Moray Maternity Services: Cabinet Secretary for Health's Ministerial statement

Thank you Deputy Presiding Officer,

I committed to coming back to this Chamber to provide an update on Moray Maternity Services and I am pleased to be able to do that here today. I intend to set out the progress that has been made to date, my initial response and crucially what the next key milestones will be.

But, before I do this it is important for me to reiterate this Government’s absolute commitment to the delivery of a consultant-led maternity service in Dr Gray’s Hospital.  While Model 4 will deliver improvements for families in Moray, it is Model 6 which very firmly remains the destination.

Members will be aware I started this process in December last year when I was considering the report of the Independent  review into Moray Maternity Services. I proceeded to meet and engage with senior teams in boards, with clinicians, local community campaign groups and elected members from right across the political spectrum. This was important to do and  helped me to come to my final decision, which I announced in this chamber in March. This was to progress with Model 6, a full Consultant-led Maternity Unit at Dr Gray’s, with Model 4, a networked maternity model, linked primarily with Raigmore  as part of the development towards that final destination.

I also announced, in line with the recommendations of the independent review, that I would bring some level of independent assurance to this process and I was delighted to announce, in July, that Professor Linda de Caestecker would lead this work. Since then, Professor de Caestecker has identified further clinical support and expertise  to work with her to provide this external assurance.  The team working with Linda includes representatives from relevant specialties such as paediatrics, anaesthetics, obstetrics and midwifery. This External Panel will be a sounding board and critical friend to NHS Grampian and NHS Highland, and crucially, will provide assurance and reassurance to the community and to me here in Government. This has already begun through meetings and email exchanges providing me with a further level of scrutiny and advice on progress and plans.

Presiding Officer,

Members are aware of the NHS Grampian and NHS Highland draft joint plan submitted to me on the 1st July. I welcomed this plan, but at that time I was expecting further information before giving my response to it.

The Model 4 plan is an important step in the journey towards Model 6  and I was pleased to see the ambitious timescales within it.  

What I can say here today is that before giving approval to the Model 4 plans, I am very clear that further work is required, and there are elements to be worked through locally and nationally to deliver for families in Moray. At a local level, clinical teams in Highland and Grampian need to develop the safe pathways of care to bring reassurance to both the women and to clinicians. At a national and local level there is work to be done to address the ongoing challenge of recruitment.  I have asked both Highland and Grampian to share their recruitment plans to meet the 2023 deadline in the Model 4 plan.

There are some key elements in the Model 4 plan I wish to draw the chamber’s attention to: Firstly the intention for NHS Grampian to introduce increased obstetric antenatal care to Dr Gray’s is welcomed and could result in at least 1000  ante-natal appointments a year delivered in Dr Gray’s therefore reducing  the amount of travel for pregnant women. The other element I want to highlight today is  planned Caesarean sections. This is not included in the Model 4 Plan, due to its dependency on other services and skilled staff being available.

 I expect  planned caesarean birth in Dr Gray’s to be covered as part of the Model 6 plan, which I am expecting at the end of this year,  and ambitious progress to be made to deliver that ambition. I will ask Linda de Caestecker and  her external assurance panel to look at this issue in further detail.  Presiding Officer, we should view the interaction between Models 4 & 6 as essentially a continuum. We will not wake up one day and suddenly switch from Model 4 to Model 6, I expect Model 6 to be phased in over time, and I am clear that elective sections should be given priority within that phasing process.

Concerns have been raised with me by local campaign groups and clinicians with regards to the  projected numbers in the NHS Highland draft business case for women giving birth in Raigmore. I have asked the external assurance panel, which I have just spoken about, to take this forward and investigate with the Boards, and indeed clinicians, at pace. The ambition is to achieve choice for women living in Moray, the choice to birth in Raigmore if they wish to go there and where clinically appropriate.

I understand there are concerns. There are concerns that progress in not being made quickly enough, and concerns that clinicians do not feel the changes proposed are safe. I hear these concerns and do take them very seriously indeed.  

I commend the steps NHS Highland are taking to engage with their clinical teams to identify and address concerns, this takes time and I have always been clear that change will not happen overnight.  We must work with clinicians in Grampian and of course Highland and where there are legitimate concerns, these must be absolutely addressed.

I understand the priority for women in Moray is that they have access, as soon as possible, to the widest range of maternity services that can safely and realistically be delivered as close to home as possible.

The independent review of maternity services in Moray proposed – and I agree with this proposal – that the first step in achieving this is to implement a networked maternity model, linked mainly to Raigmore.  I have already announced funding of £5m to support improvements in Raigmore. To be clear, when I visited Raigmore earlier this year I saw for myself investment in Raigmore was needed. The investment in Raigmore was not contingent on taking women from Moray however, improved maternity services at Raigmore will benefit all women who give birth there.

The redevelopment in Raigmore is key to improving the environment for both women giving birth and the clinicians who work there.

 This will be delivered by having the clarity of a safe model 4 as an interim solution, with robust pathways of care, providing care closer to home and increased choice of place of birth.  Women who need obstetric lead care will be able to have the choice of Raigmore or Aberdeen for the birth of their baby until consultant led services are returned to Dr Gray’s and it is critical  that we continue to  have a  parallel focus on implementation of Model 6 as the final destination

NHS care should not be about Board boundaries – it should be about working across boundaries to deliver the best care for all women who choose to birth there - this is key to a networked model.

I was clear back in March that I expected plans for Model 4 and Model 6 to run concurrently. I know NHS Grampian has begun the process of planning what they require for Model 4, and to lay the foundations for Model 6. As I have already made clear, I view Model 6 as a continuum of Model 4, an improvement journey with a focus on safety and led by clinicians.  Oversight of this work is provided through the Chief Officers' Group jointly chaired by NHS Grampian and Highland,

I expect the Model 6 plan by the end of December.  I expect to see evidence of collaborative working and joint plans from Boards, for example around pathways of care.

As part of this next phase of the work, monthly meetings will take place between the Boards, Linda and my officials.

Presiding Officer, I would like to talk a little about engagement, and reinforce the importance of this, particularly ongoing engagement. I am pleased to note that connections are already being made with the External Assurance Lead and that this includes the community groups of Keep MUM and the Moray and Banff Maternity Voices Partnership. Their views have been instrumental to getting us to this point, and their challenge will help us to shape the way ahead. I have spoken to Keep MUM just this week and given them a cast-iron guarantee that I remain committed to Model 6, a return to a Consultant-led midwifery unit at Dr Gray’s.

And finally presiding Officer, I would just like to outline what I see as happening over the next six months or so.

In November I  expect to have initial advice from the External assurance Panel on the NHS Highland Business Case and on the numbers of women giving birth in Raigmore which I know is causing some concern.

In December I expect to meet with NHS Highland and NHS Grampian to discuss my expectations for the Model 6 plan and its interaction with the Model 4 plan. I expect to receive the Model 6 plan by the end of December. And of course I will keep Parliament updated in that regard.

For all of our differences, I am certain that everyone in this Chamber wants to see women in Moray being able to give birth as close to home as possible. We will endeavour to make that a reality, and always ensure the priority is the safety of women and their unborn children.

From January to February I expect to have a response from the External Assurance panel on the plans received.  This will be fed back to both Highland and Grampian.

Presiding Officer, I hope this statement gives some reassurance to members, to the clinicians, and the community groups who raise concerns. Work to return consultant-led maternity services to Dr Gray’s is progressing. Yes, COVID 19 has undoubtedly impacted on delivery timescales.  And yes, the context continues to be the most challenging time for our NHS has ever faced since its creation. 

The Chairs, Chief Executives and Executive Teams at NHS Grampian and NHS Highland continue to assure me of their commitment to deliver both Model 4 and crucially the final destination Model 6. And again I reiterate my and this government’s absolute commitment not just to model 6 but to ensuring that we return that consultant midwifery care in Dr Gray’s to ensure that as many women, in Moray, can give birth as close to home as possible.