Children's services in the new NHS--a struggle for survival?

At the present time of change, muddle, and uncertainty in the health service, there are opportunities to improve services for children if we can build on the certainty of our commitment to an integrated child health service. In reply to the British Paediatric Association's (BPA) response to the government's white paper Working for Patients, the Secretary of State, Mr Kenneth Clarke, wrote 'I am aware that successive expert studies-the Court report, the Maternity Services Advisory Committee reports-have described the need for integration [of comprehensive hospital and community services for children] and I have no doubt that this is necessary for the effective delivery of services. I expect districts to share this view and to seek to contract for integrated children's services'. (K Clarke, letter to Professor June Lloyd, President of the BPA, 1989.) Under the new arrangements each district health authority or any number of health authorities joining together to form a consortium 'purchaser' will be reviewing the medical services in their districts. As child health surveillance is now primarily to be undertaken in general practice, it is essential that a comprehensive consultant children's service is organised to support the acute needs of children and those discovered during the surveillance programmes in each health district.