11 - 2025-12-10 IJB - Paediatric Modernisation Board
North Lanarkshire Council · 10 December 2025
Back to Health and Social Care Integration Joint Board — 10 December 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 11 SUBJECT: Paediatric Modernisation Board TO: Integration Joint Board Lead Officer for Report: Maggs Thomson, Head of Health, NLHSCP Author(s) of Report Pauline Izat, General Manager, Specialist Children’s Health Services Unit DATE: 10 December 2025 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Pauline Izat ☒ Reviewed By: Maggs Thomson ☒ Endorsed By: ☐ 3. EXECUTIVE SUMMARY The report will provide detail of the Paediatric Modernisation Board Structure, objectives and progress of work to date.
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2 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the contents of the report and progress of work achieved to date. 4.2 It is recommended that the IJB note the scale of challenge to delivery of sustainable transformational change. The success of programme delivery will require clinical modelling and clinician support. This has to be balanced proportionately with safe delivery of care whilst transformational work progresses. 4.3 It is recommended that the IJB note that elements of this work are impacted by current service level agreements with tertiary partners. This requires sensitive discussion via regional planning process. 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 6. BACKGROUND 6.1 The Paediatric Modernisation Board was established in current form, formally, in February 2023. The Board is Chaired by Dr Adam, Daly, Associate Medical Director for the Health and Social Care Partnership in North Lanarkshire. Membership is inclusive of professional leadership, operational management colleague and corporate support colleagues (Communication, Digital and HR Teams). Each member was made clear of expectation of their representation and role in delivering this programme of work. 6.2 The Paediatric Board is focussed on modernisation of service delivery and clinical activity generated via acute hospital and aligned community based paediatric services. The delivery of the services within scope of board, inclusive of in-patient care are the responsibility of the Specialist Children’s Health Services Unit, and hosted on behalf of NHS Lanarkshire within North Lanarkshire Health and Social Care Partnership. The Board forms part of NLHSCP Strategic Commissioning Plan and reports to North Lanarkshire CORE, North Lanarkshire Integration Joint Board, South Lanarkshire Integration Joint Board and NHS Lanarkshire. 6.3 The agreed remit of Board is: - Ensure a collaborative, inclusive approach to the design and delivery of a programme of work to implement the Paediatrics Modernisation Programme Plan Yes Health Board ☒ No ☐ N/A ☐
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3 Monitoring the financial position across the Programme, including the use of Scottish Government funding for specific areas of work; Encourage and strengthen links between the Programme, North and South Lanarkshire Paediatrics Services Plans and other relevant strategies of all key partners; Approve Programme documents and deliverables; Monitor the progress of Programme and delivery plans; Approve significant changes to the Programme scope, objectives, deliverables, funding and timescales; Provide assurance that outputs are operationally fit for purpose and implemented satisfactorily; Identify and manage risks and issues ensuring mitigating actions Agree and track benefits realisation and achievement of outcomes Approve Programme closure following implementation and ensure that any end project reports, issues, lessons learned and risks are documented and passed on to the appropriate body. 5 working groups were initially planned and established to progress this work. Not all groups have been fully implemented due to pace of progress. Comms and Engagement – has been interwoven and is responsive to the service improvement work that is being undertaken. Accommodation – accommodation challenges have been limited and been able to be managed operationally to this point. Transition and Interfaces – continues to develop through corporate work being undertaken elsewhere. EHealth (now Digital) – Trakcare activity is now being appropriately logged across acute and community. HR and Workforce – Medical Rota has stabilised. Consultant workforce has remained stable and being positively recruited to. Nursing has required a skill mix and capacity review in response to increasing supplementary staffing challenge. Additional capacity has been supported by partnership due to evidence provided. Regional and National Links – this has been focussed in particular on our surgical pathways. A 3 Horizon approach was taken to prioritisation and phasing of work to be planned and delivered: - 6.4 Horizon 1- covers current issues that require quick response. Nursing Care Assurance Review of Continence Services The Paediatric Modernisation Board are happy to advise that Horizon 1 work is progressing well. The nursing care assurance work has been led by the Associate Director of Nursing and been supported by NHS Lanarkshire Quality Improvement Team. The standards agreed have been inclusive of contributions
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4 made by nurse colleagues who work within paediatric in patient environment and of community based nurses who support specialist care for children within a clinic, their home and/or school environment(s). The Review of Continence Service has been led by Clinical Lead for Community Paediatrics. This has been more challenging to progress due to clinical demands on colleagues involved, changes within continence aligned workforce and assurance work identified that required address prior to full commencement of work. Despite these challenges, a literature review and a review of current service model has been undertaken. Progress and development of an agreed tiered pathway of support has been slower than initially anticipated. This has been due in part to clinical capacity and in part due to negotiation required to assure capacity for early interventions to be firstly offered within universally offered services- Health Visiting. This piece of work aims to conclude by June 2026 We expect further projects to be undertaken subject to availability of clinical staff. Further examples of work already undertaken or in in progress, but not specifically noted in Programme of Works include:- Development and delivery of Hospital at Home Pathways for Constipation, IV Therapy, Neuro Respiratory and Diabetes – various stages of clinical governance approval and will be established by April 2026 FNC support of incoming calls to the Paediatric Unit –commenced week beginning 01/12/2025. Palliative Care pathway – in collaboration with ICCN and CHAS. A nurse led discharge process for Bronchiolitis – Test of Change position 6.5 Horizon 2 -covers emerging issues that are likely to be faced in the next one to three years. Sustainability of medical rota This Horizon 2 focus of work emerged quickly as a clinical risk due to unsustainability of Tier 1 and 2 medical rotas that require to be in place to ensure safe function of in-patient care. Tier 1 is junior trainee doctors who provide the foundation of medical intervention within ward. Tier 2 trainees are higher trainee doctors who are working towards becoming a consultant within paediatrics. This is an important trainee rota to fill as it provides a pathway for interested trainees to return in the future as consultants. If numbers are not coming through and/or they do not have a good trainee experience whilst with us, it will have a negative impact on long term recruitment of these specialist colleagues to Lanarkshire. Tier 3 is our consultant level rota. All rotas are inextricably linked and cannot be separated without negative impact on wider system, and at times on individuals. This fragility of rota is due to a culmination of factors which included less availability of trainees being provided by deanery and increasing numbers of
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5 trainees who want to work less than full time. This has resulted at times, in increased pressures resulting in use of locums and of requests generated to consultants to act down into senior trainee roles. This negatively impacts on planned community care assessment and review and places an additional burden of stress on an already tired workforce. Due to level of risk identified, additional support was approved by Core management team. Additionally, our Medical Director continues to have dialogue with deanery to assure that we are receiving an equitable offer of trainees. This has been successful and as a result we have been offered a further 2 colleagues in 2026.This will ease pressures on rota and improve opportunities for training and development. This will enhance our reputation as a future employer. This piece of work has now concluded and a stable position achieved that will continue to be kept under review. 6.6 Horizon 3 - covers issues that might come into play in the future. New clinical model Key members of the paediatric Modernisation Board have taken time away from the main meeting to consider what next steps should be in advancing our aspiration of a paediatric service that fits current need and will be sustainable in the future. We recognised that main focus until now has been delivery of a stabilised workforce and care assurance position. This approach has been facilitated by Organisational and Development colleague. Going forward, the board leadership team have recognised the need for aspirational goal setting that uses the learning themes from our last 2 years of activity. They include:- Staff Awareness and Understanding of need for change and the activity around it. Importance and awareness of governance infrastructure. Collaborative working and a commitment to move away from siloed care approaches. Importance of staff development and proactive promotion of a positive workplace culture. 6.7 The Paediatric Modernisation Board planned activity has to be considerate of clinical demand challenge that is faced in winter months. The Modernisation Board will complete:- Getting it Right Approach fully completed within ICCN workforce by December 2026 Delivery of a Hospital at Home Service by June 2026 Delivery of a robust complex continence pathway June 2026 Increase medical training opportunities by August 2026
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6 7. SUMMARY OF KEY ISSUES 7. 1 The pace of transformational change has been slowed by limited capacity of clinicians to commit time to service improvement work. This is due to clinical demand, which can be variable throughout seasons of year. 7.2 The lack of a Project Team to support the delivery of this piece of work has slowed progress and delivery of outcomes. This will require to be considered in year going forward. 8. CONCLUSIONS 8.1 The IJB should note the progress of work to date. 8.2 The IJB should note that timescale of progress is balanced with clinical demand and activity and is affected by a seasonal element of intensity due to clinician availability. 8.3 The IJB should note that discussions in regard to service level agreement with regional partners will be supported by NHS Lanarkshire Planning colleagues. 9. IMPLICATIONS There is potential that there will be a shift in balance of care away from acute hospital to community care based sites and/or homes. This has potential further challenge demand for space within local health centres. 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐
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7 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL There are no specific financial implications of work to date. Programme of works is considerate of current financial environment. This paper has been reviewed by Finance: Yes No N/A x 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Scoping event with stakeholders took place in February 2023. This was supported by NL HSCP Project Management colleagues. This event prioritised approach and informed Horizon model. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery This is provided via staff meetings
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8 ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Representation within Programme Boards of community and acute colleagues who interface with acute and community paediatric care. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA is in progress and will be considerate and informed by UNCRC legislation. Yes No N/A In progress EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute)
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9 Maggs Thomson- maggs.thomson@lanarkshire.scot.nhs.uk Members seeking further information about any aspect of this report, please contact the following; Pauline Izat - pauline.izat@lanarkshire.scot.nhs.uk IJB Report Checklist Please note reports that are not completed as per the IJB Reporting Guidance Document or contain mistakes will not be submitted to the IJB and will be returned to the author for amendment. Late reports will only be accepted in exceptional circumstances as approved by Chief Officer / IJB Chair. The correct IJB Template has been used You have consulted the IJB Report Guidance Document Report is written in Ariel 12, Single Spacing Paragraphs are numbered e.g. 1.2, 1.3, 1.4 Spelling and Grammar has been checked Limited use of Appendences Appendences have been added/included in the report after the Chief Officer signature , not as an attachment Report does not include any embedded papers All aspects of the template have been completed including Risk and Finance Section The report has been agreed by the appropriate Chief Officer/ Director/ Head of Health. Report has been shared/ signed off via the appropriate governance structure (Route to Board)
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10 Information details of author is included for members to contact for further information EQIA has been attached to the report – if EQIA has not been completed please state why. Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction
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11 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed