Championing children’s health
Hilary Cass is the new president of the Royal College of Paediatrics and Child Health
Hilary Cass qualified at the Royal Free Hospital, London in 1982 and after graduating went into paediatrics, sub-specialising in disability. She runs a national service for children with Rett syndrome, and has published widely in this area. Cass was a consultant at Great Ormond Street Hospital for 15 years, during which time she pioneered the Snakes and Ladders programme in which role play is used to teach staff and help them reflect on the care they deliver. She is the president of the Royal College of Paediatrics and Child Health and is a consultant at Guy’s and St Thomas’ NHS Trust.
When I chose medicine I naively thought I wanted to change the world by making some kind of amazing scientific discovery. But as soon as I set foot on the ward, the humour and resilience of patients and staff, even in adverse circumstances, gave me such a buzz. That’s true in spades when it comes to children in hospital.
I started out on a GP training scheme where I was lucky enough to get a placement in paediatrics—I loved it and decided I wanted to be a paediatrician. I like the diversity, how children pick up quickly—often within hours of having been seriously ill—and the challenge of effective patient and parent engagement.
I specialise in disability so I treat a lot of children with conditions like autism and cerebral palsy disorders. It’s a confusing world out there for the child and their parents, so even though you can’t fix the disability you can give them the right information and advice on treatments that will give them a better quality of life.
What does the RCPCH do?
The Royal College of Paediatrics and Child Health is a charitable organisation that is responsible for training and examining paediatricians in the UK.
The college, which also conducts research projects into child health, focuses on five major policy priorities: mortality—preventing avoidable child deaths; tackling childhood obesity; a better NHS for children and young people; mental health; and child protection. Many of the research programmes that aim to improve or influence child health treatment and services, support one or more of these priority areas.
The college plays a key role in workforce planning for paediatrics to ensure there is an appropriately trained paediatric medical workforce to deliver safe and sustainable services for children in the UK, in the present and in the future.
What does your role involve?
As president I’m able to use the wealth of knowledge at the college to influence change in the NHS and in the wider community to improve child health—for example, this could be calling for a ban on smoking in cars when children are present, it could be working with the government to ensure the Health and Social Care Act works well for children or it could be working with clinicians and college staff members to audit services and set guidelines for trusts to adhere to. As well as the college working alone to improve child health, I am also keen that we continue to work with other organisations to present a united front and campaign on areas of child health that we all feel passionately about.
I want to improve membership engagement at the college, so one of the things that I have started doing is getting out around the country and speaking to the people “on the ground”—our doctors—by hosting free regional roadshows. Members are invited to meet and talk to me about what’s important to them and find out more about what the college is doing.
I especially like talking to trainee doctors. Every day I meet the most inspirational junior doctors who want to help shape the future of the NHS. They give me confidence that the future is secure.
What does the college recommend the government do to help tackle childhood obesity?
If there was a simple solution we’d have found it by now. We’re concerned that the environment in which children are brought up is not conducive to healthy lifestyles. So we’re calling for a ban on advertising of junk food before the 9 pm watershed, for adherence to nutritional standards for school food, and for all healthcare professionals to emphasise the importance of parents’ lifestyles on their children’s weight. We also want to see local authorities improve outdoor spaces to encourage active play for children—and further exploration of the idea of a tax on food high in salt, sugar, and fat to help make the healthy choice the easy choice.
What direction is UK paediatrics going in?
The current UK paediatric workforce, both consultants and trainees, is facing huge pressures. The harsh reality is that it’s impossible to staff all of the inpatient paediatric rotas that currently exist in a safe and sustainable way, comply with the European Working Time Directive, and continue with the present numbers of consultants and trainees.
This means that children are not getting the best possible health service and health outcomes for children are not as good as they should be compared with other European countries. Currently the mortality rate for children under the age of 5 years in the UK is 30% higher than the average for western Europe, with five excess deaths a day for children under 14 compared with the best performing countries.
Doing nothing is simply not an option. That’s why the RCPCH has set 10 minimum standards that all paediatric units should meet to provide the best healthcare for children. In some cases this means some services have to close and others merge to form larger, specialist units.
This isn’t something that can be done overnight, but once change starts to take place, I hope we will see a better join up between primary and secondary care, and more care delivered outside hospital.
Is paediatrics still a feminised specialty?
Yes. Paediatrics has always been an attractive specialty for women, and we do have a high number of female doctors in the workforce. This balance means that a substantial proportion of paediatricians on the front line are working less than full time—which in itself is good because flexible working can lead to a fresher, more satisfied workforce delivering top quality care for patients. But the flip side is that it does present challenges for us in terms of making sure rotas are covered so that we’re delivering a sustainable service.
Any advice for students interested in paediatrics?
Try and pick up some relevant experience during your training either through your special study modules or electives or through any extracurricular opportunities, like relevant volunteer work. That will help you crystallise your thoughts on whether it is the right career for you and also be a useful part of your application to train in the specialty.Hilary Cass, president of the Royal College of Paediatrics and Child Health, Ravi Mistry, second year medical student
1UCL medical school
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f1775