Maternity and neonatal care - Best Start five-year plan 2017–2024: report

Foreword

When ‘The Best Start: a Five-Year Forward Plan for Maternity and Neonatal Care in Scotland’ was published in 2017, the key objective was to focus on the individual needs of each and every family, to improve the quality and safety of maternity and neonatal services and secure improved health and wellbeing for mothers and babies.

As chair of the Strategic Review of Maternity and Neonatal Services I laid the foundation for the ‘Best Start’. As chair of the Best Start Implementation Programme Board, I have witnessed the remarkable dedication and efforts from those across Scotland committed to meeting that goal. Their commitment is truly inspiring and continues to generate the positive changes we are seeing in our maternity and neonatal services. Together, we are making a profound difference.

We set out to deliver a transformation of maternity and neonatal services, guided by the best evidence and designed to meet the needs of women, their babies, partners and families. The original Best Start implementation period of 2017 to 2022 was interrupted by the Covid-19 pandemic, which had a significant impact on our health and care services and services providing maternity and neonatal care. Recognising these challenges, we extended the Best Start delivery timelines by two years to account for this unprecedented period. The pandemic underscored the importance of delivering care close to home and adopting innovative approaches. Many of the successful strategies developed out of necessity during this time continue to be employed now.

Over the past seven years, an extraordinary amount of work has been accomplished by teams within local and national Health Boards, in Best Start Subgroups, and in national bodies, each with their own part to play in this journey. I am extremely proud to present this report, which details the improvements made across Scotland. It is the culmination of the hard work of many individuals and recognises real, tangible improvements which are having a positive impact on those who use our maternity and neonatal services. On behalf of the Implementation Programme Board, I would like to express my sincere thanks for your dedication and hard work. I would also like to thank everyone who contributed their stories. They provide valuable insights and add a new dimension to the report.

Finally, I would also like to thank every member, past and present, of the Implementation Programme Board, who have overseen the delivery of the Best Start and those who have participated in our subgroups. It has been an honour to chair this group, and I truly believe that we have made significant improvements to the experiences of women, babies, partners and families who rely on our maternity and neonatal services during such a significant time in their lives.

Jane Grant

Chair of Best Start Implementation Programme Board

I am pleased to present this report which demonstrates the remarkable progress made in fulfilling the 76 recommendations of ‘The Best Start: Five-Year Forward Plan for Maternity and Neonatal Services in Scotland’.

Providing safe, high-quality maternity and neonatal care is fundamental to our goal of ensuring that all children in Scotland have the best possible start in life. It is also essential to fostering positive physical and mental health and wellbeing for women during their maternity journey. We know that there is a link between maternal health and lifelong health, wellbeing and attainment of children. That is why the recommendations of the Best Start are so important, and I am delighted to see that there has been such significant progress.

The vast majority of the Best Start recommendations are now complete and fully integrated into maternity and neonatal services provided by our Health Boards. Women receive care that is tailored to their needs and preferences, is planned with their input, and they have the information they need to make informed decisions about their own care. Our services also appreciate the important role partners and wider family can play in supporting the woman and her baby, and more facilities are available so that families can stay together. In addition to these changes, we have seen improvements in the systems which underpin maternity and neonatal care, in areas such as education, data and team training.

Since becoming Minister for Public Health and Women’s Health in March 2023, I have been lucky to visit some of our maternity and neonatal services to see them first-hand. In February 2024 I met staff and families at the Ninewells neonatal unit, celebrating with them as they received their gold standard Bliss Charter accreditation for their high-quality, family-centred care. I am proud that a number of our neonatal units have achieved Bliss Charter accreditation, demonstrating the wonderful care provided to Scotland’s families.

There is still work to be done though, with the implementation of the continuity of carer model of midwifery and obstetric care still underway and due for completion by mid-2026. There is also a significant amount of work taking place to implement the new Model of Neonatal Intensive Care, which will be completed by 2026. It is important to say that no neonatal units will close under the new model, and the smallest and sickest babies will receive their complex care in three designated specialist centres, which evidence shows will improve outcomes for babies. I am grateful for those leading the work to deliver these significant improvement programmes.

Maternity and neonatal care is a key part of the Scottish Government’s Early Child Development Programme, a wider programme of work which aims to renew the focus on the critical pre-birth-to-age-3 stage of development. It is an evidence-informed programme, with prevention at the core, which will provide oversight, focus and better integration of the policies that contribute to early child development, identify gaps and build collaboration across the whole system to address them. The programme’s aim is to reduce by a quarter the proportion of children with developmental concerns identified at the 27-30 month review, in 2030 (from 18% to 13.5%). We are also committed to reducing the inequalities between the most and least deprived areas. We know that the right maternity care contributes to reducing health inequalities for women and families, and improving infant development, through early identification of needs and timely intervention.

It is impressive to see the scale of work which has taken place to meet the vision of the ‘Best Start.’ It is by working together that we can create sustainable change which will have a truly positive impact on Scotland’s families.

I am immensely proud of all those who have been involved in helping to achieve the Best Start vision for maternity and neonatal services, and I hope you enjoy reading about some of the work which has taken place.

Jenni Minto MSP

Minister for Public Health and Women’s Health