Paediatricians need to decide how committed they really are to joint working

This  presidential election for the Royal college of Paediatrics and child health is an important one,  in which all members should vote. Like all public services,  paediatric services are under unprecedented pressure,  and we’re all struggling to maintain quality and safety, as well as seeking to improve outcomes for children.
In their response to this challenge,  each of the candidates can be placed along a continuum between two positions: either we circle the wagons,  and fight to maintain paediatric services and the primacy of paediatrics in child health,  or we take a leap into the unknown with some version of the multidisciplinary  foundation for child health which was controversially rejected by the college EGM in October.
The point of this post,  apart from urging people to vote,  is to argue for the latter approach. For me there are three big reasons to go for a multidisciplinary approach to the college’s work.

1) child health is changing. 20 years ago the great spectres haunting paediatrics were meningococcal disease and leukaemia,  conditions which call for clear medical leadership and a biologically driven response.  Now,  thanks to immunisation and huge advances in oncology,  as well as social changes, the big issues are long term conditions,  obesity and mental health.  This might be disappointing for that part of all paediatricians that wants to be saving children by giving the right drug at the right time, but the world has changed and we need to adapt to conditions where we may not be the most important contributors to a multiprofessional team.

2) even if we move away from the messy world of this ‘new morbidity’, and consider mortality, we can no longer pretend that children die solely due to a lack of hospital treatment. The college’s own report, the brilliantly blunt ‘why children die’, has seen to that- in order to get fewer deaths in our hospitals we need to reach out beyond the car park to the wider professional and policy world.

3) we can’t do it alone,  and we shouldn’t try.  The RCPCH is only one along many organisations concerned with children’s health. Rightly or wrongly,  we are regarded by politicians as being concerned with the interests of our members over those of children. This may enrage you,  but think about what message our trashing of the foundation sends out.  Not only do we look self interested,  but we also can’t speak with any real unanimous purpose with other organisations,  and can therefore be safely ignored. The foundation proposals weren’t perfect, but they were a start in giving  children’s health a genuine political voice.

The debate about the future direction of college has become very incestuous,  technical and often quite nasty.  But at root it’s a simple choice about how much of our power and status we are prepared to risk in order to have a proper tilt at improving child health.  Over to you.

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