A DISCUSSION document outlining proposals to shake up paediatric provision in Greater Manchester has sparked off renewed fears for the future of children's service at Trafford General Hospital.

The document recommends a new slimmed-down model for children's healthcare services based on three types of units - and warns that the current number of paediatric inpatient units in Greater Manchester cannot be sustained.

And that has raised concerns over the future of the children's ward and special care baby unit at Trafford General Hospital. Children's services at the hospital were threatened with closure four years ago because Salford and Trafford Health Authority said the unit was too small. It was only reprieved after a massive campaign spearheaded by the Oliver's Army campaign.

The discussion document proposes a set up of three types of unit - a local one providing community services; an area-wide specialist unit, and a 'super-specialist' regional centre. Currently 15 trusts provide child health or paediatric services, which the report says vary greatly in their scope.

The document - commissioned by the chief executives of the six Greater Manchester health authorities - says: "The current configuration of children's secondary healthcare services in Greater Manchester will not support the development of best practice in children's care, and furthermore cannot be sustained in light of the significant 'drivers for change', clinical and non clinical, within paediatric and child health services."

It warns that new European employment legislation will have a major impact. Under the rest time directive, the current level of service could only be maintained if training numbers were doubled - whereas they are likely to fall.

The report says: "The work done is in its early stages but nevertheless a clear message emerges - the current number of paediatric units within Greater Manchester cannot be sustained when new European legislation is fully implemented. The forecasting work indicates that between six to eight 'traditional' 24-hour paediatric units, excluding the children's hospital, can be staffed within Greater Manchester when the legislation is implemented."

But although the document does not pinpoint any units for closure, Oliver's Army founder Angela Gray fears that the services at Trafford General are vulnerable.

The local units in the recommended new set up would provide medical, emergency and community services for children on an 'extended day' basis, for a population of about 250,000. A specialist area-wide centre would include medical, surgical and emergency services for children on a 24-hour basis for a population of about half a million. There would then be a regional super-specialist centre dealing with emergency and specialist admissions, with facilities including dedicated children's surgical, medical and neonatal beds and a paediatric intensive care service.

When SAM approached Oliver's Army founder Angela Gray about the report, she said: "I am devastated - we seem to be back to where we were four years ago. I am very privileged to have been the voice of the community for the past four years and I will fight on to keep the children's services at Trafford General - until the people of Trafford tell me they don't need them any more.

"We need local services. If we didn't have them it is our most deprived areas that would suffer most. People from Partington would have to travel to Wythenshawe - how would they get there?

"We have a brilliant service at Trafford General - it is one of the best children's wards in the North West. They should not shut down what works - and that goes for all the hospitals they are talking about."

She pledged: "If we get definite proposals to close the services at Trafford General, we will resume the campaign to keep them."

Since its successful campaign to save Trafford General's children's services from closure, Oliver's Army has raised thousands of pounds to improve them. It has raised £10,000 for a dedicated Oliver's Army children's unit in the A and E department and £15,000 to renovate the children's ward in a child-friendly way.

It is now aiming to raise £50,000 to provide better facilities for children with special needs.

David Cain, the chief executive of Trafford Heathcare NHS Trust - which runs Trafford General Hospital - said: "Trafford Healthcare NHS Trust is looking forward to playing a full part in the further discussions on children's services as they impact locally and throughout Greater Manchester."

Public consultation on the report is set to get underway in the spring.

? TRAFFORD General Hospital's maternity unit is to receive a £179,300 cash boost, while Wythenshawe Hospital has been awarded £626,000 for its unit. The two hospitals are benefiting from a nationwide Government scheme to upgrade maternity centres.

Thirty North West maternity units will share £13.9 million to modernise and improve facilities.