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I am grateful to Dr Waterston for his commentary. In order to
clarify the issues that he raised, I will confirm the following:
(1) I was suggesting that the practice in all branches of tertiary
paediatrics should be considered as a disability service from the
perspective of the family and child’s predicament. I was not confining
the proposal to traditional neurodisability.
(2) I was indeed specifically proposing to change the ethos of
(3) My consultation has been with a number of support groups which are
part of Contact a Family.
(4) I have no problem with supporting community paediatrics, providing
we are clear what it is and that it is appropriately resourced, but this
is another issue.
(5) I have no problem about supporting a community based approach to
the whole of paediatrics and have worked with research groups in India,
Bangladesh and Kenya on community based rehabilitation. Whether community
paediatrics as presently practised meets the definition of being a process
which enables disabled people and their families to function and
participate fully within their community and support the primacy of the
community in the use of resources is open to question, as Dr. Waterston I
think agrees. This process would require facilitation of a bottom up
approach, ie, giving power and resources from health, education and
social services to the community, and the research testing of such models.
I was proposing a much more confined revolution of tertiary medicine which
let the users and community into the action reorganising the difficulties
and influence that the people in tertiary services face.
Brian G R Neville
Professor of Paediatric Neurology