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Abstract
The sustainability of two currently practices now common in UK paediatric neurosurgery are examined. These are service provision by surgeons who also treat adults, and provision without a specific on call rota. It is argued that either both are sustainable or neither but not one without the other. The consequences of these two possibilities are considered. If neither practice is sustainable the medium to long term result will be fewer paediatric units with no emergency service provided by adult units. If both practices are sustainable there would be more paediatric units treating fewer cases each, but a greater likelihood that adult only units could continue to provide emergency paediatric surgery.
Declaration of interest: The author is employed as a neurosurgeon treating adults and children.