Child health: the elephant in the corner?

For me, moving from children's social care to children's health has been like seeing a familiar animal but in a very different way.

Previously, in my various management roles at council social services departments and large national charities, I was focused on spotting gaps in statutory provision. This could be developing preventive family services — which might reduce the need to take children into care — building services for under-eights in the light of Sure Start or building youth justice services to keep young people out of the courts. In all honesty, the health agenda figured only fleetingly.

This is partly because it is difficult to engage with health commissioners. Their focus is more narrowly defined on either acute children's services or the growing elderly population and voluntary organisations are unlikely, for example, to be seen as strategic partners when a narrow definition of health is adopted.

Since moving to the Royal College of Paediatrics and Child Health, I have seen care for children in a new way. I have realised that we do live in parallel universes, but we do not always make the links or realise how a collaborative approach will benefit children.

Viewing the elephant from a health perspective can help colleagues in social care settings and beyond to understand the complexity of the current health agenda.

Three examples help illustrate this.

The first of these concerns the report by Sir Ian Kennedy into the current state of child healthcare. The report was instigated by the previous Labour government and its publication followed the launch of the coalition's white paper Equity and Excellence: Liberating the NHS. Kennedy concludes that child health services are of very variable standards and have not been given the attention or resources they require.

But Kennedy's report has largely been lost in the white paper and its move to hand GPs more commissioning power. There is a huge issue of how children's services — in health, local authorities and the voluntary sector — will be delivered in the light of GP commissioning.

The second example is that of "reconfiguration" and arguments about how far specialist child health services can be provided in all district hospitals. While many paediatricians argue for centres of excellence and the aggregation of specialist services in, say, regional units, it is often seen as a suicide note for political careers. Which MP, for example, wants to agree that his local asthma service is moved 50 miles down the road to another MP's patch? But the implications for social care — and especially disability services — can be profound. You may get a better specialist health service for your child at a regional centre, where expertise is congregated, but the cost to your family of travelling long distances might be considerable.

And third is the complex area of child protection, where health concerns mirror those of social care. After all, paediatricians were also involved with Baby P and are often the experts on which convictions for child abuse stand or fall. Paediatricians stand firmly with social care professionals in being very concerned at the relaxation of media reporting of family courts and, in busy clinics, share the same fears that child protection social workers have of missing evidence of child abuse.

So health and social care need to move more seamlessly together. The reality is that an elephant is trunk, tail, legs and more besides. Unless we understand both worlds more closely, services will continue to be disjointed.

Dr Chris Hanvey is chief executive of the Royal College of Paediatrics and Child Health