Reduction in the number of neonatal intensive care units correspondence: FOI release

Information requested

All external correspondence involving Scottish Ministers relating to the reduction of the number of neonatal intensive care units (NICU) from eight to three as per the Best Start policy

All Internal correspondence involving Scottish Ministers relating to the reduction of the number of neonatal intensive care units (NICU) from eight to three, per the Best Start policy

Between 1 January 2021 and 15 September 2025.

Response

While our aim is to provide information whenever possible, in this instance the costs of locating, retrieving and providing the information requested would exceed the upper cost limit of £600. The reason for this is that in order to locate and retrieve that information, we would need to conduct a search of all records held by the Scottish Government over the 4-year period.

Under section 12 of FOISA public authorities are not required to comply with a request for information if the authority estimates that the cost of complying would exceed the upper cost limit, which is currently set at £600 by Regulations made under section 12.

You may, however, wish to consider reducing the scope of your request in order that the costs can be brought below £600. For example, you could specify the subject matter further of the correspondence you are interested in or restrict your request to a shorter period of time, as this would allow us to limit the searches that would require to be conducted. You may also find it helpful to look at the Scottish Information Commissioner’s ‘Tips for requesting information under FOI and the EIRs’ on his website at:
http://www.itspublicknowledge.info/YourRights/Tipsforrequesters.aspx.

However, I would like to provide you with some addition information as to why this decision has been made to move to a new model of neonatal care for Scotland which aligns with existing neonatal intensive care service models across the UK.

The announced new model of neonatal intensive care was recommended by The Best Start 2017 report following evidence that providing specialist care in units that care for higher numbers of very preterm babies gives the best survival chances and clinical outcomes. These are babies who are born at less than 27 weeks gestation, weigh less than 800 grams, or who need multiple complex intensive care interventions or surgery.

The Best Start also recommended that new models of neonatal care should be based on the BAPM (British Association of Perinatal Medicine) definitions of levels of care. This moves us away from the previous descriptions of units as level 1, 2 and 3, and describes units as Neonatal Intensive Care Units, Local Neonatal Units and Special Care Baby Units, terminology which is already well recognised in the Scottish neonatal community.

Based on the small numbers of these babies born in Scotland, The Best Start recommended that we would need three units to provide this level of neonatal intensive care.

The Best Start Programme Board initiated an options appraisal process to identify where the three neonatal intensive care units would be located. The process of determining which units should be providing Neonatal Intensive Care was undertaken by an expert group, including clinical leads and service user representatives, and their recommendations, published within the Options appraisal report, that Queen Elizabeth University Hospital, Edinburgh Royal Infirmary and Aberdeen Maternity Unit should be designated as the three Neonatal Intensive Care Units for Scotland was accepted by Scottish Ministers.

All remaining neonatal units will continue as local Neonatal Units to provide neonatal care for their populations. Local Neonatal Units, will continue to offer care for the vast majority of babies, including a level of intensive care, and will be able to care for singleton births over 27 weeks gestation. You may be interested in the Framework for Practice ‘Criteria to Define Levels of Neonatal Care including Repatriation within NHS Scotland’ which was published on the same day as the announcement and describes the new model of care.

For babies who are required to be within one of the three Neonatal Intensive Care Units, as soon as they are well enough, they will be moved to their local neonatal unit for any ongoing care.

In advance of these changes, we have tested the model in two early implementer areas, involving four units, to ensure that we get the approach and transition right for clinicians and families. The first is in the west between Glasgow’s Royal Hospital for Children at the Queen Elizabeth University Hospital and University Hospital Crosshouse in Kilmarnock. The second is in the east between Simpson’s Centre for Reproductive Health at the Edinburgh Royal Infirmary and the Victoria hospital in Kirkcaldy.

The testing phase of the new model, including transfer pathways and repatriation is operating well, with only a very small number of out of pathway transfers.Learning from the testing continues to inform change as we move forward with full implementation of the model across Scotland.

This model is supported by a range of stakeholders and clinicians, including Bliss the leading charity for babies born premature or sick, 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.

The Best Start aims to keep mums and babies together as much as possible therefore, if it is identified during the pregnancy that there is a high risk of the baby (or babies, in multiple pregnancies) needing highly specialist intensive care after birth then all antenatal care will be planned with the input of a specialist maternity team, and with an expectation that the woman will be admitted to a maternity unit in a hospital with a NICU on site when it is time to deliver.

If a pregnant woman goes into extreme pre-term labour, or looks like she is going to, depending on the timing of this, either: she will be transferred by ambulance to a maternity unit in a hospital with a NICU on site, if it is safe to do so, to deliver the baby there; or, if there is no time to transfer the woman before birth, the baby will be delivered in her nearest hospital and given immediate short-term intensive care on site to stabilise the baby, before being transferred to a NICU by the specialist neonatal transport service ScotSTAR when it is safe to do so.

The same level of care will also be provided to the mother who, once stable enough, will also be transferred to the maternity unit within the same hospital as her baby.

The Best Start emphasises parents as key partners in caring for their baby and aims to keep mothers and babies, and families together as much as possible in the crucial early weeks, with services designed around them. We have a number of measures already in place to support families who have babies in neonatal care including:

• Providing accommodation for parents to stay on or near neonatal units;
• Roll out of the Young Patients Family Fund (formerly the Neonatal Expenses Fund) to support families with the costs of travel, accommodation and food whilst their baby is in neonatal care;

and

• Repatriating babies to their local neonatal units as soon as clinically possible.

As we now move forward with implementation of the New Model of Neonatal Care, we will now work with all health boards affected to plan for this service change.

This decision has been made on the basis of evidence that this change will improve outcomes for these very smallest and sickest babies. It is our understanding that parents would very much expect us to act on such evidence in the best interests of their babies.

About FOI

The Scottish Government is committed to publishing all information released in response to Freedom of Information requests. View all FOI responses at https://www.gov.scot/foi-responses.