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Objectives: ENT has a high paediatric workload. National recommendations for provision of paediatric surgical services are provided by three key documents produced by the Department of Health and Royal Colleges of Surgeons and Anaesthetists. This second cycle audit assesses the current state of paediatric services in ENT departments in England and Wales based on these recommendations and whether progress has been made since the first audit in 2003., Methods: A hyperlinked web-based questionnaire was e-mailed to ENT consultants in 164 ENT departments. The questionnaire addressed key areas recommended in the guidelines - theatre and anaesthetic provisions, inpatient/outpatients facilities and staff training. The responses were categorised according to hospital type - teaching hospitals, large or small district general hospitals and specialist stand-alone hospitals., Results: An overall response rate of 56% was achieved. Children's ward facilities remained high across all types of hospitals, with most having dedicated paediatric medical cover and specialised staff. There was an improvement in the number of staff qualified to provide paediatric life support. The level of anaesthetic supervision and expertise in theatres improved, as did the overall level of post-operative management. However, the provision of acute pain services remained relatively low., Conclusions: Overall there has been an improvement in the provision of paediatric surgical services in accordance with the guidelines but there remains variability in some aspects relating to the size of the hospital., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Otolaryngology is the surgical speciality with the highest paediatric workload, accounting for 29% of the total. Children are not miniature adults and require specially trained staff, equipment, facilities and an environment appropriate to their needs. Documents from the Department of Health and the Royal Colleges of Surgeons and Anaesthetists have been published outlining national standards and recommendations for paediatric surgical service provision. We undertook an audit to assess the current state of paediatric services in ENT in England and Wales and how they conform to these guidelines., Method: A database of ENT departments in England and Wales was constructed and a postal questionnaire sent to a named consultant in each unit. The questionnaire encompassed the areas of recommendation outlined in the aforementioned reports. Respondents were also asked to state the kind of hospital in which they worked so a further breakdown of the results could be made., Results: One hundred and eighty-nine units were included in the audit with a response rate of 56%. Structurally the documents recommend that each unit has a dedicated named paediatric ENT consultant and a designated clinical lead for children's surgery. This is being met in 54.7% and 56.6%, respectively. Omitting the specialist stand alone group the paediatric facilities in theatre were of a lower standard and overall only 30% met the requirements set by the reports. This theme continues when analysing the data of the provision of anaesthetic services with only 50% of the small district general hospitals having the appropriate level of supervision and expertise. One of the worst met targets is that of acute pain service being provided in only 26% of the hospitals that responded. Overall there is a common theme with the specialist stand alone units scoring the highest and the small district general hospitals scoring the lowest., Conclusion: This audit reveals that we are not meeting the guidelines in nearly 50% of the targeted areas. Paediatric care should be "child centred" and if we are not able to provide this specialised care then paediatric surgical services could be forced into centralisation.