The majority of paediatric surgery carried out is for minor procedures in fit and healthy children and can be performed as day-case procedures. A large quantity of this work is performed in non-specialist hospitals. Children and families need to be able to access high-quality services close to home, and delivering care locally, where possible to do so safely, can add to the patient and parent experience. A non-specialist centre should have arrangements and local guidance for treating and managing simple surgical emergencies in the paediatric population, along with the ability to resuscitate and stabilise critically ill children of all ages before transfer to a tertiary specialist centre for either paediatric critical care or surgery. Continual education and training within regional networks are vital in maintaining skills and confidence of staff in non-specialist centres, and standardisation along with protocols is helpful in the anaesthetic management, analgesic plan, preassessment and critical transfers of children in a non-specialist centre.

From 1994 to 1996 the Enquiries had a psychiatric assessor, Prof. Channi Kumar, followed by Dr Margaret Oates. Regional assessors followed in 2006-8. The importance of psychiatric illness was recognised by WHO in 2012 when suicide was categorised as Direct death. Suicide and substance abuse are the main causes. Most deaths are Late (> 42 days after birth) and under-reporting is a problem. All social classes are at risk of suicide but social deprivation increases the risk of death from substance misuse. Screening for mental health disorder is now standard practice at booking. Good communication between primary care and maternity services is essential. Red flag indicators of risk should lead to review by a senior clinician and possible referral to a mother and baby unit. Risk factors include failure to restart medication after pregnancy. Each area should have a clinician responsible for the perinatal mental health service. The 2009-13 Report recommended regional networks to coordinate care. Rapid referral may be needed and the 2017-19 Report identified a lack of clear pathways into care. Management of substance misuse needs integrated multidisciplinary specialist services.