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Child health surveillance
One of the most comprehensive reviews of child health services in England and Wales was commissioned by the UK Government and published in 1976 under the title of 'Fit for the Future'. 1 It was chaired by Professor Donald Court and was acclaimed by paediatricians but met opposition from other sections of the medical establishment and many recommendations were not implemented. The report emphasised the importance of prevention of illness and handicap and recommended a programme of health surveillance which included five principal professional activities:
oversight of health and physical growth of all children
monitoring the developmental progress of all children
providing advice and support to parents, and treatment and referral of the child
providing a programme of effective infectious disease prophylaxis
participation in health education and training in parenthood.
It was suggested that these activities would be best performed by the primary care team (general practitioner (GP) and health visitor (HV)). The Court Report recommended that child health services should be integrated between the then current arrangement of community health services provided by local authorities, general medical services delivered by GPs and specialist services provided by hospitals. In order to implement this strategy it proposed the establishment of two new professional crafts: the consultant community paediatrician and the GP paediatrician. The former took off and is now one of the most popular subspecialties in UK paediatrics; however, the latter was aborted and did not emerge, although many general practices include GPs who have special expertise in child health.
In 1989 Butler basically reiterated the above list in his Report to the Department of Health on child health surveillance (CHS) in primary care and endorsed Court's recommendation that GPs were the best professionals to deliver it. 2 He emphasised the importance of secondary prevention by detection of developmental problems at an early stage.
Report recommendations
In 1989 a report entitled Health for All Children (the Hall Report) 3 was also commissioned and published by the British Paediatric Association (which became the Royal College of Paediatrics and Child Health (RCPCH) in 1996). This reviewed the CHS programme and identified a lack of evidence for many of the procedures in practice at the time. Many of the historical interventions to detect developmental abnormalities were...