Avon Children's NHS

The Bristol area has a galaxy of paediatric talent working in its hospitals, clinics, schools and elsewhere. Doctors, nurses, allied health professionals, social workers, teachers, managers and many others collaborate with child patients of all ages and their families to provide as accessible and effective a service as possible. The medical professionals have worked as a group for many years and have argued consistently for maximum dispersal of out of hospital services, to be provided as close to home or school as possible, together with the minimum of hospital sites for in patients. An opportunity was missed to achieve the concentration of children's beds at the new children's hospital but that will have to wait for the single tertiary care development. For now we have them scattered in the three Bristol hospitals but hope before long that an interim disposition of two sites will be provided at Bristol Children's and Frenchay Hospital for the older patients with Southmead and St Michael's housing neonatal intensive care. We would also like to see a development at Weston, which will relieve families of the need to come to Bristol with their not-so-sick children. One of the pressures driving this is the change in working patterns of trainees and the inevitable effects of the European Working Time Directive upon us all. Our aim is to offer a specialist provided comprehensive secondary and tertiary care service as soon as possible.

I have dwelt upon the acute services but the pressures on non-hospital services are just as great. The new morbidity of behavioural paediatrics with its general medicine/psychiatry interface, educational medicine, child protection and efforts to ameliorate the effects of poverty and inequality pose as great if not greater challenges as the reconstruction of a heart the size of a walnut. During my Med Chi presidency we heard from the then City Chief Executive an apocalyptic view of the consequences of neglect in this area. Little has changed. Paediatrics now has to make effective links with colleagues in primary care, local authorities (social services, education, housing) and the youth offending teams to achieve as much transformation in social paediatrics as has been done in curative care for children.

The Chief Executives of the Bristol, North Somerset and South Gloucester PCTs and their CE colleagues in the acute (2 Bristol and Weston-super-Mare) trusts have tasked me as project director to establish a managed child healthcare network for the area. This will co-ordinate and manage all secondary and tertiary services in the area and work with other health and allied agencies to establish a single service for infants, children and young people, removing institutional barriers to cross professional care. The publication of the report into the death of Victoria Climbie and the National Service Framework for children will demand that - and we should remember that the origins of the NSF were in the Kennedy Enquiry into some Bristol children's services. Bristol was visited recently by the National Director for children's health and he was impressed by our ambitions and challenged us to realise them. We will expect users to play a full part in their development and communication with staff and users will be an early imperative. The shadow Network Board is working hard to transform itself into substance - and to keep ahead of the stream of initiatives that flow from the centre. Multi agency children's trusts are the latest. Trusts? Now where have we heard of these before? Trust is a most appropriate word for child care - we have the privilege of accepting the trust of children and their families for individual curative care: now we have to justify it in our care of the child population. It will mean change; but change is required in order not to change. It is happening already with the prospect of a unified service for the newborn (and not just those receiving intensive care) and out of hospital paediatric and child and adolescent mental health services. Services for the acutely ill child will follow.

My personal view is that management exists to enable best health care to be delivered and I have found it an educative and rewarding experience to take on fresh clinical management responsibilities and to discover so many talented managerial colleagues doing just that - despite the financial gloom. I have been impressed by the willingness of busy people of all the paediatric healthcare professions to work collaboratively in this way. The main reason why they do is summed up in the motto of Great Ormond Street Hospital: The Child First and Always.

T L Chambers