Maternity and neonatal review: Best Start Implementation Programme Board

Overview

The purpose of the working group is to enhance collaborative working between physicians and obstetrics to improve the outcomes for pregnant women with acute and chronic medical conditions across Scotland. This is in response to the implementation of the Best Start recommendations 28 and 29.

To deliver this aim, the group has been tasked to:

• undertake a scoping exercise to understand current practice across Scotland for the treatment of pregnant women with acute and chronic conditions
• evaluate current training and education provision to ensure they are relevant to need
• develop robust referral pathways

Progress

The group was remobilised in November 2021, following a pause in implementation due to the COVID-19 pandemic.

Through a smaller working group comprised of obstetricians and neurologists, Standards of care for the treatment of pregnant women with epilepsy and standards of care for those who present with headache has been produced. These will be published on the Scottish Perinatal Network.

Membership

• Claire Gordon, Consultant in Acute Medicine, NHS Lothian (Chair)
• Mark Strachan, Consultant Physician, NHS Lothian (Chair)
• Corinne Love, Scottish Government Obstetric lead
• John Paul Leach, Consultant Neurologist, NHS Greater Glasgow and Clyde
• Tara Fairley, Consultant Obstetrician, NHS Grampian
• Laura Stirrat, Clinical Research Fellow, NHS Lothian
• Marie Freel, Consultant Endocrinologist, NHS Greater Glasgow and Clyde
• Janet Brennand, Director Obstetrics and Gynaecology, NHS Greater Glasgow and Clyde
• Sarah Murray, Clinical Lecturer, NHS Lothian
• Claire Alexander, Consultant Clinical Scientist and R and D Lead, NHS Lothian
• Shona Finch, Clinical Manager Women and Children's, NHS Borders
• John Thomson, Divisional Clinical Director, NHS Grampian
• Nikki Walker, Cardiology Consultant, NHS Golden Jubilee
• Cassandra Ferguson, Anaesthetics, NHS Lothian
• Ryan Rodgers, Haemophlia Centre Directort, NHS Greater Glasgow and Clyde
• Kirsteen Guthrie, Lead Midwife, NHS Borders
• Katrina Shearer, Obstetrics and gynaecology, NHS Grampian
• Tom Mackay, Sleep and Ventilatory Support. Clinical Lead RIE, 
• NHS Borders
• Beth Routledge, Acute Medicine, NHS Forth Valley
• Rosamunde Burns, Consultant Anaesthetist RIE, NHS Lothian

Overview

The Evidence and Data Subgroup will provide strategic oversight and co-ordination of the evaluation and data requirements for the Best Start Implementation.

To deliver this aim, the group has been tasked with:

• overseeing and co-ordinating delivery of the Best Start recommendations relating to evidence and data
• considering and driving priorities for evaluation raised by subgroups, other organisations or Evidence and Data Subgroup members
• ensure co-ordination of related work with other relevant organisations

Progress

A report into the rising rate of caesarean sections in Scotland was published in September 2021. Research into Perinatal experiences during the COVID-19 pandemic in Scotland was published by Public Health Scotland in April 2022.

Due to the pause in Best Start implementation, brought about by the COVID-19 pandemic, the group will remobilise to focus on the evaluation of Best Start.

Membership

• Prof Mary Renfrew, Professor of Mother and Infant Health, School of Nursing and Health Sciences, University of Dundee (Chair)
• Public Health Scotland
• NMAHP Research Unit
• SMART Group
• researchers
• professional representation (maternity and neonatal e.g. SHoMs/CDs, public health)
• MCQIC, NRS, service user/advocate representation
• Scottish Perinatal Network
• Bliss
• Scottish Government

Overview

The group has been asked to deliver Best Start recommendations relating to choice of place of Birth and Maternity Care Pathways. 

To deliver this aim, the subgroup has been tasked with:

• revising the 2009 Pathways for Maternity Care reflecting the current evidence context , a person centred approach and recognising the biopsychosocial factors affecting the woman in her context
• to agree on the design, content and format of evidence based information for use around choice of place of birth

Membership

• Corinne Love (co-chair), Senior Medical Officer for Maternity and Women’s Health, Scottish Government
• Justine Craig (co-chair), Chief Midwifery Officer, Scottish Government
• Jaki Lambert, Director for Scotland, Royal College of Midwives
• Leena Thomas, Consultant Obstetrician NHS Highland
• Lesley Sharkey, Associate Director of Midwifery, NHS Tayside
• Katie Colville, Consultant Midwife, NHS Grampian
• Ewen Johnston, Neonatologist, NHS Lothian
• Arlene Wise, Consultant Obstetric Anaesthetist, NHS Lothian
• Alastair Campbell, Royal College of Obstetricians and Gynaecologists
• Karen McAlpine, Senior Educator, NES
• Rebecca McLean, Newly qualified midwife, NHS Ayrshire and Arran
• Laura Stirrat, RCOG National Trainees Committee Representative, Scotland South/East/North
• Christy Lamont, RCOG National Trainees Committee Representative, Scotland West

Overview

This group was asked to deliver the 'best start' recommendations relating to perinatal care which will focus care for the most complex mothers and babies and develop standardised pathways and structures for care.

To deliver this aim, the sub-group was originally tasked with:

• making a recommendation for moving to five and ultimately three Neonatal Intensive Care Units in Scotland and recommendations for locations of specialist maternity care
• developing a national framework for standards for timely medical care out with a maternity setting
• developing a national framework for practice with pathways for newborn care and referral
• developing a national neonatal transfer risk assessment tool, cot locator system, and a cot availability protocol
• developing a neonatal transfer staffing model

Following a pause in implementation, brought about by the COVID-19 pandemic, the group’s remit was refocussed to:

(i) oversee a programme of preparatory work required ahead of full implementation of the new model of neonatal intensive care, following the pause brought about by Covid, including:

• consideration of cot capacity data and the impact of this on a phased implementation plan
• develop a phased implementation plan
• consideration of the readiness of the final three NICUs

(ii) reporting progress and highlighting delays and any issues with implementation of delivery of the new model of neonatal care to the Maternity and neonatal review: Best Start Implementation Programme Board

Progress

The group completed the majority of the work it was originally tasked with, including:

• development of a National Neonatal Discharge Planning and Follow Up Framework for Scotland
• ScotCAT tool for determining unit cot and staff capacity
• development of a national framework for practice with pathways for newborn care and referral (still to be published)

Outstanding work on developing a maternity transfer risk assessment tool is being taken forward through the recently established Scottish Perinatal Network.

Outstanding work standards for timely medical care out with a maternity setting is being taken forward by the maternal medicine group.

Membership

• Jim Crombie, Deputy Chief Executive, NHS Lothian (Chair)
• Andrew Murray, Medical Director, NHS Forth Valley (Chair)
• Alison Wright, Advanced Neonatal Nurse Practitioner, NHS Tayside, Chair of Scottish Neonatal Nurses Group
• Tara Fairley, Clinical Lead, National Maternity Network.
• Caroline Lee-Davey, Chief Executive, Bliss
• Lesley Jackson, Clinical Lead, National Neonatal Network
• Carsten Mandt, Scottish Perinatal Network Programme Manager,
• Allan Jackson, Clinical Lead, ScotSTAR Neonatal
• Colin Peters, Clinical Director for neonatology NHS Greater Glasgow and Clyde Board HQ
• Corinne Love, Senior Medical Officer Maternity & Woman’s Health, Scottish Government/NHS Lothian
• Shetty Bhushan, Lead clinician and neonatologist NHS Tayside & Scottish Neonatal Consultants Forum
• Kenny Mitchell, Scottish Ambulance Service
• Eddie Doyle, Professional Advisor Paediatrics, Scottish Government/NHS Lothian
• Dr Mary Ross-Davie, Director of Midwifery , NHS Greater Glasgow and Clyde Board HQ
• Dr Ben Stenson, Neonatal Consultant, NHS Lothian
• LNU/SCU rep: Philine Van Der Heide (NHS Highland)