Reflecting and learning as we look to the future

In his August blog, Russell considers the implications of increasing workforce pressures and unveils exciting plans for a new College programme examining "the future paediatrician".

The future of our profession has been very much on my mind since I started this job six months ago (I’d like to say ‘where has the time gone?’ but I have felt every month of it). Today I want to talk to you about my plans for a “Future Paediatrician Commission” or “Child Health 2040” (or whatever we will eventually call it). This is a major new College programme we will be kicking off in late 2018 which aims to look 20-30 years into the future, work out what paediatricians will be doing – and how and where – and plan how best College can support and train paediatricians in the mid-21st century. 

Ever increasing pressures

It’s easy to be pessimistic about the future. Almost every service across the UK suffers from middle-grade rota gaps, leading to real issues for the quality of care we can deliver and the quality of life for our members and fellows. There is a sense of ever increasing pressure and demands and that we work, in each UK country, in systems that are under-funded and in some cases failing.

While these issues are common to all areas of medicine, paediatrics seems under particular pressure. The prosecution and subsequent regulatory action against one of our trainees, Hadiza Bawa-Garba, drew many of these issues into very sharp relief, against the background of the hugely sad death of Jack Adcock. In a different way, the very painful and heartbreaking cases of Charlie Gard in London and Alfie Evans at Alder Hey highlighted the potential for increased pressure on paediatricians as evolving medical science doesn’t keep up with changing parental and societal expectations. In Northern Ireland, the publication of the hyponatraemia related deaths inquiry report shone a spotlight on serious historic system failings, and the need to learn from our past if we are to drive improvements in the future.

Getting workforce on the agenda

The College has been doing and will continue work across each of these areas and I won’t attempt here to outline all of it. For me we need to start at the top. First, more money for the health services. Check – well, partially. We believe that the medical Royal Colleges (united through the Academy) played a major part in the discussions that got us the 3.4% long-term uplift for the NHS in all countries. It’s not enough – but it’s certainly better than many of the alternatives.

"...suddenly there is light at the end of the tunnel"

Second, more of this money into child health. Again, a partial check. Scotland has been making some important strides towards developing a new child health strategy, and similar in Wales – with important work by our Scotland and Wales offices. England was the laggard here, but suddenly there is light at the end of the tunnel, with infant, children and young people’s health a priority in the long-term plan.

And then into the detail of workforce, training and safety. Workforce is hugely high on our agenda. When I met the new Secretary of State, Matt Hancock, last week, I used my three minutes of ‘face-time’ to press him on workforce. I’m sure you’re aware of the incredible work that members and the College team are doing to push recruitment and retention of paediatricians – from medical students through to retirement age paediatricians. The College has also been highly active in promoting new models of care and our new Progress training curriculum is the start of reshaping our training to meet future needs.

What might the future have in store?

We need, however, to take a much longer-term view and think long and hard about how the College supports its members in the 21st century. Our Commission will need to use the best data and analysts to work out, as best we can, trends in population and health/disease among children and young people out to 2030 or 2040. It will need to take into account coming trends, such as the use of artificial intelligence (AI) and personalised medicine and the use of new technology such as wearable tech, and consider what they may mean for paediatricians.

"Children born today who grow up to be paediatricians are quite likely to be living to 100 or beyond relatively routinely"

It will need to consider what all this, plus the expansion of integrated child health services and consolidation of inpatient services, may mean for the number and type of paediatricians we train. And for the careers of increasingly long-lived paediatricians – children born today who grow up to be paediatricians are quite likely to be living to 100 or beyond relatively routinely. 

Saying it is impossible to know the future is of course a cliché; however, I am convinced that by using data and recent trends we can identify likely scenarios and how the College can best respond to these. We plan for the Commission to be participatory, involving members and children and young people at the heart of it. Our current trainees will be central to this work – not least as they are likely still to be working in 2040 whereas I will be long-retired. The exact details of the Commission are yet to be agreed by Council but this will be firmed up shortly and the Commission will work across 2019 and report in 2020-21.

I look forward to coming back to you with more details in a couple of months.