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Compared with 17 other high-income countries since 1970, the UK has failed to match the equivalent reduction in deaths among children and young adults.1 Two further reports have recently commented on the unsatisfactory child mortality rates in the UK.2 ,3 These reports highlight the contribution of injury and mental health to death statistics and the importance of accurate recognition of the signs of acute, serious illness. Since around five million children require emergency or urgent care each year in the UK, and children form 25% of emergency department (ED) attendances, the issues highlighted in these reports are core business for EDs.
Provision of emergency care has been a high-profile issue for British healthcare, the UK Government and the media for a number of years, yet there remains considerable variation in service provision between hospitals. Set against this, most governments of developed countries, including ours, aim to reduce health inequalities. While the NHS Centre for Workforce Intelligence has a remit to project the UK's requirements for the future healthcare workforce, and Health Education England was set up with the remit of training the right staff to match the population's requirements for healthcare, getting more paediatric emergency medicine (PEM) specialists, in the right geographical distribution, is difficult when employment of staff is largely determined by local factors.
We must remember that children form 25% of ED attendances. By the late 1990s, EDs started to provide child patients with designated space and staff, in line with national guidelines first published in 1999.4 These state that all EDs seeing more than 16 000 children per year should have a PEM-trained consultant. UK-wide, this translates to around …
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