BMJ 11 Aug 2007 Vol 335

Earlier this year, Sir Alan Craft visited our locality in order to advise the hospital trust on downgrading our paediatric service and replacing our consultant-led obstetric service with a midwife-led unit. In this editorial he asks, “Are health services in England failing our children?”, and observes that England now lies 15th in the European league table for perinatal mortality. I’ve been stung into a reply in the Rapid Responses and I would ask any reader who is worried about similar developments to contact me, because efforts to challenge this policy urgently need to be coordinated on a national level.

Whereas British neonatal statistics used to be good, our cancer survival statistics used to be shameful. A lot has changed for the better in the last ten years and I’ve been inclined to think that the two week wait system for suspected cancer is a good thing, purely because it provides a swift answer for worried patients – it can hardly influence the natural history of cancer. But this study of breast cancer finds that the system is not operating to anyone’s benefit.

A clinical review of gallstones provides few surprises, except its prediction in the closing paragraph that surgery may be possible in the future without any incision at all. In the meantime, some hospitals are managing to get up to half of their laparoscopic cholecystectomies done as day surgery. A big change from the days when ladies with large scars would lie on the ward for ten days, next to a bottle containing their stones.