A geographically integrated service may now be achieved

Paediatric intensive care is a low volume, high cost specialty which depends on the training and skill of staff and availability of specialist equipment. Critically ill children have a changing range of illness and pathophysiology from early infancy to adolescence which is different from that of critically ill adults. In Britain paediatric intensive care has developed in an ad hoc and fragmented way. Now, however, after two decades of effort, Britain may be moving towards a more integrated service.

The Paediatric Intensive Care Society and the British Paediatric Association voiced concerns about paediatric intensive care in the early 1980s. The Paediatric Intensive Care Society has defined standards for paediatric intensive care,1 and these have been an important reference source that has informed many of the subsequent developments. This document defines two levels of paediatric intensive care. Level 2 refers to stable intubated children or unstable non-intubated children with airway problems requiring continuous nursing supervision, and level 3 to children who require complex therapeutic and nursing procedures in addition. (Level 1 is high dependency care.)

In 1993 a multidisciplinary working party on paediatric intensive care highlighted the fragmented configuration of paediatric intensive care provision.2 Its report was based on a retrospective survey of 12 882 children identified as having received intensive …