The need for and the role of a coordinator in child health surveillance/promotion.

In the case of the individual consultation initiated by the patient, it is relatively clear where the doctor’s responsibilities lie in terms of providing a quality service and how this is organised. However, when a consultation is initiated by one or more of the health care team, as part of a nationally prescribed screening programme involving a number of professionals, there is an issue of who takes ultimate responsibility for the quality and delivery of the preventive programme as a whole. The UN Convention on the Rights of the Child places a clear responsibility on the state to provide access to preventive care, such as maternal and infant health clinics and immunisation (Article 24). The UK has a long history of setting up successful maternal and infant welfare programmes from the turn of the last century, involving doctors and health visitors with a specific role in this field. The child health surveillance/health promotion programme in the UK is one such nationally prescribed programme developed from professional consensus. The integration of doctors previously employed by the local authority as medical oYcers of health working in child health clinics and schools into the NHS structure in 1974 started the move towards a clearer integration of preventive and curative services. With the 1990 NHS Act, the preschool child health surveillance programme for children became an integral part of the general practitioner (GP) contract with the school health programme being maintained by medical oYcers and school nurses. Pre 1974, there was a strong tradition of child public health, often headed up at district level by a principal medical oYcer. One of the roles of that individual was to provide an annual report on the state of the children’s health in that locality and to take an “overview” of child health in that population, usually making recommendations for action to the next level up of the health service management. Who is providing that overview in the twenty first century? It could be argued that the vacuum now left in the area of child public health is being filled by paediatricians, senior nurse managers, and public health physicians. The coordination of preventive programmes has been described in Working together for tomorrow’s children as one of the key interface tasks for paediatricians involved in child public health. This task of coordinating the diVerent elements of the child health screening programmes as laid out in the national reports by Hall and Polnay is assumed by paediatricians, usually consultant community paediatricians in over 80% of districts in the UK. This article explores some of the issues relevant to paediatricians and others who are nominated as child health surveillance coordinators for their health authorities. What is the recommended child health surveillance (CHS) programme in the UK? At the time of writing, the programme is being reviewed by a joint Royal College of Paediatrics and Child Health national working group chaired by Dr David Elliman, convenor of the British Association of Community Child Health. Table 1 describes the diVerent elements of the current UK policy at the recommended ages as recommended by the last national working group. This programme encompasses components of screening, immunisation, monitoring and oversight, individual health education/health promotion, and population based health promotion. The various constituents are based on the best evidence to date. Who does what formally is very much a local decision and has not been prescribed. Many individuals are involved informally— parents, teachers, children, and young people. In order to coordinate the programme so that it can be eVectively delivered and monitored, a number of functions need to be considered.