Publication - Advice and guidance

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

Published: 16 May 2025
From: Minister for Public Health and Women's Health
Directorate: Children and Families Directorate
Topic: Children and families, Health and social care
ISBN: 9781836915447

This report provides insight into the key actions and achievements that have been delivered during the lifetime of the Best Start.

Supporting documents

Key Achievements: Implications for Neonatal Care

Key Achievements: Implications for Neonatal Care (Recommendations 43 – 54)

The Best Start outlined a new model of neonatal service provision which emphasises parents as key partners in caring for their baby; aims to keep mothers and babies together as much as possible, with services designed around them; and suggests care for the smallest and sickest babies is consolidated to deliver the best possible outcomes.

The 12 Best Start recommendations which relate to the new model of neonatal care are underpinned by these principles and include:

involving parents in decision-making and providing care for their baby.
providing funding support and accommodation for parents to stay on or near the unit and facilities within the unit to encourage kangaroo skin-to-skin care and early support for breastfeeding.
development of Transitional Care.
development of clear information for parents.
a model of seven-day neonatal community service to support early discharge and ongoing care.
rotation and skills maintenance structures for staff in smaller units.

Recommendations 43, 44 and 46 – 54

Below are some of the key achievements made in relation to Recommendations 43, 44 and 46 – 55. Some neonatal care recommendations are not relevant to the Island Health Boards (Shetland, Orkney, Western Isles), who do not provide neonatal care.

Bliss is the leading charity for babies born premature or sick. Bliss’s Baby Charter is the leading UK accreditation programme that works with neonatal units to develop, measure and improve partnership with parents. The Baby Charter encourages healthcare professionals to empower parents to be primary caregivers through joint decision-making and hands-on care, as well as understanding families’ needs in order to provide truly individualised care. This facilitates a solid foundation for Family Integrated Care, and achieving Bliss Baby Charter accreditation is an esteemed marker of quality. All Boards in Scotland have registered for the Bliss Baby Charter, with three units having made a pledge of improvement, eight units at bronze, one at silver and two units having achieved gold accreditation, as of December 2024.
Building on the progress with Baby Charter accreditations, the SPN is working with all neonatal units in Scotland, parents and Bliss to further develop a shared, national approach to family integrated care. The initial priority focus in that work is on consistent unit information for parents and support for effective transitions.
The Neonatal care levels criteria: framework for practice was developed by the Perinatal Sub Group (PSG) and published in July 2023. The framework describes a clear service delivery framework across NHS Scotland, defining levels of neonatal care, including repatriation.
The National Neonatal Discharge Planning and Follow-up Framework was published in November 2019. The Framework describes the overarching principles of Discharge Planning and was developed by the National Discharge Planning Group.
The Neonatal Allied Health Professionals in Scotland - Building the Future Workforce report, commissioned by the Scottish Government and written by the Neonatal AHP Workforce Leads team for the SPN was published in 2024. The report summarises the work undertaken and makes recommendations for further development and investment in neonatal Allied Health Professionals to ensure optimal care and outcomes for the sickest and smallest babies admitted to neonatal units in Scotland and their families.
At a local level, Health Boards have been implementing Recommendation 48 – provision of a seven-day neonatal community service. The neonatal Discharge Framework set out that Neonatal community liaison services must be provided over seven days, ensuring safe transition of babies to the community setting. Depending on clinical demand and geography, a seven-day service may be delivered using telephone, face-to-face visits, utilising e-Health, or any combination of these approaches. This recommendation is relevant for the 11 mainland Health Boards which provide neonatal care.
- Four Health Boards report this recommendation is complete and they offer seven-day neonatal community services.
- Two Health Boards offer five-day services and are hoping to expand this to seven days.
- Five Health Boards offer a form of neonatal community care, through community nursing or neonatal outreach staff or core teams who provide this service. This includes one island Board, who report that if a neonate were repatriated from the mainland, they would provide care through GP, Paediatric and Health Visiting services.
- One Health Board is training staff with the expectation of offering a service from 2026 onwards.

NHS Lothian has expanded their Neonatal Community Outreach Team to include seven-day community care for babies from the Simpson’s Centre for Reproductive Health in Edinburgh and St John’s Hospital in Livingston, West Lothian.

Amongst other service developments which have arisen from this expansion is the provision of home phototherapy. Before the expansion of the neonatal community team, babies had to attend hospital for blood tests and be readmitted from home if the jaundice required treatment. However, with the expansion of the Community Team, blood tests and phototherapy treatment for jaundice can now be managed in the home setting, avoiding the need to attend hospital or readmission. It is now unusual to readmit a baby from home for phototherapy.

NES delivered actions to meet Recommendations 50 – 52, which relate to neonatal staffing. Recommendation 50 was a review of the role of Advanced Neonatal Nurse Practitioner (ANNP) staff to ensure their skill set is maximised, with a clear training and development support mechanism to retain and develop staff.

A rapid Service and Educational Needs Analysis was conducted in September 2021 to explore the current clinical and educational considerations for both ANNP and Qualified in Specialty (QIS) Neonatal Nursing. All regions identified a need for continued development of existing and new ANNPs.
Their positive contribution to service provision was reported as extensive and combined both their expert clinical contribution as well as support for neonatal services and education and training more broadly.
An Advanced Neonatal Nurse Practitioner Capabilities Framework | British Association of Perinatal Medicine (bapm.org) is available, as well as the refreshed Advanced practice toolkit | Turas | Learn (nhs.scot). The role of the ANNP will also be captured within the relaunched Transforming Roles activity.
Scottish Neonatal Nursing Group (SNNG) is providing a forum for Scottish ANNPs to meet, share best practice and collaborate.
Continuing professional development (CPD) and skills maintenance support is ongoing. Rotation and skills maintenance discussions will progress following the formal announcement of the new model of neonatal care in Scotland.

Recommendation 51 was that Neonatal Nursing Qualified in Speciality and Advanced Practice education should continue to be available and quality assured to ensure it meets course requirements and the demands of the new models of care.

To explore the contemporary educational and clinical considerations for Qualified in Specialty (QIS) Neonatal Nursing a national listening event was held on 19 November 2021.
The key outcome of the listening event was the need for a SLWG to progress any necessary development work. As a result, two task and finish groups were created. The ‘Competency and Capability’ group focused on Recommendations 51 and 52 with the first meeting held in April 2022. The ‘Sustainable Education and Professional Development’ group focused on Recommendations 50 and 54 with the first meeting also held in April 2022. Both groups subsequently met several times to complete their work.
Following in-depth discussions with key stakeholders at an SLWG in May 2023, it was agreed that QIS should continue to be provided as an educational programme rather than a training programme.

Recommendation 52 was that non-registered neonatal staff should have a clear role definition, competency framework, training and skills pathway to ensure they can work flexibly across all aspects of care.

The activity for this recommendation is closely linked to that of Recommendation 24 outlined above.
The key role for NES was to support the secondment of an experienced neonatal nurse educator to refresh the neonatal competency and capability framework for both non-registered and registered staff working in neonatal care.
Through close collaboration with clinical service representatives at all levels in an SLWG this was developed and supported the work-based component of the Edinburgh Napier University provision.
Development of non-registered neonatal staff is contained within the Perinatal HCSW activity for Recommendation 24 (see above). This provides a range of specific capabilities at Levels 2 - 4 and provides the foundation for future work to develop a Neonatal Care Assistant (NCA) role, comparable with the existing Maternity Care Assistant (MCA) role established within maternity services. This will also support future workforce diversification within neonatal services, both in hospital and within community settings.
Since 2017, Scottish Multi-Professional Development Programme (SMMDP) has delivered more than 800 courses to over 8,500 maternity and neonatal health care staff, including prehospital clinicians, e.g., GPs, paramedics etc. Key courses that support the safe and effective delivery of maternity and neonatal care in Scotland.

NES worked closely with Health Boards, Clinical Educators, the National Neonatal Network and Scottish Neonatal Nurses Group and other stakeholders during the process of progressing these recommendations. A report on the progress of each recommendation is included in Annex A.

Recommendation 53 identified that an adequate number of general paediatricians with a special interest in neonatology should be trained. This recommendation was progressed through the Workforce and Education subgroup of the Best Start Implementation Programme Board, which highlighted this to Deanery Training Managers.

Finally, Recommendation 54 stated that a formalised and structured approach to rotation and skills maintenance for staff in smaller units should be developed and resourced through the appropriate Managed Clinical Network. This will be considered as part of the implementation of the new model of neonatal intensive care. The Scottish Government asked Regional Chief Executives and Regional Planners to highlight arrangements for ongoing professional development of staff where required within the region as part of the Regional Plans for implementation of the new model of neonatal intensive care.

The New Model of Neonatal Care

Recommendation 45 of the Best Start report stated that the new model of neonatal care services should be redesigned to accommodate the current levels of demand. It was recommended that Scotland should move to a model of three-to-five neonatal intensive care units (NICUs) in the short term, progressing to three units within five years supported by the continuation of local neonatal (LNU) and special care units (SCU). It was also recommended that formal pathways should be developed between these units, to ensure that clear agreements are in place to treat the highest risk preterm babies and the sickest term babies in need of complex care in fewer centres, while returning babies to their local area as soon as clinically appropriate.

This recommendation is aimed at the most premature and sickest of babies and is based on evidence which shows that outcomes for very low birth weight babies (VLBW), are better when they are delivered and treated in Neonatal Intensive Care Units (NICUs) with full support services, experienced staff and a critical mass of activity (defined as care for a minimum of 100 VLBW babies a year). This is in line with a framework for practice from the British Association of Perinatal Medicine (BAPM), published in 2021.

The PSG of the Best Start IPB was asked to take forward implementation of Recommendation 45 and identify which of Scotland’s current eight NICUs should be the final three units. This process began in 2018 and was supported by NHS National Services Scotland (NSS).

The PSG’s options appraisal report was published in July 2023. The report describes the options appraisal process undertaken, and the feasibility analysis and testing that followed the conclusion of that process. In addition, it outlines the review undertaken following the pause brought about by Covid-19, including consideration of additional evidence and data since the publication of the Best Start, and an assessment of readiness of the proposed final three neonatal intensive care units. The report recommended Queen Elizabeth University Hospital Glasgow, Edinburgh Royal Infirmary and Aberdeen Maternity Hospital as the locations of the three NICUs in Scotland.

Testing

At the request of the then Cabinet Secretary for Health, to enable a better understanding of the processes required to implement the new model of neonatal care, the model was rolled out first in two sites in Scotland to enable testing of the entire model ahead of wider roll-out.

In February 2019, the test sites were announced as University Hospital Crosshouse and Queen Elizabeth University Hospital in the west, and the Victoria Hospital and Edinburgh Royal Infirmary in the east.

Health Boards were asked to roll out a range of aspects of the new model of neonatal care, including the new model of neonatal intensive care, to enable better understanding of the implications for patient flow associated with other aspects of the new model.

Planning Groups were established in the west and the east, which included representatives from the PSG. These Early Implementer Boards reported progress with establishment and operation of the new model to the PSG.

To inform roll-out of the new model, the PSG developed the following documents:

1. Criteria to Define Levels of Neonatal Care Including Repatriation Within NHS Scotland: aFramework.

This framework describes:

the management of babies who require Intensive Care, High Dependency Care or Special Care.
the safe and efficient transfer of babies to the most appropriate care facilities to receive care to meet their clinical requirements.
the safe and effective repatriation of babies to the nearest appropriate care facility as soon as clinically indicated.

2. Neonatal Care: Information leaflet for women inScotland

This leaflet provides information for families on the new model of care, different levels of care and where care is provided, and what to expect in the event of the need to transfer mother and/or baby.

Feedback on the framework and the leaflet was sought from the early implementers as they tested the process.

The model is supported by a range of stakeholders and clinicians, including Bliss (an organisation that champion the right for every baby born premature or sick to receive the best care) who recognise that this new model of care is based on strong evidence and will improve the safety of services for the smallest and sickest babies.

Next Steps

The following work has been carried out, is underway or planned.

Modelling work. The Scottish Government commissioned RSM UK to provide detailed analysis of the capacity requirements of the new model. The neonatal intensive care unit services final report was published on 29 May 2024 and has been provided to the regional planners to progress with implementation.
Regional Planning are leading planning and implementation and have nominated a lead Chief Executive in each region. Planning and implementation will be informed by the outcomes of the modelling work, and the testing that has been underway over the last few years. The Scottish Government will continue to provide funding to help transition to the new model.
Regional CEs have been asked to produce plans to implement the new model of neonatal intensive care, with a target date for full implementation by 2026.
The Scottish Government consulted with families on implementation of the proposals, so that we could take account of their concerns and views when the pathways and processes for the new model of care are designed. An online new model of neonatal care survey was developed through Citizen Space and targeted focus groups followed.

Rated: Green

Delivery: National Delivery

Contact

Email: maternalandinfanthealth@gov.scot

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