Community paediatrics and change.

hould community paediatrics continue as a separate specialty, as it has been since the publication of the Court Report, 1 or should it merge with general paediatrics, or with primary care? The Royal College of Paediatrics and Child Health has taken a lead role in the debate on the future configuration of child health services and training and on the future shape of community child health. Two documents, Looking ahead: paediatrics and child health—the next 10 years, 2 and the review of community paediatrics , Strengthening the care of children in the community, 3 have been published to facilitate and stimulate discussion. There are other important factors which will hasten change in community paediatrics: a stated government commitment to eradicate child poverty, the long awaited decision to develop a National Service Framework for children, the establishment of Primary Care Trusts, and the recent Bristol Royal Infirmary Inquiry. As a result, all child health services will be expected to undergo change and we would urge that this be in the direction of integrated services and a greater community orientation. Over the past three decades the whole context in which we operate as paediatricians has changed enormously. We are much better able to investigate and treat childhood illnesses, but at the same time parents' expectations are much higher. The government has identified new priorities in the NHS Plan—children looked after, adoption, mental health, and nutrition. 4 There is the increasing evidence of the poor health of children looked after (in local authority care) and hence the need to devote more paediatric time to their assessment and support. 5 There is government concern that there should be a move towards coordinated service planning for vulnerable children and young people; this will clearly have important implications for future practice for all paediatricians, especially those who have a role in the community. 6 There is an increasing workload in mental health, disability and chronic illness, high risk behaviour (drug and alcohol abuse, smoking, earlier sexual intercourse), and the impact of deepening inequalities in child health. The UK is currently ranked fourth bottom of 23 industrialised countries in the proportion of children living in relative poverty; this has a huge impact on their health. 7 There is a current epidemic of emotional and behavioural problems in UK children which is impacting adversely on educational attainment, on self esteem, and on the health and well-being of families …