Objectives The objective of this study was to identify what children and young people in a health district in a large urban area experience as positive -and not so positive -about their local health services, in the light of a growing expectation that users play a more central role in the design and delivery of services.Design A qualitative study incorporating a range of methods, including interviews, play techniques and a website.Setting Schools, nurseries, community groups, in-and outpatient settings in an inner London health authority.Participants Young people aged between 4 and 19 years, from community (n ¼ 92) and clinical (n ¼ 57) settings. This included Ôhard-to-reachÕ children, including those leaving care, those in touch with the criminal justice system, asylum seekers, and those with learning disabilities.Results Alongside planning and environment issues, young people particularly emphasized the impact of communication and relationships with staff on their experience of health services.Discussion and conclusions Using a range of flexible and ageappropriate techniques, young people, even those as young as 4 or 5, are able to comment helpfully on their experiences of service provision. What children had to say is revealing but not astonishing to those working in the National Health Service (NHS). Clinicians and managers, to whom our findings were fed back, made this clear. If we have known for so long that the issues raised here are problems, why are we so poor at acting on this knowledge? The authors suggest four explanations.

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Intentional injury is responsible for an average of 335 deaths of children and teenagers each year in England and Wales. Unlike for unintentional injury, there has been no reduction in death rates from intentional injury, which now accounts for 25 per cent of all injury deaths. There is a steep social class gradient in intentional injury death rates, which has widened over the period 1980-1995.

Procedures can be developed for recruiting people with diverse cultural backgrounds to take part in research. This helps to address the issue of possible bias in generalizing research findings by increasing external validity, and respects the ethic that everyone should have the right to be eligible for inclusion in research.