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Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, explains his vision of the future and why he thinks that "blur in hospitals" improve care

"is extremely emotionally demanding work," says Dr Hilary Cass its role as an advisor on disability pediatric hospital in St. Thomas in the center of London. Some of the children I work with a disability deep. His workload includes the treatment of patients and their families hope and hunger for information about the treatment of their children and opportunities. Palliative care is also part of the workload Cass.

"Sometimes it is the parents who make decisions on when they want to continue to make all the stops, with maximum response, and when they want to be less interventionist and say" quality of life [] is now more important than quantity "for your child," she explains.

advise parents that explore what we hope is a miracle cure for your child is not easy. "It may be that parents are looking and looking and looking for a cure. 'Re Spending lots of time on internet. You must manage your expectations and try to help them understand the limits of what is possible and what is not possible. "

compliance comes from the positive response even grieving parents can give. "In fact, if a family can leave the hospital after losing his son and say no support could be better, then I can go home and feel good about it," said Cass.

After 30 years as a doctor, she recently took office as President of the Royal College of Paediatrics and Child Health (RCPCH), which represents doctors in the United Kingdom, 11 500 children. The heads of royal medical colleges tend to be innovative leaders who challenge its members, or those who opt for an easier life and ask your colleagues some awkward questions about the care they provide. Formidable in the tray, which includes a tighter sound financial reforms induced agitation and the urgent need to treat more patients outside NHS hospitals means that there is more demand for the former.

Cass is one of them. Pediatric Too much is not enough, said firmly. The mortality rate in the UK for less than 16 years is the highest in Western Europe, 26% of child deaths are potentially preventable infant mortality and the conditions that can be treated here is much higher than in the other European countries. These sobering facts could be considered as emphasizing his point of view. Can you explain these results?

"It will be a combination of systems, people and education in both the public and the profession," said Cass. The RCPCH has recently launched an investigation, called Child Health Reviews - United Kingdom, why many children die needlessly every year and take corrective action

Without prejudging its conclusions, Cass offers some initial thoughts. Research conducted by the Confidential Enquiry on Maternal and Child Health in 2008 called Why are children dying, also found that inadequate training is an important factor in at least some of these deaths, said. Thus, the university is looking into this matter closely.

Cass explains that the current setting of pediatric units also helps explain the gaps in the care of children in some of the most common conditions, less serious, such as asthma. There were 218 hospital units specializing in children's health in the United Kingdom, although the university is of the opinion that there should be much less.

"The recent review of safe and sustainable services for children undergoing cardiac surgery is only a problem largest specialist result is that we can not maintain the security services in the 218 units hospitalization. This is too much and too scattered, so that they do not receive the quality of care in each of these units, we would like the children to do, "she said. "We medicine in very inefficient uneconomic It is not only [to] children with heart disease is very rare in children with asthma, diabetes, pneumonia, meningitis - .. common conditions that we live at the lack of staff to provide adequate care. "

shortage of doctors or clerks average quality also means that some of the 3,000 pediatric consultants should fill gaps in shifts. "This can be done in a. Draft, and more worryingly, they end up having to be on call at the last minute, because there is nobody in that night and have to work the next day Here's where it gets risky. I would not fly on a plane by someone who has done the day before and the day is still working, so why would you want your child in the care of someone who is sleep deprived, you think are good, but not in the least risk possible? "he asks.

The solution to too many units, the problems of staffing and inconsistent attention, or 25% reduction units or increase the number of consultants by 50%, said. Although she adds: "I acknowledge that the first is politically difficult and the second is financially difficult."

According to Cass, the NHS needs to "blur in hospitals as the place to be" and start to offer many services close to patients' homes. Commission considers that the system of payment rates for hospital activity as "encouraging people to come to the hospital like bees to honey" and "surreal." A key element of the response, Cass says, is a big change in how and where the work of many pediatricians.

She wants to see a great expansion in the handful of pediatricians in the community and work on the second surgery or GPS. Children represent 25% of the workload of family physicians. Pediatricians who work closely with them, and also for patients nvenient, cheaper and produce better care. Your self-confidence is to try to organize a pilot project in this direction.

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