Intended for healthcare professionals


Improving child health services in the UK: insights from Europe and their implications for the NHS reforms

BMJ 2011; 342 doi: (Published 08 March 2011) Cite this as: BMJ 2011;342:d1277
  1. Ingrid Wolfe, specialist registrar public health1, general paediatrician2,
  2. Hilary Cass, paediatric neurodisability consultant3,
  3. Matthew J Thompson, senior clinical scientist and general practitioner4,
  4. Alan Craft, emeritus professor(child health)5,
  5. Ed Peile, professor emeritus (medical education)6,
  6. Pieter A Wiegersma, youth healthcare physician-epidemiologist7,
  7. Staffan Janson, professor8,
  8. T L Chambers, consultant paediatrician9,
  9. Martin McKee, professor10
  1. 1London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  2. 2Whittington Hospital, London N19 5NF
  3. 3Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London
  4. 4Department of Primary Health Care, University of Oxford, Oxford, UK
  5. 5Newcastle University, Newcastle, UK
  6. 6University of Warwick, Warwick, UK
  7. 7 Department of Health Sciences, University Medical Centre, Groningen, Netherlands
  8. 8Karlstad University, Centre for Public Health Research, Karlstad, Sweden
  9. 9Bristol and Weston-super-Mare, UK
  10. 10European Observatory, Health Systems and Policies, London School of Hygiene and Tropical Medicine
  1. Correspondence to: I Wolfe Ingrid.Wolfe{at}
  • Accepted 15 February 2011

The coalition government’s Health and Social Care Bill is unlikely to deliver the improvements in children’s health services that are urgently needed. Useful lessons can be learnt from how other European countries deliver healthcare for children, say Ingrid Wolfe and colleagues

The care provided by UK children’s health services is inferior in many regards to that in comparable European countries. Although there are many examples of good practice, health services too often provide poor outcomes and are seemingly planned around the needs of organisations rather than those of children, young people, and families. Service models are often inefficient and wasteful. Budget constraints and dramatic changes in the NHS make it more important than ever that children’s healthcare is planned carefully and appropriately for their needs (box 1). However, current plans insufficiently recognise children and young people’s special requirements and fail adequately to acknowledge important recommendations made in Ian Kennedy’s review of children’s healthcare.1

The Marmot review emphasises the importance of investment in children to reduce health inequalities at all ages.2 Health services in the UK need to adapt both to the changing nature of the challenges of disease in children and to the opportunities to intervene. Other European countries offer helpful insights into ways of improving children’s healthcare.

Box 1: How children’s health needs differ from those of adultsw1

Diseases—Some diseases are specific to childhood, but children can also manifest illnesses differently: in signs and symptoms, in the rapidity of decline and recovery, and in behavioural responses. The burden of disease in childhood is shifting away from mostly infectious illnesses to more long term conditions

Demography—A large proportion of children in the UK live in poverty. Extensive evidence links poverty to poor health outcomes, and since childhood is one of the most vulnerable periods in the life course, health of children suffers disproportionately

Dependence—Children are usually …

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