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

Introduction and Overview

Introduction and Overview of the Best Start

In 2017 the Scottish Government published ‘The Best Start: Five-Year Forward Plan for Maternity and Neonatal Services in Scotland’ (hereafter the Best Start). The plan was the result of the Strategic Review of Maternity and Neonatal Services in Scotland, which was announced in early 2015. The aim of the review was to make recommendations for a Scottish model of maternity and neonatal care that contributes to the Scottish Government’s aims of person-centred, safe, and effective care, provides the right care for every woman and baby every time and gives all children the best start in life.

The review authors heard from expert academics and professionals, listened to the views of service users, staff, service providers, and commissioned six evidence reviews, data analysis and analysis papers to inform the review. The review provided 76 recommendations for change.

The Best Start set out a ‘future vision’ of maternity and neonatal services across Scotland, which was that:

• all mothers and babies are offered a truly family-centred, safe andcompassionate approach to their care, recognising their own unique circumstances and preferences.
• fathers, partners and other family members are actively encouraged and supported to become an integral part of all aspects of maternal and newborn care.
• women experience real continuity of care and carer, across the wholematernity journey, with vulnerable families being offered any additional tailored support they may require.
• services are redesigned using the best available evidence, to ensure optimal outcomes and sustainability, and maximise the opportunity to support normal birth processes and avoid unnecessary interventions.
• staff are empathetic, skilled and well supported to deliver high-quality, safe services, every time.
• multi-professional team working is the norm within an open and honest team culture, with everyone’s contribution being equally valued.

Prior to the Best Start the delivery of maternity and neonatal care differed from Board to Board, meaning some began their implementation journey from different ‘starting points.’ The future vision and recommendations were a mechanism for bringing the best standard of maternity and neonatal care to all services across Scotland.

Since 2017, an incredible amount of work has been undertaken across Health Boards, Special Boards and Networks to implement the recommendations. To support this work, the Scottish Government has provided over £30m in Best Start core funding to Health Boards.

There have been many examples of tangible improvement in outcomes, experience and sustainability which this report will explore. There have also been some challenges some of which could not have been anticipated when the Best Start was published. The Covid-19 pandemic had a significant impact on Scotland’s health service, and this required a response to the challenges it brought. A decision was taken by the Scottish Government to pause work on the implementation of the Best Start to ensure Health Boards had capacity to deliver what was required of them during the pandemic. Though Best Start implementation was paused, Health Boards continued to develop aspects of their services to meet the needs of women, babies and families during the pandemic, including increasing use of technology to deliver appointments, consultations and antenatal education.

In 2022 work on the implementation of the Best Start was formally restarted. The implementation deadline of recommendations was revised to mid-2024 to account for the pause. Additional time has also been allocated to two of the most significant and complex service redesign recommendations - the new model of neonatal intensive care and continuity of carer - to provide sufficient time for services to introduce such large changes sustainably. These have implementation deadlines set for 2026 and mid-2026, respectively.

This report provides insight into the key actions and achievements which have taken place throughout the life of the ‘Best Start.’ An evaluation of the implementation and key outcomes of the Best Start is being undertaken separately to this report and will include the two recommendations with longer implementation timelines. An evaluation strategy will be published in 2025. More information about this is available in the section on Further Research.

Information used in this report has been gathered through the monitoring system set up to maintain overview of the progress of recommendations. It includes examples from Health Boards, which have been provided to the Scottish Government for the purposes of illustrating some of the many changes which have taken place since 2017. The last data collection for recommendations due for implementation by mid-2024 took place in April 2024, and this data has been included in the report and summarised in Annex A.

Challenges have also been included to reflect the true scale of the change to maternity and neonatal care. Whilst we could not include all the examples provided, those included show the breadth and scope of changes made, the dedication and hard work of midwifery, medical, clinical and management teams across Scotland and the experiences of some of those who have used these services.

While the implementation timescale for the majority of Best Start recommendations has passed, all recommendations remain in place as national maternity and neonatal services policy. Implementation of those recommendations still underway will continue.