Leading Article: Taking extra care of children

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The Independent Online
It is every parent's nightmare. A sick child, getting sicker by the minute, is shunted from hospital to hospital, kept waiting for hours only to be denied life-saving intensive care because there aren't enough beds. Such was the story of young Nicholas Geldard, who died before Christmas. And his was not an isolated case, according to the Independent's survey of paediatric intensive care units this week. Top hospitals across the country have turned away scores of children from specialist units because they could not cope.

This is not a new problem. As far back as 1987, the death of baby David Barber of heart failure after being shuttled from one hospital to another set people talking about a crisis in paediatric intensive care. And in 1993, a report from the British Paediatric Association pointed out that critically ill children were being turned away from the units that could have given them most specialist help.

Behind these cases are family tragedies. But we should be wary of hysteria. Paediatric intensive care is a victim of its own success. Virtually unknown as a discipline 20 years ago, it has proved an extremely effective area of medicine. Advances in medical knowledge, technology and a sustained focus on child health have made it possible to keep children alive who not long ago would have quickly died. And as usual with health care, supply has created its own demand. As the range of treatments has expanded so more people have come to expect the NHS to deliver them. There is a "crisis" in paediatric intensive care because hospital managers and resources have not kept pace with the demand for new treatments.

Paediatric intensive care needs to expand. Now that we have the extra knowledge and the new techniques we are morally obliged to use them. On the Health Secretary Stephen Dorrell's own proposals to employ more evidence-based medicine - funding procedures which have proven results - this one's a winner.

Of course, extra resources for expanding paediatric care and training additional nurses mean something else has to give. A child dying in an ambulance when the technique to save her life is readily available must be of greater priority than cutting waiting lists for routine operations. The Government and health authorities should make sure resources are shifted towards this field with more funding for specialist centres of excellence and greater investment in nurse training. One of the biggest problems is the lack of trained staff. Incentives to help nurses to study for the extra paediatric qualification should be arranged.

Sadly, the Government has been slow to respond. The Department of Health is delaying formulating a detailed plan for the future of children's intensive care until it sees the outcome of a long term study by the Medical Research Council. This is wasting time. The Government remains politically vulnerable on its health policy. Another case like Nicholas Geldard's and it will regret, as only politicians can, how long it has taken to give children the best care we can afford.

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