Planning and commissioning of health services for children and young people.

BACKGROUND Local audits in England and Wales performed in 1994 showed that child health commissioning was not being given priority. We were concerned that child health commissioning was in addition not performed in a child-centred way, with the best interests of children to the fore. METHOD A survey of health authorities and boards was performed, to investigate child health commissioning in the United Kingdom. A questionnaire was sent to all directors of public health medicine in post in November 1994. The main outcome measures were child health experience within commissions and the context of children's services within the wider commissioning process. RESULTS A total of 120 (92%) of 129 authorities replied. Sixty-nine (58 per cent) had a named person with responsibility for child health services, of who 7 (5 per cent) worked exclusively within this area, 42 (32 per cent) had experience within clinical child health, and 19 (15 per cent) had postgraduate qualifications in child health. One hundred and five (81 per cent) authorities replied to a question on the comprehensiveness of the commissioning process; of these, 45 (34 per cent) planned and commissioned children's services in their entirety and 60 (46 per cent) planned and commissioned children's services in the context of other service areas. A majority did not plan and commission acute and community services together. CONCLUSION Many authorities had no named person with responsibility for a child health strategy. Of those that did, most named persons had inadequate experience and few had postgraduate qualifications in child health. Most authorities had no comprehensive planning mechanisms for children's services. In consequence, most commissions were failing to comply with the UN Convention on the Rights of the Child.