At the start of my term the major issues in policy were workforce, service configuration and child protection. Since then, those challenges have been massively affected by the pandemic. As we seem to be approaching some sort of entente cordiale with the current iteration of the virus, the inequalities that were ingrained in the system have been dramatically exposed.
...without the staff you can do none of the developments required to bring the UK in line with the outcomes in countries of equal wealth
As I leave my post, I am delighted that workforce, its planning and the numbers of paediatricians needed to deliver the quality of healthcare the children of the UK deserve are now the first, second and third most important agenda items. As I have been saying since I was a mere Head of School for Yorkshire and Humber and subsequently as the RCPCH Workforce Officer, without the staff you can do none of the service developments required to bring the UK in line with the outcomes in countries of equal wealth.
England is moving forwards towards a unified Paediatric Early Warning Score (PEWS) system. This large and complex programme of work was paused because of the pandemic. Some of the devolved nations adopted a single system several years ago. There is much excitement that the English PEWS will, like the adult version, National Early Warning Score (NEWS2), be able to be used in the primary care and urgent care settings, allowing tracking of physiological signs across. I have a wager with Simon Kenny, the English National Clinical Director for Children, that everyone will call it PEWS for many years to come rather than SPOT (System wide Paediatric Observation Tool). In much the same way we still talk about SHOs, despite that grade not existing since 2007!
The incoming Vice President will be able to continue to push the crucial work the RCPCH Child Protection Standing Committee perform. I have been deeply impressed at the commitment and dedication to this challenging workload at every committee meeting I have attended. The breadth and scope of work done by paediatricians to keep children safe is generally undervalued and not fully understood by local and national government, as cost cutting and outsourcing of services to those with virtually no experience of working with children have recurrently demonstrated. I would urge my successor to put this at the forefront of his agenda. I was delighted that the Purple Book, the guidance resource to support clinicians in the diagnosis and management of children who have been sexually abused, is now being updated by the RCPCH. There was a time when it looked like funding for this would not be found but after significant input from the College’s Chief Executive, funding streams were secured for this critical update.
...despite concerted efforts, some health outcomes will have worsened
The health inequalities exposed by the pandemic also need to be drawn to the attention of governments and politicians. The incoming Vice President will need to support both the advocacy stemming from our work and the Health Improvement Officer to look at air quality, healthy weight, water fluoridation to improve dental outcomes, along with many other parameters, where inequalities worsen outcomes. These have been very difficult to drive forward during the pandemic and despite concerted efforts, some outcomes will have worsened.
I am very sad to be leaving behind my RCPCH roles; it has been a huge part of my life for over 10 years. I have tried to help wherever I can and only the members can truly say whether I have been of any use to them, as of course they are key funders of the College work. However, to fill my time and potentially suffering from delusions of grandeur my next project is trying to help neonatal medicine across an entire nation: that is a tropical island paradise of Mauritius in the Indian Ocean. As well as teaching, training and service developments, I have obviously had to visit the island to tour the neonatal units. I did fit in some scuba diving and golf, too. I was struck by the similarities with workforce challenges, training pathways, communications with other services, funding streams and working in estate that was never designed for its current use.
As restrictions lift and life returns to some semblance of pre-pandemic normalcy, I might see you around at various meetings as we get back to face to face and that joyous ping pong networking that happens before, between and on the way to meetings.
Best wishes,
Simon