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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 28; 335(7612): 177.
PMCID: PMC1934457

Children's surgery services under threat from competition, says report

Children's surgical services could disappear from district general hospitals if they are not exempt from health policies involving competition, forcing children to travel to large specialist centres for routine operations, experts warn.

A report from the Children's Surgical Forum has called for routine surgery for children to remain available locally in the future and not be threatened by initiatives that have introduced competition between trusts.

David Jones, chairman of the Royal College of Surgeons of England and chairman of the forum, said that children's surgery was not seen as an attractive option by many trusts because of the high costs.

“The dangers are that children are not going to be given a fair deal because of payments by results,” he told the BMJ. “Trusts should not be allowed to abdicate their responsibilities for children.” Instead, children's surgical services should be commissioned separately to other services, and trusts should have to negotiate between themselves to ensure that there is a children's surgical service available locally, he said.

“Where possible children's surgery should be delivered locally, and when that is not possible children should be referred centrally,” said Mr Jones.

A survey of general paediatric surgeons working in district general hospitals in England, Wales, and Northern Ireland, which had a 100% response rate, showed that 86% of respondents wanted routine surgery for children's services to remain local.

The report from the forum, which involves specialists from the medical royal colleges, surgical specialist associations, nursing bodies, the Department of Health, and patients' representatives, acknowledges that there have been considerable improvements in children's surgery since its first report was published seven years ago. But it says that fewer hospitals are now able to provide children's surgical services and warns of a looming problem in children's surgery if the workforce is not expanded.

England and Wales have only 104 consultant paediatric surgeons, considerably fewer than the estimated requirement of 256 by 2010. Some specialties have a severe shortage of specialist paediatric surgeons. Of 1700 orthopaedic surgeons, only 15% have an interest in children's surgery, leaving 25% of units without a paediatric consultant.

Cohesive workforce planning is required to ensure that an appropriate number of surgeons are trained to deliver routine paediatric surgery across all specialties, says the report. It also calls for more children's nurses and clinical nurse specialists for inpatient and outpatient care.


The report, Surgery for Children: Delivering a First Class Service, is at

Articles from The BMJ are provided here courtesy of BMJ Publishing Group