Neonatal intensive care unit services - demand and capacity modelling: final report

1. Introduction

1.1 Background

RSM UK Consulting LLP, in collaboration with neonatologist Prof Neil Marlow and neonatal nurse advisor Doreen Crawford, were commissioned by the Scottish Government (on behalf of NHS Scotland) to undertake a demand and capacity modelling exercise for neonatal intensive care unit (NICU) services in Scotland.

Neonatal care in Scotland has been a key area of focus and improvement over the last decade. A Strategic Review of Maternity and Neonatal Services in Scotland was announced by the Minister for Public Health in early 2015. In 2017, the Scottish Government published ‘The Best Start : A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland’. Within this transformational plan, the traditional models of healthcare provision were replaced by a family centred approach to care delivery and participation, decision making and service structure which have been shown to optimise infant outcomes.

For this ambitious plan to succeed, several changes need to occur, including:

• Redesigning service provision;
• Ensuring opportunities for education and training are available to deliver the new model and ensure competency;
• Undertaking workforce planning based on the new model;
• Improving care using information and communication technologies in clinical and non-clinical domains; and,
• Facilitating seamless transfer across the country and beyond.

The Best Start outlined a new model of neonatal service provision that suggests that care for the smallest and sickest babies should be consolidated to deliver the best possible outcomes. The implementation of the new model includes:

• Consolidation of NICU services into three designated NICUs for Scotland for pre-term, very low birth weight, and critically ill babies, based on evidence to support better outcomes;
• A new networked model of three NICUs working alongside local neonatal units (LNUs) and special care units (SCUs), supported by transitional and community care services; and
• Leveraging lessons learnt from successful transformation of neonatal services across the rest of the UK.

The plan emphasises parents as key partners in caring for their babies and aspires to keep mothers and babies together as far as possible, with services designed around them.

1.2 Purpose of this report

This report outlines the modelling approach, inputs, and interpretation of the outputs to support the future of NICU services. This aligns with the Best Start recommendations and focuses on the three regional NICU sites chosen for adoption in Scotland. This report also outlines a series of considerations for implementation that can be taken forward beyond this commission.