Professor Malcolm MacLachlan:

The impediments are partly to do with staffing, such as the number of paediatricians available, for instance.

They are also to do with different cultures of practice. For instance, I have said a number of times that the clinical programme for people with disabilities is a rights-based and social model. Obviously, in the hospital context, there is more of a medical model. There is no necessary conflict between these two approaches but what is needed are lines of referral that respect the different sorts of expertise. What has generally happened is that a paediatrician might make a referral but there are insufficient paediatricians within the community to work with that person.

We are involved in a group, which is looking to strengthen both the number of paediatricians and the establishment of the children's disability network teams. Once they are there, and have dietician and public health nursing support and so on, then there will be a much better chance that we will have a seamless service.