This issue of the Archives brings two papers on neonatal transport. The paper of Cusack et al¹ is of a pessimistic key. Reporting from the former Trent Health Region, with its longstanding Neonatal Survey (formerly Trent Neonatal Survey), the authors note that the proportion of inappropriate transfers amounted to as much as 20% of all transfers, with no evidence of decline over a 10 year period. Inappropriate transfer was defined as the transfer beyond the nearest appropriate neonatal service of a baby born in a service’s district or transfer of a baby out of a tertiary neonatal service in the district where it was born. The focus in this paper is on transfers as a remedy for the lack of capacity of the stationary services—as an indicator of insufficiency.

Practising in another country, of the size of the former Trent Health Region but with its own geographical and historical peculiarities, I can comment from a different view. During a visit to Nijmegen, the Netherlands, 10 years ago, I saw my host being taken aside to help make a decision on whether to transfer a pregnant woman by helicopter to Groningen, 150 km to the north. The transfer was to be done because the neonatal intensive care unit in Nijmegen was full, the woman was to be delivered by caesarean section at 31 weeks’ gestation and there was no nearer neonatal intensive care unit with free space. I was astonished. I was …