical Agreed, the NHS is far from perfect, He revisits some of the memorable topics with experts in their fi eld and I get that he is having a dig cases that he has dealt with over his and exploring non-clinical aspects at politicians and managers, but career, both in the UK, Nepal and the of paediatric life, such as Schwartz I’m unsure of his methods. There Ukraine carrying out humanitarian Rounds and wellness programmes. is immense kindness and support work. The descriptions of the surgery Future episodes will also focus on for peers, juniors and seniors alike, will have you on the edge of your seat. global health issues, such as the recent and I continue to be amazed by the Interlaced among these accounts, he measles outbreak in Samoa. The aim is wonderful people who make the NHS describes his attempts to renovate to create pioneering, evidence-based, what it is today. Anyway I would rather a lock-keeper’s cottage against the community-focussed, collaborative believe someone who remains within ravages of time, which acts as a fi tting educational and fi ghts than without and moans. metaphor for where he is in his own life. materials in So dear Adam, If This book is written with scalpel- keeping with I am ever looking sharp precision. It is both an the DFTB for a laugh I will unsentimental love letter to the ethos. read your book and NHS, which he has witnessed being pay to watch your gradually dismantled over the show. In turn, if latter part of his career, you are unwell, do but also a moving come to us. We will treatise on the look after you. Free transience and of cost. fragility of life. 1/4 ...of 4 to 5 year olds are either overweight 24 SPRING 2020 Milestones or obese MEMBERS

STARTER FOR TEN

We put 10 questions to a ST7 paediatrician and a consultant to see what makes them tick

Dr Rebecca Broomfi eld Dr David James ST7 Paediatric Emergency Medicine Consultant Paediatric Emergency Medicine, GRID, University Hospital Southampton University Hospital Southampton @RCBroomfield @DrDaveJames

1 Describe your job in three words. 1 Describe your job in three words. Challenging, enjoyable and fulfi lling. Tough, but rewarding. 2 After a hard day at work, what is your 2 After a hard day at work, what is your guilty pleasure? guilty pleasure? No pleasure should ever be guilty after a hard day! Watching truly awful romantic comedies. 3 What two things do you fi nd particularly challenging? 3 What two things do you fi nd particularly Balancing the need to deliver a great service and great challenging? Not knowing the answer; you don’t training. Running out of co ee. always have all the pieces of the jigsaw puzzle, 4 What is the best part of your working day? which can be frustrating. Rotas also make it Seeing the relief of parents when you tell them their child is OK. di cult to balance a young family. 5 What is the one piece of advice you wish you could 4 What is the best part of your working day? The impart to yourself as a junior trainee? Take your time. variety – you have to be able to switch from playing It’s not always about the destination, enjoy the journey with a toddler singing Baby Shark to reassuring and do more fun stu ! parents. 6 Who is the best fi ctional character of all time, 5 What is the best advice you have received as a and why? Skipper the penguin leader from trainee? You are never alone, it’s OK to not know all the Madagascar – we could all learn from his answers. One of the most reassuring things ever said leadership style. to me by a consultant was that they actually didn’t 7 What three medications would you like know. with you if you were marooned on a desert 6 Who is the best fi ctional character of all time, and island fi lled with paediatric patients? why? Princess Tiana – she gets to be a princess, but she Paracetamol, wound glue and lots of ketamine. had to work hard for her dreams. 8 If you were bitten by a radioactive gerbil, 7 What three medications would you like with you if you what would you like your superpower to be, were marooned on a desert island fi lled with paediatric and why? The ability to see into the future. patients? Dexamethasone, paracetamol and antibiotics. It would make o ering safety netting 8 If you were bitten by a radioactive gerbil, what would advice a whole lot easier. you like your superpower to be, and why? To fl y. I spend a 9 What is the single, most lot of my time commuting, so fl ying would be quick, and it’s a encouraging thing that one of your bit more fun than teleportation. colleagues can do to make your day? 9 What is the single, most encouraging thing that one Put the kettle on! of your colleagues can do to make your day? Smile – it’s 10 How do you think you and your contagious and fi lls everybody’s bucket. colleagues can inspire 10 How do you think you and your colleagues can inspire the next generation of the next generation of paediatricians? By being positive paediatricians? about the job. If you are honest about the reality of the job, We can always aspire to but demonstrate through your language and behaviour be the colleague that we how enjoyable it can be, then you will inspire people to want to have. love paediatrics.

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Milestones SPRING 2020 25 MEMBERS Dr Adrian Plunkett presenting at the College’s Conference and Exhibition 2019 in Birmingham

BEST PRACTICE Learning from Excellence

A different approach to studying could unlock a wealth of insight

ALMOST ALL OF our attention in patient safety is focused on failures, such as error and harm, yet the majority of our work that these excellent, non-technical skills were While this is important, there are two is successful. If we could almost always accompanied by excellence obvious negative consequences of this Dr Adrian learn how to identify and in competence, and started to wonder if we unilateral, defi cit-based approach: Plunkett study successful work, we could learn from these interactions. 1. Only a very small part of our system is Consultant may be able to tap a wealth During my recovery, I wrote a letter of examined (failure is comparatively rare Paediatric Intensivist, of insight. This is the idea thanks to the hospital sta , describing the compared with success). Birmingham behind Learning from excellence I had witnessed. My intention was 2. Sta may perceive patient safety as an Children’s Excellence (LfE). to pass on my gratitude and provide positive exclusively negative initiative, concerned Hospital @lfecommunity LfE is a strengths-based feedback to the sta . I later discovered this only with mistakes and poor performance. philosophy and practice, letter had not been received by the sta In order to address this, we created intended to complement the prevailing members for whom it was intended. a positive reporting system, which sits defi cit-based approach to patient safety. At alongside the adverse incident reporting. its core, LfE is a reporting system, designed The power of positivity We named this system Learning from to recognise and appreciate excellence in the It occurred to me that positive feedback Excellence and made it available to all workplace. The idea that we could learn from is not given the same status as negative sta in our trust. Sta are invited to excellence occurred to me after an episode of feedback: a complaint results in a mandated report witnessed excellence, however serious illness. investigation and response. My letter of they defi ne it, using a very simple online thanks, on the other hand, was ignored. form. The contents of these forms are Thinking differently After returning to work, I continued rapidly forwarded to the cited individuals In 2010, not long after taking up a post as a to choose to view the work of the NHS (or teams), thus providing a formal new consultant, I was admitted to hospital through an appreciative lens. I started to positive feedback loop. Selected reports with pneumonia. During my hospital feel increasingly uncomfortable with the are investigated in more detail using admission, I realised that I had started actively unilateral negative approach to patient a structured conversation based on looking for what was working. Initially, my safety. It seemed to me that our sole e ort to Appreciative Inquiry. motivation was to seek reassurance that the make our system safer is to recognise and After implementation, we learned that system was safe, but after a while, I realised mitigate error, despite the prevalent other centres were beginning to do the same that I was choosing to notice and appreciate success in our work. type of work, and we discovered a huge the good work I was witnessing – good work demand to implement this system across that is usually taken for granted. the NHS (and beyond). Thus, we created Many of the sta were displaying an open access website with resources and excellence in non-technical skills. I noticed blogs, and a community of practice has that if I drew my attention to these non- Under developed across the NHS, and overseas. technical skills (such as compassion and Learn more about the initiatve kindness), I started to feel safer. I also noticed 18... www.learningfromexcellence.com ...conception rates have halved from 26 SPRING 2020 Milestones 2008 to 2017 Hin Cheng Man- Mark Dr mood issues early in life” children with sleep and not surprising to find expectations. is It high with parents with faced are “Children Hong Kong Hospital, Margaret Princess Fellow, Paediatric Paediatric in close proximity to residential areas, the the areas, to residential proximity close in centre city the in located hospitals regional some With growing. ever is doctors from demand the expectation, patient increasing day. every face doctors frontline that challenges are barriers language and Cultural care. health public on rely and privileged less are ofthem Many minorities. ethnic and China mainland from people many serve Iwork in that hospitals regional city. Several vibrant and 2018. afellow in became and hospital aregional in Medicine Adolescent and Paediatrics in training specialist Iwent through Subsequently, In a world of protective medicine with with medicine aworld ofprotective In multi-ethnic adiverse, is Kong Hong The challenges and rewards of working in amulti-cultural city encounters attracted me. me. attracted encounters real-life these strength, their who regained toddlers ofthe laughter joyous to the listening fi to oflife, months rst their through striving infants premature witnessing From patients. paediatric particularly drawn to Iam that to realise Icame my internship, During 2011. in MBBS my obtained Kong and ofHong University the FROM I GRADUATED A paediatrician paediatrician A in Hong Kong Hong in doctor-patient relationship. doctor-patient relationship. agood to develop order in understanding and respect mutual develop and families ofthese trust the to earn experience and di patience It takes ours. from erent very are ofpractice principles whose practitioners, Medicine Chinese Traditional recovery. to their crucial are infection tract respiratory upper for treatment symptomatic believe strongly to fi who common families and nd patients fl cold, common the It is pneumonia. u and are we encounter admissions frequent most children with sleep and mood issues early early issues mood and sleep with children to fi It not surprising is nd expectations. who have high parents with faced are Children prospects. and achievements academic their about anxious children, their above hovering Parents Tiger see to It common is competitive. highly is system education The Kong. Hong in face people young ofchallenges number a are too. There trend arising to be seem issues psychological with Patients trends Growing Some families seek advice from from advice seek families Some view from Princess Margaret Hospital at sunset at Hospital Margaret Princess from view Top: outdoor space to use for fun. for fun. to use space outdoor of alack and environments living crowded with faced therefore are families these in a Children rooms. tiny in to live ord only can class lower socio-economic the in families Many conditions. crowded and dwellers are living in increasingly costly City- population. Kong Hong the by faced problems. behavioural and psychiatric complex to workers tackle social and paediatricians, psychiatrists, psychologists of team amultidisciplinary It takes life. in treat every day. every treat we children ofthe faces smiling the I see when especially apaediatrician, to become going. us keep that we treat children happy the and colleagues ofour comradeship mentors, our from supervision and encouragement the it is all, After faces. sleepy the despite too, call anight out after We enjoy hanging ill. seriously who are for kids night of the offi middle memories the in together ghting Ishare and butresidency, my colleagues paediatric during long are hours On-call Working together The The Above: skyline crowded Kong’s Hong Land shortage is another big problem problem big another is shortage Land I never regret my decision eight years ago ago years eight my decision regret I never Milestones SPRING 2020 2020 SPRING 27 INTERNATIONAL 28 WELLBEING SPRING 2020 2020 SPRING SELF CARE SELF Dr Sanjay Suri Sanjay Dr Trust Foundation NHS RotherhamThe Paediatrician, Consultant can help deal us with stress Learning how to practice mindfulness work and in life at Mindfulness Because it is there. Because it brings us into the moment. into the us it brings Because there. it is Because ofit. sake Just for the clouds. darkening the shop sign, fl roadside –the things lopsided the owers, small the noticing as such activity, daily any almost with We dothis can present. staying and moments noticing about is Mindfulness awareness. choiceless so-called –the ugly or bad good, – arises whatever with to present stay ability the develops mind the time, Over rehearsing. needs and not intuitive is Meditation meditation. called are ofawareness practices body. the These and breath ofthe awareness practising practice. needs that achallenge is moment present the in mind monkey this to keep Trying future. ofthe anxieties and expectations dreams, and past ofthe guilt and regret sorrow, on –feeding to branch branch from swings that to amonkey likened been It has to wandering. habituated is but not easy. it mind is The straightforward, Sounds curiosity. and kindness with nonjudgmentally moment, recently, benefi its apparent. becoming are wellbeing in ts More pain. chronic anxiety, and management, depression We spend most of our lives on automatic pilot. pilot. automatic on lives We ofour most spend by is achieved be can this which in ways ofthe One present the in purpose on attention paying is Mindfulness Milestones years. The evidence mainly relates to stress to stress relates mainly evidence The years. 2,500 back going teachings Buddhist ancient in roots its has which practice, ofscientifiwealth secular for this c evidence to fi amazed was and literature the the nd Ireviewed base. evidence ofthe unaware but was was what this idea some I had Mindfulness? interventions. ofthe one as mindfulness suggested had She symptoms. anxiety-related with achild referred had to whom I psychologist clinical our from areply across Icame AGO YEARS A FEW Wellbeing Support, guidance and reflection mindfulness developing key to is meditation Regular 28 April www.rcpch.ac.uk/conf2020 April 28 Tuesday on session mindfulness Sanjay’s attend annual Conference this year in Liverpool. in year this Conference annual College’s at the session abreakfast to delivering forward sta for trust sessions looking am taster and mindfulness two-hour leading enjoyed University. I’ve really Bangor to fi o has also what life embrace able to fully Ifeel nd that er. but better stress with to deal doImanage Not only life. in and benefi Ihave it ofgreat found skill. this t at work developing thinking. our dominate but they feelings, natural perfectly from arise thoughts GMC”. 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NHS Communication and transparency throughout the induction? your in lockers and showers home. drive the before afterwards, or shifts, –for night to rest Somewhere shifts. night the and day the to a Access throughout food tasty and healthy ordable, Di work for di will but strategies people, erent erent to medical leads phenomenon, occupational an Burnout, Clark Emily Dr Health Wales Health Public Health, ST1 in Public Public in ST1 wellbeing boost will andfood drink tasty Healthy, Ourselves individuals: doas for what we can suggestions methodolo research rigorous identifiMy same some ed The people Each other

Look out for your friends. Signpost people to available to available people Signpost out friends. for your Look asked my colleague about her cat’s trip to the vets! to the cat’s trip her about my colleague asked that went well? Why did it go well? it well? go did Why went well? that aresuscitation from learned be can What events. negative as well as positive Debrief groups. Balint and rounds Schwartz signifi through incidents cant discussing and environment, learning ano-blame Nurturing honoured. to be likely more are leave requests that so design rota Improving Can we start something similar? something we start Can over aco together roll!). time acinnamon (and ideally ee have fi Swedes ofspending The phenomenon social the ka, network. support your Prioritise friends. your See friends. Make battery. compassion your Recharge for you. out time block out and diary your Get your patient. fi that address see you and go able to, before you are if rst, tired, late or angry, hungry, HALT. you are If Remember Manage negative thoughts. apps. Headspace or CALM Try Read wellbeing. on guidance BMA and RCPCH up the Look The Baker’s Dozen of Mental Toughness Mental of Dozen Baker’s The www.rcpch.ac.uk/wellbeing aGP. or Unit, Support Professional the health, occupational consultant, ahelpful that –be resources

For further resources on wellbeing visit visit wellbeing on resources further For on stress management. management. stress on mindfulness, nutritional projects, and training lunchtime coaching, peer-to-peer or system buddy the include initiatives Successful ordinate? co- and initiatives you share Can departments? paediatric other in or hospital, your in happening –what’s where on out what’s going Find Milestones toolkit. SPRING 2020 2020 SPRING 29 WELLBEING A DAY IN THE LIFE

“Community paediatrics was an easy choice”

Dr Rakesh Tailor government. This can Paediatric Registrar in Community be really frustrating. Child Health (ST8), Upton and Wexham Park Hospitals, Hertfordshire The best part of the job is that I enjoy having the chance When I’m I decided to become a paediatrician after to work closely with finished work watching ER. Dr Doug Ross was easily the different professionals, I like to... coolest guy on the show, and he happened to be such as teachers, ...spend time with a paediatrician. I knew then that I wanted to do audiologists and my family and go to paediatrics! Community paediatrics was also an social workers. I have the theatre. I have a easy choice, offering a true teamwork approach plenty of time for passion for medical to holistic medical care with a better work-life appointments, which history so love to balance. (Now that I am greying my wife says I allows me to listen read about this in look like Dr Doug Ross too.) more and build a my spare time. I try strong doctor-patient to get down to the My typical working day involves getting into the office by relationship with both them and their parents. Emirates as much 9am, and over an espresso catching up on work emails and This is vital in community paediatrics as you will as I can (when patient letters. In my clinics I will see four to five patients in often meet your patients in infancy and continue not on-call) to the morning. Each appointment ranges from 30 to 60 minutes, to see them until they are 19 years old – you get to watch the Arsenal, depending on whether they are follow-up or new patients. The know your patients very well! although this just afternoons are usually set aside to dictate letters and I also, on gives me stress and occasion, go on home visits with our community nurse. I run My most memorable moment was last year is becoming less special school clinics once weekly where I see children with when I presented some new research on the and less enjoyable disabilities in their school setting. Some community paediatric association of autism with ethnicity in Tbilisi, these days! Playing departments have a safeguarding on-call rota where your role Georgia at the European Academy of Childhood football once a week is to attend strategy meetings and perform child protection Disability’s international conference. It was great gets me running medicals. I’m generally heading home by 6pm after I’ve to share my findings amongst academic rock around a bit – but completed my admin for the day. stars and get some great feedback. I was also mostly I enjoy the amazed to witness how in the post-Soviet era, social aspect after The most difficult part of my job is being unable to deliver the with comparatively little funding, Georgia had the match. care that I would like to. For example, families with severely set up a state service to reach out to children with disabled children in the area that I serve have had their disabilities and social communication disorders funding for in-house and respite care cut. I often get asked to with fantastic results. Their motto ‘together we write letters to the local authorities to help, but this is usually are stronger’ just summed up the teamwork ethic out of our control and down to local, and ultimately, central in community paediatrics.

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30 SPRING 2020 Milestones