Nigel Speight

Liberating the NHS

Reflecting on the 2006 NHS White Paper, Professor Stephenson (now President of the Royal College of Paediatrics and Child Health) observed that successive reforms stemmed from government determination to ensure National Health Service (NHS) Trusts should break even financially. He implied that this goal might be questionable, not least because childrens services were likely to suffer disproportionately.1 We now have yet another White Paper (‘Equity and Excellence: Liberating the NHS’) proposing the most fundamental changes to the health service since its inception. If adopted, these proposals will establish a full healthcare market, with all hospitals becoming Foundation Trusts and being able …

Controversy: Is the Children Act failing severely abused and neglected children?

Is the Children Act failing severely abused and neglected children? The simple answer to this question in our opinion is an emphatic “Yes”. The press carries articles almost daily concerning the plight of children in our society.1 2 Most paediatricians we have approached who have a special commitment to child protection work admit to feelings of near despair about the current state of child protection in this country. They feel that things are getting worse rather than better, and lay much of the blame for this on the Children Act and on the interpretation being put on this act by social workers, guardians ad litem, and the courts. We have received comments to the effect that the Children Act can be regarded as “A charter for abusive parents” or “A charter for abusive parents, lawyers and medical experts”! While these comments are anecdotal, impressionistic, and subjective we believe they deserve to be acknowledged as reflecting the deep sense of disillusion that exists, much of which we share. It is perhaps unfair to expect perfection from any system or legislation in such a difficult and complex field as child abuse, and no developed society we are aware of has ever approached perfection. However, in this country we are entitled to expect that 27 years after the death of Maria Colwell we are entitled to legislation that would improve child protection significantly rather than make things worse. In our opinion it is the latter that has happened. Before the Children Act, legislation and practice placed a stronger emphasis on protection of the child and insistence that abuse should stop. Early intervention was potentially firmer and more decisive. This protection was still far from perfect, as evidenced by the long list of children murdered while within the child protection system, each of …

Myalgic encephalomyelitis/chronic fatigue syndrome: Review of history, clinical features, and controversies

Myalgic encephalomyelits/chronic fatigue syndrome (ME/CFS) has been both a medical mystery and a source of controversy in Western medicine for over 50 years. This article reviews the major historical developments over this period, describes the clinical pattern and spectrum of severity, and then explores the current major controversies surrounding the subject.

Open letter to Professor Peter Rubin, Chair of the General Medical Council.

You must know that the inclusion of Mrs Penny Mellor on the General Medical Council Expert Group on Child Protection,1 which has been set up in the wake of David Southall’s successful appeal, is an affront to paediatricians and other professionals involved in child protection work. On 9 May 2010 we wrote to you and Mr Dickson congratulating you on setting up an expert panel to review what is expected of doctors involved in child protection. We had stated: “We have long argued that child protection is an area of medicine made uniquely difficult because the parents of children [or their appointed advocates, that is, those who complain about doctors to the GMC] cannot be assumed always to be acting in the best interests of their child. It is difficult for lay [fitness to practise] panel members, or medical panel members who do not have personal experience of child protection work, to understand this professional environment.” We are astonished that you consider Mrs Mellor an …

Treatment of children with asthma. Entrust parents with "crisis pack" of steroids.

EDITOR,--In their excellent and comprehensive account of treating asthmatic children John Rees and John Price rightly emphasise the importance of “partnership in management” and “self management plans,” including “an agreed action plan of what to do…if the child has an acute asthma attack.”1 However, in the subsequent part of the article dealing with acute severe asthma, the principle of partnership with parents …

Abolishing the internal market to save NHS costs

Ham clearly describes the scale of the financial crisis facing the NHS and rightly points out that a greater proportion of Gross Domestic Product could easily be justified in helping to resolve some of these problems.1 However, one easy solution is already available, …

Suspension verdict for doctor treating torture victims is unfair

As doctors who regularly work with survivors of torture we are well aware of the devastating short term and long term effects that torture has on those subjected to it. We also recognise the obligations on doctors stated in the …

Professionals Against Child Abuse express support for David Southall

www.thelancet.com Vol 373 June 13, 2009 2021 and cancel its international meeting” in light of the H1N1 infl uenza outbreak. In response, we are submitting this joint letter by the presidents of the ATS and the European Respiratory Society (ERS), with the unanimous support of the executive committee of the ATS and the majority consensus of the steering committee of the ERS. The ATS carefully considered the implications of holding this conference during the current infl uenza outbreak. WHO has issued a phase 5 pandemic alert, which means that the virus has caused sustained community-level outbreaks in at least two countries in one WHO region. Phase 5 does not relate to the severity or virulence of the outbreak. Our deliberations were, and continue to be, guided by the available scientifi c data. The data indicate that the severity and virulence of the H1N1 outbreak are similar to that of seasonal fl u. The ATS and ERS consulted with experts within and outside our societies and followed published guidelines on travel by government agencies, including the US Centers for Disease Control and Prevention (CDC), the European Center for Disease Control, and WHO. Travel restrictions were not, and are not, recommended by any of these agencies. In fact, according to WHO, “limiting travel and imposing travel restrictions would have very little eff ect on stopping the virus from spreading...” Furthermore, the ATS believes this conference provided an unprecedented opportunity to educate and update more than 12 000 conference participants from around the world, and we organised a late-breaker session aimed at pro viding the most up-to-date infor mation on this novel infl uenza A (H1N1). While acknowledging that “the personal health risk for conference participants is probably limited”, Nemery and colleagues imply that travel to San Diego presents a greater health risk because of its proximity to Mexico. In fact, CDC has not recommended any restrictions on travel to San Diego, or Professionals Against Child Abuse express support for David Southall

Book review of Physical Signs of Child Abuse

Editor,—The medical aspects of child abuse and neglect are undeniably an area of some controversy within the profession. Clearly doctors you invite to review books on the subject are entitled to express their opinions within the context of their reviews. However, even allowing for this we were disconcerted by the tone and content of Dr Sunderland’s review.1 To us it read as an oblique attack on the overall work of Jane Wynne and Chris Hobbs from someone in an opposing camp. Where Dr …

Case conferences for child abuse

Case conferences have been an integral part of child abuse procedures since 1974 when the recommendations of the inquiry into the death of Maria Colwell were published. The case conference is a multidisciplinary forum for the sharing of information, for discussion, and for making recommendations to social services departments, which are ultimately responsible for the welfare of the child under discussion. In principle, therefore, case conferences are advisory rather than executive. In practice, considerable weight is usually attached to their recommendations. In some areas children leave hospital on the day of the case conference as a result of its decisions. In effect, the director of social services has delegated responsibility in advance to the local office managing the case. In other areas the director insists on vetting personally all case conference recommendations. Even so it is relatively rare for such recommendations to be over-ruled. Few people love case conferences, and many hate them. Certainly their procedures are open to criticism on many fronts.