Abolition of strategic health authorities threatens screening of newborns, expert says

BMJ 2011; 342 doi: (Published 16 June 2011) Cite this as: BMJ 2011;342:d3786
  1. Jo Carlowe
  1. 1London

The Health and Social Care Bill could put infants at risk by weakening the regulation of paediatric screening.

This warning comes from Dr David Elliman, consultant in community child health, strategic co-director of the newborn blood spot screening programme and clinical lead of the newborn and infant physical examination programme. Dr Elliman expressed his concerns at a meeting of the Royal Society of Medicine’s paediatrics and child health section in London.

Because the bill seeks to abolish Strategic Health Authorities (SHAs), which currently oversee screening programmes, Dr Elliman fears that infants will be put at risk because there will be no provision for “foolproof screening systems locally.”

Newborn blood spot screening is used to test for disorders such as congenital hypothyroidism and phenylketonuria.

Dr Elliman warns that division of services among competing trusts could lead to delays in the system and increased risks in the care pathways.

“Screening programmes are complicated pathways involving a number of different disciplines and healthcare organisations. It is important that the links between these different players are seamless,” Dr Elliman told the BMJ.

“Newborn blood spot screening is perhaps an extreme example of this. It is important that once a child is found to have one of the conditions, they embark on appropriate management as soon as possible (the target is 21 days). Delays may mean permanent brain damage or even death.

“Currently there are well established pathways … these pathways are set nationally in principle and then in detail at a level such as the SHA. It would bring chaos if each individual GP consortium decided which lab a sample should be sent to and then which clinician should see a child found to have the condition. This should be decided at a level equivalent to SHA, if not nationally.”

Dr Elliman says greater emphasis is needed on “cooperation rather than competition,” and he welcomes the recommendations in the NHS Future Forum’s final report regarding the role of the regulator Monitor.

In its report, NHS Future Forum has called on all local authorities and health and social care bodies to cooperate and advised against establishing Public Health England fully within the Department of Health (BMJ 2011;342:d3777, doi:10.1136/bmj.d3777).

“I welcome a move from competition to collaboration and a positive mention of patient pathways. The dilution of Monitor’s role in relation to competition and the requirement for it to support choice, collaboration, and integration may help protect screening pathways,” said Dr Elliman.

Dr Chris Hanvey, chief executive of the Royal College of Paediatrics and Child Health, echoed these views, stating that the recommendations in the Future Forum report represented “significant progress in recognising the specific needs of children.”

Responding to Dr Elliman’s concerns, a Department of Health spokesperson said: “Under the Healthy Lives, Healthy People consultation the Government proposes to bring the commissioning of screening programmes under the control of the NHS Commissioning Board, working on behalf of Public Health England. Under the new arrangement screening programmes would be commissioned for populations of at least 1 000 000 people, ensuring integrated high quality screening pathways.”


Cite this as: BMJ 2011;342:d3786

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