I HAVE been following with interest and apprehension the proposals in the document Children and Families First.

I am employed as an associate specialist in ophthalmology by the Pennine Acute NHS Trust, and have particular interest in the services for premature babies.

For at least 12 years, I have been responsible for the ophthalmic screening of some premature babies in Rochdale and Bury. Since March this year, I have also undertaken this screening at North Manchester General Hospital.

The babies I screen are either born very prematurely (less than 32 weeks) or have a very low birthweight (less than 1500 grams). I see a larger number of these babies at Fairfield than either other site. This indicates to me that should this unit close, a larger number of parents will have to travel to visit their baby at a time when bonding is very difficult as so many of these little ones are in an incubator. Is this the best for the babies and their families?

It has been asked why consultants and other senior medical staff have not made their views known earlier. The reason is the existence of the document Children and Families First was very poorly publicised. It was only through reading correspondence in the Bury Times that I became aware of its existence.

Meetings of any sort have, similarly, been poorly publicised. Despite screening babies at three sites in the Trust, I have never been made aware of any workshop concerning possible changes. Some time ago, I read a short paragraph in the Bury Times expressing regret that more people had not attended a "consultation" meeting concerning possible suggestions for changes in child healthcare. I discovered that the announcement had been under Public Notices I strongly suspect that I am not alone in not perusing that section of the newspaper closely.

Despite the fact that I screen babies in three special care baby units (Rochdale, Bury and North Manchester), I only became aware of the existence of this Children and Families First document following many letters in the paper. Even then the advice was "look at the website". How many people have access to the internet?

The document is very complex, and written in a manner which many people will find difficult, if not impossible, to follow. It is also arrogant. "The proposals contained within this report will achieve these objectives". Until any proposal is adopted, there is no guarantee that any change will be beneficial. Many changes in the Health Service (starting with the Salmon Report in the 60s) have not achieved their aim.

Page seven (subsection e. neonatal intensive care) paragraph eight "the evidence strongly suggests". I cannot see that this evidence is presented, nor is the source of this evidence quoted.

Of the three baby units I attend, Fairfield is the busiest, certainly in terms of the numbers, and frequencies, of babies I see.

Encompassing all services on one site does have advantages. Since departments at Bury General were moved to Fairfield, I have less travelling, and easier close contacts with colleagues. Against that, the move to Fairfield has increased congestion. I frequently pass Fairfield en route to Rochdale. In the mornings, traffic congestion is much more marked. If a mother has to be transferred to another hospital during peak travelling times, the journey will be much slower.

Emergencies happen, despite all planning. I am aware of at least one extremely premature baby who was born precipitously in a taxi outside the maternity unit. There were paediatric staff capable of resuscitating him. Had there not been, it is unlikely he would have lived.

As an ophthalmologist, I only screen a small well-defined proportion of premature babies requiring special care. If I am unaware of one case, how many are there?

The document does not mention any possible impact on the recruitment of staff. Will nurses at Fairfield be prepared to travel to another hospital? Certainly a number of them travel quite a distance already.

On a personal note, I am aware of the tiredness induced by having to visit a loved one in hospital while maintaining a home and dependent children. Some years ago, my wife spent three weeks as an in-patient at North Manchester General and Bury General; both a lot more accessible than either Bolton, Hope or St Mary's. At that time, we had two young children. Besides caring for them, and general care of the home, I was working full time. I was exhausted. Had my wife required "super" specialist treatment, of course I would have travelled to Hope or St Mary's, but without that additional journey, I was exhausted. I did not start tired; I had not had a pregnancy, however short; I had not undergone a difficult labour, or emergency surgery. How about these mothers?

At some times, special care baby units have had to refuse admissions; partly due to the number of babies already being cared for, and partly due to shortage of staff. Let us look at these two factors:

1. The number of babies. Obviously the units cannot alter the number of babies requiring admission. The only way to alter this might be through persuading some mothers of the importance of antenatal care. It will not be accomplished by having fewer units with a greater geographical separation. But will the single units proposed have sufficient capacity to cope with so many admissions?

2. The number of staff. All units are already short staffed. Will the situation improve by having a small number of units? Will staff be prepared to travel further? When I moved here over 30 years ago, it took me only 20 minutes to reach Birch Hill Hospital, Rochdale. Now it takes 45 minutes, sometimes over an hour.

While acknowledging that improvements can always be made, I cannot accept that the proposals for the special care baby units are anything but retrogressive.

DR PETER NORTH