Sir, Your report (June 23) that the number of acutely ill children with diabetes being seen in emergency departments is increasing will not surprise many UK paediatricians. The diagnosis and care of diabetes in childhood is uniquely difficult, but your report reflects a deeper and wider lack of investment in children and young in the UK.

The widening gap in society beween the rich and the poor (also reported this week) has had adverse effects on educational attainments in less affluent families, higher numbers of teenage pregnancies, binge drinking and horrifying levels of reported child abuse. All of these worrying statistics must reflect familial and societal neglect of children in various ways and at increasing levels.

Paediatric diabetologists have been reporting for many years that services provided for children with diabetes are seriously deficient in terms of facilities and staffing. These arguments have been consistently ignored at local and national levels by NHS authorities that, as in many other paediatric services, pay lip service to the stated notion that children should be our priority.

In the UK we should be ashamed that we do not understand that substandard nutrition and health in young people is the grim harbinger of chronic disability in our adult-orientated society.

Peter Swift
President, Leicestershire Parents Group, Diabetes UK

Sir, It is extremely dismaying that “the UK is much slower in diagnosing brain tumours” and that “delays were occurring because GPs were reluctant to refer children for brain scans or through lack of awareness of the early warning signs” (report, June 25).

Unfortunately, the UK also lags behind comparable countries in survival from other childhood cancers, and outcomes for common diseases such as diabetes are inferior for Britain’s children, too (“Failure to diagnose diabetes is putting lives of over 3,000 children in danger”, June 23).

We welcome the news that the Royal College of Paediatrics and Child Health is considering guidelines to improve GPs’ awareness of the symptoms of brain cancer in children. But international comparisons of health services and systems provide a clue as to why the UK may be needlessly behind other countries in the diagnosis and treatment of childhood brain cancer and other serious childhood conditions, and suggest that more substantial changes should be made. Our system of inflexible hierarchies between GPs and paediatricians is unhelpful in providing the best care for children. We need to catch up with other countries, by integrating health services for children, and by building strong community-based teams of children’s healthcare professionals including family doctors, paediatricians, specialist children’s nurses, and other allied health professionals. Such integrated teams could provide the ideal balance between access and expertise, and help to raise UK children’s healthcare to be among the best in the world.

Dr Ingrid Wolfe
Dr Hilary Cass
The National Collaborative for Children’s Integrated Healthcare

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