Paediatric surgery in a district general hospital

Abstract

The sentiment inscribed on the Denis Browne Gold Medal reflects the aspirations upon which the British Association of Paediatric Surgeons was founded 40 years ago. The subsequent decades have seen a dramatically improved outlook for the child with a critical illness or life-threatening malformation. Advances in technology take much of the credit but the growth of specialisation and sub-specialisation in the paediatric disciplines has been another major factor. If anything the pace of change is set to intensify during the 1990s. The introduction of the new deal on junior doctors’ hours threatens the closure of many smaller district units with rationalisation of paediatric services around larger, better staffed units. As a result it will prove increasingly difficult for general surgeons to continue operating on children in hospitals which no longer possess an acute paediatric presence on site. Furthermore, the audit process, confidential enquiries and sharp eyed litigation lawyers are likely to adopt an increasingly unforgiving view of surgeons and anaesthetists undertaking occasional paediatric practice. Against this background we examine the respective roles of district hospitals and specialist centres in the surgery of childhood and review some recent developments in the management of common paediatric surgical conditions.