Arch Dis Child 79:65-72 doi:10.1136/adc.79.1.65
  • Controversy

Where should paediatric surgery be performed?

  1. G S Arul,
  2. R D Spicer
  1. Department of Paediatric Surgery, Bristol Royal Hospital for Sick Children, St Michael’s Hill, Bristol BS2 8BJ, UK
  1. Mr Arul. Reprint requests to: Mr Spicer.

    “The aim of paediatric surgery is to set a standard, not to create a monopoly”—Dennis Browne

    In 1959 the Platt report made a number of recommendations about caring for children in hospital.1The six main principles were identified as: child and family centred care, specially skilled staff, separate facilities, effective treatments, appropriate hospitalisation, and strategic commissioning. While everybody accepts that these principles remain fundamental to the provision of health care for children, interpreting them in today’s NHS can be difficult. In particular the role of the specialist paediatric surgical centre, in the context of providing comprehensive national paediatric care, has never been formally defined.

    In 1989 the National Confidential Enquiry into Perioperative Deaths (NCEPOD) reporting on perioperative deaths in childhood made three particularly relevant recommendations2:

    • Surgeons and anaesthetists should not undertake occasional paediatric practice

    • Consultants who take the responsibility for the care of children (particularly in district general hospitals and in single surgical specialty hospitals) must keep up to date and competent in the management of children

    • Consultant supervision of trainees needs to be kept under scrutiny. No trainee should undertake any anaesthetic or surgical operation on a child of any age without consultation with their consultant.

     Numerous paediatric surgical specialties are provided at district, regional, and supraregional level. These arrangements have often arisen on an ad hoc basis. In this report we review the literature on the way in which paediatric surgical care is provided throughout a region and how the service should ideally be organised. In particular we wish to define the distinction between specialist and general paediatric surgical care.

    The specialist paediatric surgical centre

    The British Association of Paediatric Surgeons (BAPS) defines specialist paediatric surgery in four clinical categories3;

    • Neonatal surgery, which involves the care of infants up to 44 weeks postconceptional age

    • Complex surgical conditions requiring …