Better Health, Better Care: National Delivery Plan for Children and Young People's Specialist Services in Scotland

The National Delivery Plan meets a key milestone in the commitments set out in Better Health, Better Care. It establishes a national infrastructure for the sustainability of specialist children's services in Scotland, not just in the specialist hospitals but also in District General Hospitals and in the community: it identifies work that needs to take place at a national and regional level to sustain and develop services, drawing down the additional £32 million commited over the 3 financial year


15. In response to the pressures and challenges facing specialist children's services and the recognised desire to address these issues in a collaborative and equitable manner across Scotland, the National Steering Group for Specialist Children's Services was established in 2006.

16. Building on earlier work, including a previous review of Tertiary Paediatric Services (2004), and informed by clinical and organisational opinion regarding issues of immediate priority, the National Steering Group initiated a range of workstreams looking at both individual specialist services and cross-cutting themes (Table 1). The reports generated by the various workstreams can be accessed on the National Steering Group website

Table 1 - National Steering Group Workstreams

Clinical Specialties

Cross-Cutting Themes


Planning and Commissioning




Models of Care


Age Appropriate Care

Complex Respiratory


Critical Care

Remote and Rural

Inherited Metabolic Disease


General Surgery of Childhood

17. Although extensive, it was always recognised that the range of specialty services covered was ultimately selective. In part this reflected the fact that some areas of specialist children's services had either been the subject of recent separate reports and guidance including, in particular, Child and Adolescent Mental Health or were being considered within parallel workstreams addressing both adult and paediatric services, for example neurosciences and laboratory services.

18. The National Delivery Plan does, however, acknowledge and incorporate the requirement to undertake further work to ensure that issues of sustainability, access and quality are identified and addressed across the full range of specialist services for children and young people.

19. The proposed content of the National Delivery Plan was considered at a national conference in November 2007 and, subsequently, through consultation on a draft Delivery Plan launched in March 2008. Full details of the consultation exercise, the responses received and the Scottish Government's response can be accessed at and

20. The consultation demonstrated broad support for the National Delivery Plan and welcomed the significant investment being made available to enable real and sustained change. The challenges facing specialist children's services were seen to have been accurately represented and there was widespread agreement that the service needs identified for early action reflected immediate priorities.

21. Key issues raised through the consultation included the:

  • Need for clarity and confidence as to how additional resources would be applied to gain maximal and sustained benefit.
  • Magnitude of the workforce issues, both in terms of staff training and development and also recruitment and staffing levels.
  • Benefits of networks and the need to explore the further development of networked service models.
  • Value and potential increased role of telemedicine, particularly given the pattern of population and service distribution in Scotland.
  • Importance attached by young people themselves to age appropriate facilities, services and care.

22. The consultation also reiterated the clear desire, already recognised in the draft National Delivery Plan, to incorporate other specialty areas which have not been the subject of review, either through this or any parallel process, and which face similar challenges. Particular examples raised included; anaesthesia, radiology, surgical sub-specialties, asthma, palliative care and child protection.

23. The Scottish Government welcomes this consultation response, particularly given the breadth of contributions from across the NHS and, very particularly, from children, young people and their families. The results of the consultation have been incorporated into this National Delivery Plan and will continue to inform the work of the Specialist Children's Services Implementation Group which has been established to take this work forward.

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