Maternity and neonatal care - Best Start implementation: FOI release

Information requested

Information relating to the recent decision by the Scottish Government to downgrade 5 neonatal units in various Scottish hospitals.

Specifically focused around any assessments undertaken by Scottish Government or related parties by way of any impact assessments or risk analysis that details the expected impact in downgrading the five units and the potential impact this could have on baby care or mortality rates once the units are downgraded.

Response

While our aim is to provide information whenever possible, in this instance we are unable to provide the information requested under section 25(1) of FOISA, we do not have to give you information which is already reasonably accessible to you.

If, however, you do not have internet access to obtain this information from the website(s) listed, then please contact me again and I will send you a paper copy.

A full EQIA was carried out and has been published under Supporting documents - Maternity and neonatal care - Best Start implementation: equality impact assessment - gov.scot  covering the implementation of The Best Start as a whole thematically, as some of the individual recommendations are more complex and multi-faceted than others. In this way, implementation of each of the 76recommendations is considered in a proportionate manner.

• Continuity of carer.
• Person-centred maternity and neonatal care.
• Multi-professional working.
• Safe, high quality and accessible care.
• Re-designing neonatal care and services.
• Supporting the changes.
• Wider implications.

It should also be noted that, for the implementation of recommendations which are being led locally, it is expected that Health Boards will undertake their own Impact Assessments to satisfy their local requirements. This EQIA therefore takes national implementation as its primary focus. The EQIA was commenced in 2020 and remains a live document as implementation of the Best Start continues.

The recommendations for the new neonatal model of care are underpinned by strong clinical evidence that population outcomes for the most premature and sickest babies are improved by delivery and care in units looking after a “critical mass” of these babies. These include access to on site paediatric, surgical, laboratory and radiology services, which is beneficial for the most preterm babies.

The review of evidence that informed Best Start was was carried out by Dr Anna Gavine, Dr Steve MacGillivray and Prof Mary Renfrew of the University of Dundee - Maternity and neonatal services: efficient evidence review. The evidence showed that outcomes for very low birth weight babies (VLBW) are better when they are delivered and treated in NICUs with full support services, experienced staff,and a critical mass of activity.

This evidence has been further underlined by updated publication of the British Association of Perinatal Medicine (BAPM) Framework for Practice in 2021, which sets out optimal arrangements for Neonatal Intensive Care in the UK, and outlines that Neonatal Intensive Care Units in the UK should have a throughput of at least 100 new very low birth weight admissions per year.

To meet the needs of our population the Best Start report recommended that we move to three neonatal intensive care units (NICU’s) supported by the continuation of current NICUs redesignated as Local Neonatal Units (LNU’s).

An options appraisal was undertaken by an expert group, including clinical leads and service user representatives, based on the evidence, now underpinned by BAPM Guidance as highlighted above, that outcomes for the most premature and sickest babies are improved by delivery and care in units looking after a critical mass of these babies, with experienced staff, and with full support services. These services include access to on-site paediatric, surgical, laboratory and radiology services, which are beneficial for the most preterm babies.

You can find more information on the extensive engagement process that informed the review of maternity and neonatal services, which led to publication of The Best Start report in chapter four of The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland (www.gov.scot)

The Best Start: A five Year Forward Plan for Maternity and Neonatal Care was published in 2017. It setout a future vision for maternity and neonatal care which focuses on putting women, babies and families at the centre of maternity and neonatal care to ensure they receive the highest quality of care according to their needs.

The engagement process throughout the review with mothers, partners and families provided significant insight into the current service provision. It also identified areas where improvements should be made. Staff highlighted many examples of innovative practice and service provision where teams across NHSScotland were working together to provide high quality, person centred care. They also outlined opportunities for improvement.

Listening to the views of service users, staff and service providers was critical to the Review and an extensive engagement programme was undertaken in all of Scotland’s NHS territorial Board areas.

The Best Start recommended that Scotland should move from the current model of eight Neonatal Intensive Care Units (NICU) to a model of three units within five years supported by the continuation of current NICUs redesignated as Local Neonatal Units (LNU). These Local Neonatal Units will continue to provide a level of neonatal intensive care, but the care for the most preterm and sickest babies receive specialist complex care in fewer NICUs, while returning babies to their local area as soon as clinically appropriate.

In advance of these changes, we have also 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 continue to inform change as we move forward with full implementation of the model across Scotland.

The Scottish Government has consulted with families on implementation of the proposals so that their concerns and priorities are included when the pathways and processes for the new model of care are designed. A survey was launched on Citizen Space on 21 June 2024 followed by targeted focus groups. The results of the survey and focus groups has been shared with the Perinatal Sub Group, Regional Chief Executives, Regional Planners, and the Neonatal community to support implementation.

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