Interview - Striving for better care

The powers that be have told Dr Sheila Shribman to be realistic aboutwhat she can achieve in her new role, she says with a slight smile.

As national children's health lead, her chief task will be to implementthe National Service Framework for Children, Young People and MaternityServices, which was launched in September 2004 to transform the deliveryof children's healthcare within 10 years. It is early days, both forShribman, barely in the post for six weeks, and for the framework. Butshe is undeterred.

"I want to see the implementation of those standards," she states. "Iwant children's health and healthcare to improve and I want a moreeffective culture of people working with children and families. Itsounds obvious but achieving that in practice is something that has tobe striven for."

Shribman, who wanted to be a paediatrician from the age of 13, hasalready led by example on this front. A consultant paediatrician formore than 20 years, she helped to create an integrated child healthdepartment with input from colleagues in nursing, psychology and socialservices in the early 1990s.

She was also medical director at a district general hospital for 11years, was registrar for the Royal College of Paediatrics and ChildHealth, and has worked on inter-agency groups and an area childprotection committee.

The breadth of her experience, she says, was a big part of why she gotthe job. And she will need it to help implement the framework, a 2.5kgdocument that touches on nearly every aspect of child health.

"There are some areas where we're seeing a lot of progress," shereveals.

Medicines for children have come a long way in the last year, withimproved pain control in emergency and palliative care, and the firstguide on children's medicines for frontline practitioners, she pointsout.

A "big push" on the maternity standard, which has to be delivered by2009, in contrast to the rest of the national service framework whichmust be in place by 2014, is also taking place, she says. The choiceagenda, she adds, will mean women deciding, for example, where they wantto have antenatal appointments.

Child and adolescent mental health services have also made goodprogress.

While there have been reports of the knock-on effect of health trusts'financial problems on services, Shribman believes they are likely tomeet their targets for a comprehensive service by the end of the year,following a recent meeting with regional child mental health leads.

"Most of the signalled cuts are in, for example, the speed of reducingwaiting list times for surgery - not specifically children's areas," shesays.

However an area of the framework where "less has yet been achieved" isimproving services for children with disabilities and complex healthneeds.

"I always hesitate when people ask 'is that your top priority' because Ihave priorities in a number of areas. But I certainly have a personalpriority. A lot more needs to be done," she says.

These young people, including those with chronic illnesses such asdiabetes, are at risk of serious long-term health problems if thetransition from children's to adult care is not properly managed. Aconference in March is to unveil a major initiative that will help raisethe profile of transition care for these young people, bringing togetheradult and children's specialists, she reveals.

Shribman is also working with leads on other national service frameworksto gain "double benefit" for children by marrying the two agendastogether.

Working in tandem with the diabetes framework, for example, will helpdevelop a "total approach" to helping children manage the condition,which research shows they often fail to do.

But she is wary of being seen to favour some areas more than others.

There will be a balance, she says, between tackling new areas of workand building on old ones.

"I've got to start new streams of work, but there's a fantastic amountof good work going on, and I've got to add value to that," sheconcludes.

BACKGROUND - Personal and professional history

- Educated at Birkenhead High School for Girls, Girton College,Cambridge and St George's Hospital Medical School

- Developed the sub-speciality of community child health in Northamptonwhere she has been a consultant community paediatrician for more than 20years

- She is married to a local GP and has three children aged 23, 21 and18.