Maternity and neonatal services - neonatal intensive care plan: options appraisal

This report describes the options appraisal process undertaken, and the feasibility analysis and testing to identify which out of Scotland’s current eight neonatal intensive care Units should be the final three Units as proposed by Best Start.

Annex B - Current Status and Work Completed to Date with Implementing the New Model of Neonatal Care

Parents as Partners in Neonatal Care

At a local level, Boards have been supported by the Scottish Government to work towards Bliss Baby Charter accreditation, which will support the ethos of parents being partners in care. The Bliss Baby Charter Scheme accredits neonatal units which deliver the gold standard of Family Centred Care. This means parents are fully involved in decisions about their baby when they are in neonatal care, and that they are supported to be primary care givers, providing as much day to day care as possible for their baby.

All Boards are signed up and are at different stages of accreditation. The Scottish Government continues to support Bliss to roll out the Bliss Baby Charter in Scotland, negating the requirement for Boards to pay a fee to be involved in this process. The Royal Hospital for Children’s Neonatal Unit at the QEUH has become the first Unit in Scotland to be awarded the Gold standard in family centred-care.

The neonatal community have also welcomed the introduction of The Neonatal Expenses Fund (NEF) since 1 April 2018 which supports parents with babies in neonatal care with the cost of meal and travel expenses. Promoted to parents at a local level, NEF supports keeping families together and ensuring that parents are key partners in care. The scope of this fund has now been widened to include all families with a child under the age of 18 in hospital allowing more equity of access for parents and is now called the Young Patients’ Family Fund.

Keeping Mums and Babies Together With Services Designed Around Them

The Best Start recognised that many babies requiring special care could be discharged home earlier if appropriate neonatal/community services were in place and highlighted that significant variance existed across Scotland. Under the umbrella of the Best Start Perinatal Sub-Group, Guidelines for post-discharge follow up, including a model for a neonatal community service, have been developed and published by the National Neonatal Network.

As some aspects of neonatal care will be delivered in fewer NICUs over time, the importance of a consistent approach to repatriation across neonatal services was also recognised. Additionally, The Best Start noted that neonatal care should continue after the baby is discharged home and that a consistent follow up process, supported by clear guidelines should be developed to support families at home. The National Neonatal Discharge Planning and Follow Up Framework was launched in November 2019, supplemented by information for parents on neonatal care. It sets out a Once for Scotland approach to effective discharge planning, repatriation and follow-up neonatal care. It’s publication completes the original asks of recommendations in relation to discharge planning set out in Best Start and the National Neonatal Network will support units in the implementation of the principles set out in this framework. They will also highlight progress, as well as areas of on-going challenge by interval audit and be responsible for hosting the accompanying resources and parental information to support the implementation of this framework.

More families are being enabled to stay together through the introduction of Neonatal Transitional Care. Under the auspices of the Best Start Continuity of Carer Sub-Group a framework for Transitional Care has been developed, which Boards can use as a benchmark for planning development of this service. Since the publication of The Best Start, there has been an increase from two to eight Transitional Care units and in some units this has resulted in a 20% reduction in admissions to the LNU.

Launch of the National Neonatal Network

The Best Start also recommended the creation of a single national neonatal network to facilitate integrated working across NHS Board boundaries, including input from service management and clinical staff, to support the new model of neonatal care. The National Neonatal Network was launched in 2019 and is managed together with the National Maternity Network under the umbrella of the Scottish Perinatal Network (SPN). It aims to encourage collaboration across maternity and neonatal care services and supports the best possible outcomes for mothers, babies, fathers and partners and their wider families.

Since its creation, a Core Steering Group has agreed a work plan which will support the implementation of the new model of neonatal care. It details a number of projects which will create nationally consistent protocols, guidance and care pathways across neonatal services; support NHS Boards with implementation of national or regional pathways at local level as agreed by The Best Start Programme Board/SPN Oversight Board; support appropriate quality assurance, clinical pathways and continuous improvement to further enhance standards of care and outcomes for women and babies; and support CPD and training opportunities.

For example, The Network’s Escalation and Cot Capacity Group has progressed work on guidance for escalation of unit closures and has further developed the ScotCAT tool for determining unit cot and staff capacity. This work has now linked up with the development of national Real Time Staffing Resource tools, led by Healthcare Improvement Scotland in support of full implementation of the Health and Care (Scotland) Staffing Act 2019. Utilising emerging Real Time Staffing Resource tools for neonatal capacity management and escalation will allow these processes to be streamlined and delivered consistently.

A repatriation sub-group has been developed, reporting to the Network’s Steering Group. It continues to support the implementation of the Discharge Planning Framework working with individual Boards to develop streamlined repatriation criteria and cot cards for babies who have transferred to a tertiary centre for care, which details base hospitals and timescales for repatriation. Regular communication meetings have also been set up between boards to facilitate improved communication and sharing of information. Virtual planning meetings are now encouraged that include parents and units are sharing virtual unit tours with parents prior to repatriation to familiarise themselves with the new unit.

The Network has also established a Consultant Forum, (following on from the previous Scottish Neonatal Consultants Group) and AHP Forum. Proposals for a remote and rural forum (to be taken forward across both neonatal and maternity networks) are currently being agreed.

The Network’s Core Steering Group, will report to the IPB, currently serving as the Oversight Board. The Scottish Government will continue to work with the Network to support Boards in establishing processes which will facilitate the implementation of the new model of neonatal care.



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