What I learnt this week: Balancing proper procedure with paediatric passion #WILTW

This is the tweentieth #WILTW

In my humble opinion the Royal College of Paediatrics and Child Health have been very lucky. On Tuesday an Extraordinary General Meeting took place in regard to the governance and trustee structure which would lead to an opening up an arm of the RCPCH to all child health professionals. Details on the proposals can be found here

The outcome of the EGM was that the Foundation of Child Health was rejected. This is a great shame but I say the college has been lucky as I had half expected to see a Daily Mail headline:

Paediatric doctors feel they are more important than other health care professionals“.

Fortunately this angle was not taken, in fact there was virtually no media coverage. Those opposed cited a potential conflict if the paediatric ‘medical’ lead for the college and a non medical lead for the Foundation disagreed with each other which would be bad for public relations. Given the lack of interest in the event I’d be more worried that we have any paediatric voice at all!

My position was clear (from a previous Running Horse Group blog)

“This junior paediatrician  feels the concept of not moving in a direction that makes us multi-professional is almost absurd. I work on a daily basis with nurses, nurse practitioners, health care assistants and play specialists. I have also been part of a college structure which is bureaucratic, hierarchical and slow to react.”

Having passionate views about something makes you very dangerous. The moment you are not willing to pause and reflect is the moment you no longer have sound judgement. I therefore always make a big effort to step into other peoples shoes and aim to see things from their stand point.

Boat Land


cartoon courtesy of Dr. Hilary Cass

So, to be fair to those against the motion, there were some issues with the approach the College had taken. Changes to the governance structure were/are independent of the need for a Foundation of Child Health. Placing them together did cause confusion and potentially gave the impression of rail-roading the policy. The hosting of a significant event on a lunchtime, on a weekday, in London, did not invite a high turnout (to be fair the rules governing the college’s charitable status dictated that the vote needed to be in person). Finally at the hustings stage it would have been preferable to have an ‘against’ speaker as well as those ‘for’.



During the hustings the chair of the parent and carer’s group gave a emotional talk about her experiences of being a parent. She showed pictures of the twitter celebrity that is Adam Bojelian and the multiple interactions with doctors, nurses and therapists he has:

no child has ever died of too much communication between health and social care professionals

Her talk, followed by a focused argument from Dan Lumsden, the chair of the Trainees Committee, set out I think an unintentional confrontation between ‘procedure’ and ‘passion’. On one side, yes, there were some governance and policy issues at stake. Things could have been done differently in a very systematic fashion with extreme attention to detail. One the other we were deciding on a tone for the future. If the college of Paediatrics and Child Health are unable to embrace their fellow professionals and create a unified organisation to improve outcomes who else will?

I therefore found it very unnerving when the following was quoted as an argument AGAINST the changes…

“Management is doing things right; leadership is doing the right things.”

― Peter F. DruckerEssential Drucker: Management, the Individual and Society

A further speaker then worried that the potential non-elected nature of some of the trustees would risk a situation that is currently occurring in Hong Kong.

I spoke up in support of the motion but emotions are a strange thing. I have been more confident in a crowd of 1500+ than I was in front of the 100 or so in the audience. This was due to the fact, and I said this at the time, I was speaking against people who have mentored and supported me in the past. But it was also because I felt an overwhelming surge of righteousness about the motion; inflamed by an argument that the previous consultation was invalid due to its low turnout. This seems ridiculous given the equally poor responses rates for the Health and Social Care Act debate (context of table):

Voting in Health and Social Care Act

But also on reflection I was perhaps not as charitable as I should have been in regards to the comment comparing the college to the Chinese government.

Only time will tell as to the long term impact of this EGM. Many of the those voting no said they were voting against the lack of information  or “devil in the detail” provided. They weren’t against the Foundation in principle. Was this simply a case of the right thing to do but at the wrong time? I remain to be convinced. I worry that if the chance is to come again some equally obscure bye-law will be raised. If we are to be a multi-professional organisation then there will come a point that hierarchy and power is shared. That is unavoidable and no amount of procedure can bypass it.

Or maybe I just can’t see past my passion….

What did you learn this week? #WILTW

Additional Entry 11th October 2014

Please see the comments section. There has been some confusion I think about the Foundation being more important than the RCPCH. This is not the intention or the proposal. This diagram clarifies I hope:

Integrated College of Child Health

5 thoughts on “What I learnt this week: Balancing proper procedure with paediatric passion #WILTW”

  1. Confused. com. I don’t really get it to be honest.
    What makes paediatric practice so special?
    Families, allied health professionals, our nursing colleagues – are equally important in all walks of medicine. Medical Royal Colleges are there for the medical profession, ensuring high quality training for wannabe specialists and professional standards for the specialists. Harmony with our non-medical colleagues is of course essential, but dilution of the purpose of a medical royal college may weaken a college. The psychiatrists, GPs, emergency physicians, obstetricians – could all go down this road. Not sure it helps though. Maybe I was missing something about the proposed purpose of the vote.

  2. Thanks Ffion – think this highlights the issues with the communication regarding the Foundation. As you say the Medical Royal Colleges are there to ensure training and professional standards. The RCPCH will always be there for that. However as you are also aware initiatives like the Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings (http://www.rcpch.ac.uk/news/new-standards-set-emergency-care-children-and-young-people) have been very successful in bringing groups together with a single voice to produce policy which has been effective. This Intercollegiate Group included nursing and the ambulance liaison committee. The Faculty is just a natural extension of this into other areas where this joint working would be effective. The RCPCH membership rejected the proposal the Foundation would sit above what is the RCPCH ‘medical’ section and felt that both should be equal partners. It appears this message has got somewhat confused – I have added in a diagram to the blog to demonstrate the proposed plan. It’s just actioning what we already know works rather than trying something new for the sake of it!

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