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Observations Life and Death

Let’s not widen the gulf in the health care of children

BMJ 2008; 336 doi: (Published 29 May 2008) Cite this as: BMJ 2008;336:1215
  1. Iona Heath, general practitioner, London
  1. iona.heath{at}

    Proposals arising out of Lord Darzi’s review of the NHS risk endangering the care of children in general practice

    An illness or accident that kills or permanently disables a previously healthy child is a shocking and terrible thing. Such a possibility creates a continual undercurrent of dread familiar to every parent. The dramatic fall in the mortality rate among children in rich countries has been one of the great achievements of modern society and modern medicine, but the fear remains.

    It is this context that informs some of the proposals emerging in the regional responses to the junior health minister Ara Darzi’s “next stage review” of the NHS. These are being published in quick succession by each region in England through May and June. An early example is that from the Yorkshire and the Humber Strategic Health Authority, entitled Healthy Ambitions ( Its proposals are organised as eight “pathways,” one of which is the “children’s pathway.”

    There is much that is good among the proposals, not least the plan for properly constituted multidisciplinary primary care teams for children, with health visitors, midwives, school nurses, community children’s nurses, paediatric therapists, and GPs all working together. Many …

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