Moray Maternity Services Review: report
Report of the independent review into maternity services for the women and families of Moray, commissioned by Cabinet Secretary for Health and Sport, Jeane Freeman in March 2021.
Appendix I: Action Plan
| Dr Gray's Maternity Model 4 Initiation Phase / Immediate actions | ||||
|---|---|---|---|---|
| Actions | Timeline | Responsible Organisations | Key Stakeholder/s | Outcome |
| Clearly define criteria for delivery in Dr Gray's midwife-led maternity service (removing use of "Life and Limb support" | Within 3 months | NHS Grampian | Mothers and families; Midwifery team Consultant obstetricians (Dr Gray's) Dr Gray's management team |
Clear criteria for maternal deliveries at Dr Gray's and at other sites, Aberdeen and Raigmore |
| Encourage appropriate "autonomy" of decision-making by midwifery staff at Dr Gray's, working within their scope of practice and agreed service / transfer | Within 3 months | NHS Grampian | Midwifery team Dr Gray's management team NHS Grampian maternity service |
Supported and confident midwifery team |
| Agree clear emergency / urgent transfer criteria and triggers between Dr Gray's and Raigmore / Aberdeen (presumption for emergency Intrapartum transfers to Raigmore) | Within 3 months | NHS Grampian NHS Highland |
Mothers and families Midwifery team at Dr Gray's NHS Grampian maternity service NHS Highland maternity service Scottish Ambulance Service |
Emergency transfers to Raigmore with minimum delay |
| Ensure that when managing transfers, within agreed criteria / triggers, that those transfers are accepted in a proactive manner so that the team at Dr Gray's are appropriately and adequately supported | Within 3 months | NHS Grampian NHS Highland |
Mothers and families Midwifery team at Dr Gray's NHS Grampian Maternity service NHS Highland Maternity service Scottish Ambulance Service |
Transfers to Raigmore or Aberdeen with minimum delay |
| Extend the use of staff with advanced skills (i.e. pharmacists / midwives with advanced skills) ensuring that skills are kept up-to-date | Ongoing | NHS Grampian | Mothers and families; Midwifery Team Consultant obstetricians (Dr Gray's) Dr Gray's management team |
Enhanced staffing and service sustainability |
| Ensure that an effective and supportive multi-disciplinary "debrief" process is in place for any incident / "near miss" so that a culture of learning and improvement is developed and embedded | Ongoing | NHS Grampian | Mothers and families Midwifery team at Dr Gray's NHS Grampian Maternity service NHS Highland Maternity service Scottish Ambulance Service |
Ongoing safety and quality of service provision |
| Progress Best Start North programme | Ongoing | NHS Grampian NHS Highland NHS Orkney NHS Shetland |
Mothers and families Midwifery team at Dr Gray's NHS Grampian Maternity service NHS Highland Maternity service NHS Orkney Maternity Service NHS Shetland Maternity service Scottish Ambulance Service |
Increased sustainability and quality of maternity services across North Scotland Health Boards |
| Re-introduce elective caesarean sections to Dr Gray's hospital | Within 6 months | NHS Grampian | Mothers and families; Midwifery team Consultant obstetricians (Dr Gray's) Dr Gray's management team |
Local elective sections; Increased number of local deliveries |
Culture The importance of culture to quality and safety in any service has been clearly articulated. The following recommendations are made, and should be progressed as a matter of priority: |
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|---|---|---|---|---|
| Actions | Timeline | Responsible Organisations | Key Stakeholder/s | Outcome |
| Identify opportunities for staff to work across both Dr Gray's, Raigmore and Aberdeen to improve relationships and understanding between staff groups including at least midwives and obstetricians from both sites. | Initiated within 3 months - then ongoing | NHS Grampian NHS Highland |
Mothers and families; All staff groups NHS Grampian |
Improved support for staff; Understanding and support for shared vision for Moray maternity services |
| Commission the delivery of a cultural safety programme aimed at the multi-disciplinary team working in Dr Gray's, including the relevant team members at Aberdeen so that the ownership of this work, and the relationships between Dr Gray's, Raigmore and Aberdeen are addressed as part of this work. Involvement of all senior clinical staff in this work should be mandatory | Initiated within 6 months – up to 1 year to deliver | NHS Grampian NHS Highland |
All staff groups | Ongoing patient safety & high quality of service |
| Invest in and protect time for the creation of a whole team focus at Dr Gray's and between Dr Gray's, Raigmore and Aberdeen | Initiated within 6 months - up to 2 years to deliver | NHS Grampian NHS Highland |
All staff groups | Service at Dr Gray's is owned as part of the maternity services in NHS Grampian and is delivered as part of a functioning networked service; |
Leadership Effective leadership of any service, including good clinical leadership and management support, is essential if a service is to thrive. There has been a gap in leadership to the maternity service in Dr Gray's in recent years and good future leadership will be a critical success factor going forward. Progress has been made with the overall leadership for Dr Gray's and this must be supported and encouraged in the future: |
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|---|---|---|---|---|
| Actions | Timeline | Responsible Organisations | Key Stakeholder/s | Outcome |
| Invest in the clinical leadership of the O&G service at Dr Gray's. The service should look to identify an experienced and respected senior clinician who can lead the service for at least the next five-year as the service goes through continued change and development: this post would require extended managerial sessions and be given appropriate management support | Within 6 months – in place for up to up to 5 years | NHS Grampian | Mothers and families; Consultant staffing groups Midwifery team NHS Grampian |
Clinical Lead supporting development of future maternity model implementation |
| NHS Grampian should build on the recent development of Hospital management at Dr Gray's and the focus / responsibility for Dr Gray's within the Moray H&SC Partnership | Ongoing | NHS Grampian / Moray Integrated Joint Board |
NHS Grampian Moray community |
Enhanced support from Leadership to Moray health services; Increased confidence in NHS Grampian by the Moray community |
| NHS Grampian, with local clinical leaders and the community, should develop a clear strategic plan and vision for the future of Dr Gray's | Initiate within 6 months – process up to 3 years | NHS Grampian / Moray Integrated Joint Board |
Moray community Grampian community NHS Grampian NHS Highland |
A clear strategic plan for the future of Dr Gray's Hospital |
| NHS Scotland should provide clear support for the ongoing sustainability of Dr Gray's as a key part of the NHS Scotland estate, including capital investment where required | Ongoing | Scottish Government / NHS Grampian | Moray community Grampian community NHS Grampian NHS Highland |
Sustainable Acute Hospital at Dr Gray's |
| NHS Grampian should ensure a clear programme plan and support arrangements (including governance) are in place to support the ongoing delivery of an improvement plan for maternity services in Moray | In place within 3 months | NHS Grampian | NHS Grampian NHS Highland All staff groups Moray community |
Effective delivery of an improved maternity service in Moray; Enhanced community confidence |
| NHS Scotland should consider arrangements for ongoing oversight of the development of maternity services in Moray | In place within 3 months | Scottish Government | NHS Grampian NHS Highland Moray community / mothers and families All staff groups |
Improved confidence of the community into the future provision of Moray maternity services |
Workforce and Recruitment The recruitment and retention of the workforce will be the main driver of success for the sustainability and improvement of maternity services in Moray. This recognises the ongoing challenges associated with recruitment and retention in rural areas of Scotland, which are exacerbated in the North of Scotland. |
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|---|---|---|---|---|
| Actions | Timeline | Responsible Organisations | Key Stakeholder/s | Outcome |
| A focussed approach to the recruitment of staff to Dr Gray's and the maternity service in particular, including a specific workforce development plan for the service | In place within 3 months | NHS Grampian | Mothers and families; All staff groups NHS Grampian NHS Highland |
A clear and creative workforce development plan for Dr Gray's in place |
| NHS Highland should take a similar focussed and creative approach to recruitment for the development of the Raigmore maternity service in line with maternity Service Level Agreement between NHSG and NHSH | In place within 3 months | NHS Highland | Mothers and families; All staff Groups NHS Grampian NHS Highland |
A clear and creative workforce development plan for Raigmore maternity service in place |
| Consideration of the opportunities to maximise links with the Ministry of Defence (MOD) facilities at Lossiemouth and Kinloss | Within 6 months | NHS Grampian NHS Highland |
Mothers and families; All staff groups NHS Grampian NHS Highland |
Maximise the opportunities to the local NHS workforce from military families (partners) moving to Moray |
| Recruitment plan to be based on the "strengths" and "benefits" of living and working in Moray and the opportunities for joint appointments and cross service working with Aberdeen and Raigmore Hospital | Within 6 months | NHS Grampian NHS Highland |
Mothers and families; All staff groups NHS Grampian NHS Highland |
Sustainable workforce for maternity service across Moray and Raigmore |
| NHS Grampian / Dr Gray's must focus on the training experience of all junior doctors working in Dr Gray's | Initiate within 6 months; and then ongoing | NHS Grampian NHS Highland |
NHS Grampian NHS Highland Medical staff across Dr Gray's / Raigmore and Aberdeen |
Enhanced quality of service; Improved long term recruitment and retention of staff |
| NHS Scotland (Scottish Government) should ensure the national workforce strategy and future national workforce plans clearly prioritise the challenges associated with rural recruitment and retention | Within 1 year & ongoing | Scottish Government | NHS Boards Professional staff groups National staffing regulators Local Communities |
Improved long term recruitment & retention to rural services in Scotland |
| NHS Scotland (Scottish Government) should develop a 'National Maternity Services Workforce Plan' that recognises the future workforce needs to sustain maternity services in rural areas that are consistent with the "Best Start" strategy | Within 2 years | Scottish Government | NHS Boards Professional staff groups National staffing regulators Local Communities |
Improved long term recruitment & retention to maternity services in rural Scotland |
| NES should develop and agree with relevant stakeholders a clear framework for advanced midwifery practice, which recognises the challenges and needs of all maternity units | In 2 years | NES | Scottish Government NHS Boards Midwifery staff |
Improved long term sustainability of midwifery staffing across Scotland |
| Consideration of how student intake to midwifery and medical school can be appropriately managed to ensure adequate successful applicants from remote and rural Scotland (recognising that individuals from these areas are more likely to return to work in these areas in due course) | Within 2 years and then ongoing | Scottish Government NES |
Universities Staff groups NHS Boards Local Communities |
Improved long term recruitment & retention to maternity services in rural Scotland |
| Following the development of an updated maternity services workforce plan, consideration must be given to the required junior doctor and midwifery training numbers necessary to support the future workforce across the whole of Scotland. This will need to include additional trainee numbers for the North of Scotland in obstetrics and anaesthetics, without reducing numbers elsewhere in Scotland | Up to 5 years | Scottish Government NES |
Universities Staff groups NHS Boards Local Communities |
Improved long term recruitment & retention to maternity services in rural Scotland |
| Consideration should be given to the future role and scope of maternity care support workers within the maternity services' workforce | 2 - 5 years | Scottish Government NES |
Universities Staff groups NHS Boards Local communities |
Improved long term recruitment & retention and workforce sustainability in maternity services in (rural) Scotland |
Engagement The support of the community to the future of maternity services in Moray will be essential. There is a developing Maternity Voices Partnership[1] (MVP) group in Moray, and this should be encouraged and supported so that this becomes the main vehicle for constructive engagement with the local community: |
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|---|---|---|---|---|
| Actions | Timeline | Responsible Organisations | Key Stakeholder/s | Outcome |
| NHS Grampian should invest time and energy to the ongoing development of the MVP group across Moray | Ongoing | NHS Grampian | Mothers and families; All staff groups NHS Grampian |
Maternity Voices continue to be engaged as maternity services develop within Dr Gray's |
| NHS Grampian should ensure this includes a clear engagement on the next steps in the development of local services, with regular updates and explanations of progress to the local community | Within 3 months and then ongoing | NHS Grampian | Mothers and families; All staff groups NHS Grampian |
Enhanced confidence of local community in Moray services |
| The MVPs in Moray, Grampian and Highland, as well as other community groups are encouraged to support the recommendations in this report as the most appropriate way of developing maternity services in Moray | Ongoing | Moray MVP | Mothers and families; Moray community All staff groups NHS Grampian |
Enhanced confidence of local community in Moray services; Improved recruitment & retention of staff |
| Elected representatives are encouraged to support the recommendations in this report as the most appropriate way of developing maternity services in Moray | Within 3 months and Ongoing | Local elected representatives | Mothers and families; Moray community All staff groups NHS Grampian |
Enhanced confidence of local community in Moray services; Improved recruitment & retention of staff |
Contact
Email: Kirstie.Campbell@gov.scot
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