Community paediatrics in crisis.

T o the armchair pundit, advertisements are always a useful antidote to the soporific parts of the scientific journal or television programme. Brief, dramatic, witty, or sentimental, they painlessly separate us from our hard earned cash. Advertising for new consultants is less sophisticated, subtle, or humorous, remaining largely reliant on ‘‘glorious countryside and local good schools’’ which are apparently endemic in all corners of the British Isles. However, the study of consultant advertisements can be illuminating and should be introduced to all junior doctors as a special study module, since they give invaluable information about how commissioners propose to invest scarce health resources on local children. Have paediatricians read the subliminal messages? Every year, over 300 substantive consultant posts in paediatrics are advertised in the British Medical Journal. For the past five years, approximately 40% have been for community, neurodisabilty, or ambulatory posts. No other paediatric specialty gets remotely close to this figure. In second and third place respectively were acute general paediatrics and neonatology. The number of advertised posts in every other paediatric specialty rarely achieves double figures. British children seem to need generalists working outside hospital boundaries, not ‘‘ologists’’ working in tertiary centres. Another useful source of information about British children is the statistics regularly produced by the Department of Health. There are 11.7 million dependent children in England and Wales; a number greater than the populations of countries like Sweden, Belgium, Portugal, or Greece. British children are disproportionately present in low income households, 2.6 million live in lone parent families, and 2.7 million live in low income households. Of the 376 000 children ‘‘in need’’, 13% have a disability. Local authorities look after 59 700 children. There are 12 600 unaccompanied asylum seeking children. Every year, 3600 children are placed for adoption, 27 500 children are placed on child protection registers, and 90 000 teenagers become pregnant. Of the 320 000 disabled children, 110 000 are severely disabled; 1.7 million children pupils have special educational needs, including 250 000 children with statements of special educational needs. At least 250 000 children live with a parent who has a serious drug problem. Ten per cent of children aged 11–15 are regular smokers, 24% have tried alcohol, 12% cannabis, 4% stimulants, 1% opiates, and 35% had been offered drugs. The prevalence rate for problematic psychological conditions in childhood is 20%, increasing to 68% in deprived areas. Non-acute, non-hospital work is growing rapidly. Increasing numbers of low birth weight babies survive. There are more children with disability, more affected by abuse and neglect, more behaviour problems, more school exclusions, and a growing public demand from parents desperate to see ‘‘a specialist’’.