• Health services research
• Child Health Services

Children’s healthcare is suffering from many of the same problems besetting services for adults, although in some instances more acutely. Earlier this year, the respected Nuffield Trust1 warned that children were facing lengthening waiting times for both planned hospital and mental healthcare at a time when the burden of mental ill health is growing rapidly. The Royal College of Paediatrics and Child Health (RCPCH) has repeatedly signalled its concern about worsening health inequalities among children.2

In theory, the government’s new integrated care systems (ICS) for the National Health Service (NHS) in England are very relevant to this. The idea is that greater joint working and system-wide planning will foster the development of new care pathways which reduce unit costs, for example by substituting community-based care for hospital care and cheaper staff for more expensive ones, enabling more patients to be treated for a given budget. Moreover, the new integrated care boards will have a duty to reduce health inequalities, something especially welcomed by the RCPCH. However, exhausted by workload pressures, the unrelenting nature of the ‘pandemic surge – recovery’ combination and the corrosive effect of good will constantly being taken for granted, some clinical staff and service managers may well be forgiven for wondering whether ICS are at best just another top-down reorganisation and at worst in danger of creating as many problems as …