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Section 3 The Way Forward - A National Delivery Plan
37. In the development of this National Delivery Plan, the National Steering Group ( NSG) recognised that the primary task within its remit was the establishment of 'a service framework that provides the best clinical outcomes achievable for children and young people'. In particular, the future provision of specialist children's services in Scotland should ensure:
- sustainable services;
- best clinical outcomes; and
- local access, wherever possible.
38. A substantial amount of work has been undertaken in respect of each of the individual specialist service workstreams hosted by the NSG. These are:
- Cancer Services
- Complex Respiratory and Cystic Fibrosis
- Critical Care
- Dermatology
- Endocrinology
- Gastroenterology, Hepatology and Nutrition
- General Surgery of Childhood
- Inherited Metabolic Disease
- Rheumatology.
39. Each workstream has developed a report incorporating a list of recommendations for action to ensure the security and development of the relevant services, leading to the progressive improvement of patient outcomes and experiences, over the next few years. These reports offer extremely valuable insights into the pressures and future requirements within individual specialties. The executive summaries and full reports of each workstream are available at the NSG website.
40. The NSG realised that effective service delivery would depend fundamentally on the creation of structures and processes that could support both the immediate and on-going planning, commissioning, organisation and delivery of services on an integrated, country-wide basis.
41. As a result, the emphasis of the National Delivery Plan is not only on the valid, and sometimes clamant needs of the individual specialty services, but also on the infrastructure and processes that will identify pressures and recommendations to be addressed in a consistent, effective and integrated manner.
42. The NSG also recognised that the provision of age-appropriate care is a theme that cuts across the spectrum of specialist services, as well as being relevant to young people requiring primary or secondary care. Many of the young people accessing specialist services will have chronic conditions that involve a significant dependence on hospital-based services. Incoming changes in the upper age limits for children's hospital services provide the opportunity to develop facilities and services focused on the specific needs of adolescent patients as well as robust processes of transition. Section 5 addresses some of these issues, fuller details of which are contained in the report on Age Appropriate Care, which can be accessed on the NSG website.
Further Work
43. As identified earlier in this National Delivery Plan, the work undertaken for the development of the Plan has not covered all the specialty services relating to children. A number of other services were identified during the review process and highlighted to the NSG. Particular areas in which there are known to be concerns about the pattern and sustainability of current service models and where work has been initiated include:
- Diagnostic services including radiology and pathology
- Palliative Care
- Immunology and Allergy
- ENT, Ophthalmic and Dental Surgery
- Critical Care - High Dependency Care
- Paediatric Burns
- Renal and Urological.
44. Some of these have been incorporated into wider reviews including adult services, but there is a specific need to ensure that the elements of the service intended for children and young people is explicitly sustainable. The NSG will require to give consideration, over and above such work as has already been undertaken, as to how the needs of these services should be reviewed and proposals for their development produced. For the present, however, the NSG would wish to identify whether those involved in specialist children's services agree that these specific services do require further consideration and whether there are any other specialties which also require to be included in any ongoing work.
We would welcome your views on the this aspect of the Plan.
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