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Where should paediatric surgery be performed?
  1. K A WILKINSON, Consultant Anaesthetist,
  1. Jenny Lind Children’s Department
  2. Norfolk and Norwich Hospital
  3. Brunswick Road, Norwich NR1 3SR, UK
    1. P CROWLE, Consultant Paediatrician
    1. Jenny Lind Children’s Department
    2. Norfolk and Norwich Hospital
    3. Brunswick Road, Norwich NR1 3SR, UK

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      Editor,—Arul and Spicer’s recent review1 on this controversial issue failed to address some of the most important points surrounding regionalisation of paediatric surgery. Other papers on the subject are equally unrewarding2 3 and so perhaps there is a need for more debate.

      We must balance the need to banish “occasional paediatric practice”4 with the rightful concerns about providing “a child and family centred service in which skilled help is readily available and accessible”.5

      The arguments used by the authors on centralisation of paediatric intensive care do not necessarily support the need to regionalise paediatric surgery along the same lines. Paediatric intensive care is a low volume, high risk speciality requiring the skills and equipment justified in only a few UK centres. In contrast the vast majority of surgery on children in the UK is low risk, high volume work very, little of which requires on site specialist paediatric facilities. Paediatric surgery is however attended by …

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