Community child-health services

Abstract

Jackie Gregg and Richard Appleton's report (September suppl II, p 28)1Gregg J Appleton RE Community child health: an essential specialist service for the millennium.Lancet. 1999; 354: 28-30Summary Full Text Full Text PDF Scopus (5) Google Scholar on community child health is timely, not because of the forthcoming millennium mentioned in the title, but rather because of issues that surround the present UK government's development of the National Health Service (NHS). I am concerned that the advent of primary-care groups and primary-care trusts in an environment of resource constraint within the NHS threatens the existence of community child-health services in their present form. None of the UK government's publications have emphasised the importance of continued support for tertiary prevention services within child health. As a result, these services have often had a low health-authority priority, and are at risk of having an even lower priority on the agenda of primary-care groups and primary-care trusts. Are these organisations even aware of the statutory responsibilities that underpin some of the key elements of community child-health provision? Those actively involved in community child-health provision should therefore do their best to heighten primary-care groups' awareness of community child-health provision in their area. Otherwise, there is a very real danger that these services will be starved of cash and resources to a point at which they will only be able to provide a skeletal service that would barely cover their statutory requirements. These objectives are to keep to a minimum the suffering and harm caused by existing departures from good health, to reduce impairment and disability, and to promote both the child's and parents' adjustment to conditions that cannot, in general, be ameliorated. One of the ways of selling community child-health services to primary-care groups would be to move away from the notion that Gregg and Appleton outline—ie, that community child health is largely a secondary-care service. From a primary-care perspective, this is clearly not the case. Much of the provision is primary-care based, or at least should be, and the remainder provides a linkage between primary and secondary care. This interface function is absolutely essential to deliver the best care. When multiple secondary-care agencies are involved in a child's care, without coordination of services by a community paediatrician, other interested parties are unaware of decisions made on the child's behalf. The community child-health service can provide an attractive service to which general practitioners, health visitors, and so on, can refer children with complex social, behavioural, emotional, and physical needs. Those involved in community child health should actively clarify their roles and responsibilities, to avoid their service being given an increasingly low priority within a resource-constrained NHS.