LOOKING AFTER THE BABY.

Dr Keith Dodd.

1.The importance of paediatric involvement in high risk births will be stressed together with the need for skilled resuscitation and routine care for all babies. The importance of team work between Midwives, Obstetricians and paediatricians will be emphasised.

2. The background to the present problems with paediatric staffing will be outlined together with the Department of Health's suggestions for tackling them.

3. The Royal College of Paediatrics and Child Health has considered these issues in some detail. The following will be described:

· Emphasis on team working · New patterns of service provision · The need for skilled resident paediatric support for high dependency and intensive care

4. Service configuration. The tensions between the quality and safety of services, accessibility to the public, and sustainability in terms of staffing and costs will be described.

5. Public opinion. It is generally very difficult to persuade the public and politicians of a need for change in patterns or configurations of services.

6. A First Class Service. The government's agenda to improve quality by setting standards and implementing clinical governance has important implications for the provision of the care of mothers and babies.

7.The conclusions of the intercollegiate working group on maternity services will be outlined in terms of service provision for low risk births, for births taking place in District Hospitals providing secondary care, and in tertiary centres.

8.The Royal College of Paediatrics and Child Health is considering workforce and configuration issues as a matter of high priority, particularly in regard to smaller and isolated units as well as larger units which are close together. The College's directory of paediatric services is assisting this work.

9.How will services be configured in 2010? Will we have moved to a service based on local units, a network of paediatric polyclinics, and large tertiary centres?

10.A framework for child health services will be outlined.

11.The importance of outcome measures will be stressed, and the value of hypoxic ischaemic encephalopathy (HIE) as a measure of the quality of intrapartum care will be described.