Maternity and neonatal services - neonatal intensive care plan: options appraisal

Options Appraisal Process Stage 1: Identifying Units

Overall aim:

11. In January 2018 The Perinatal Sub Group agreed to undertake an options appraisal process which would identify the immediate and the longer- term units that would make up the model of neonatal intensive care for Scotland. The Group would report the outcomes of the options appraisal and make recommendations to the Best Start Programme Board.

12. NHS National Services Scotland (NSS) were engaged in March 2018 to provide expertise on the design and implementation of the options appraisal process. The Perinatal Sub Group then agreed the proposed criteria-based options appraisal process.

Options Appraisal Process

1. Identify options

2. Determine critera

3. Determine weighting

4. Score options

5. Consider results

6. Conclusions & recommendation

Identifying Options

13. The Perinatal Sub Group identified possible parameters/criteria for the options appraisal process. A long list of criteria for neonatal intensive care units was developed, drawn from a range of sources including The Best Start, British Association of Perinatal Medicine Publications and other relevant policy and guidance documents. The Group devised a template based on the long list criteria and this was issued to Boards to gather site information to inform the options appraisal process.

14. NSS continued to provide expert advice on models of options appraisal and to support the process. Following discussions with NSS the Chairs of Perinatal Sub group agreed to separate the consideration of the criteria and weighting from the scoring process, and to establish a small expert group to identify the short list criteria and weighting.

Determining Criteria And Weighting

15. An expert group was convened on 31 May 2018 to consider a set of criteria and weighting as part of the options appraisal process. The group comprised:

Helen Mactier, Chair of Scottish Neonatal Consultants Group, former Co-Chair of Neonatal Sub Group of Review of Maternity and Neonatal Services in Scotland, Implementation Programme Board member, (then) Honorary Secretary of President of British Association of Perinatal Medicine (BAPM) and consultant neonatologist, NHS GG&C;

Gopi Menon, (then) President of BAPM and consultant neonatologist, NHS Lothian;

Alan Fenton, Consultant Neonatologist, Newcastle Neonatal Services, immediate past President of BAPM, Chair of Independent Advisory Group for the National Neonatal Audit Programme Advisory Group;

Corinne Love, Consultant Obstetrician, NHS Lothian Senior Medical Officer, Scottish Government;

Eddie Doyle, Associate Medical Director, Women’s and Children’s, NHS Lothian, Senior Medical Advisor, Paediatrics and Neonatal, Scottish Government.

16. There was consensus from the group on the importance of units identified as Neonatal Intensive Care units as a result^[3] of the option appraisal process meeting the following criteria as identified in The Best Start (2017):

• provide care for a minimum of 100 VLBW babies per year (VLBW =<1500g)
• deliver more than 2000 respiratory care days per year

17. The group also identified the importance of the discussions with Boards (planned for stage 2 of the options appraisal process) that will focus on capacity/potential capacity of units, and staffing, skill mix and recruitment. The group recognised the value in having a geographic spread of units, noting that this may necessarily result in some compromise over numbers of admission. The table in Annex A sets out the criteria and weighting agreed by the group.

Scoring Options And Considering Results

18. The Perinatal Sub Group met on 8 Jun 2018 to carry out the next stage of the options appraisal. The Group were provided with:

• The short list criteria, weighting and definitions (attached at Annex A)
• The responses from Boards to the site information questionnaire
• Data on unit deliveries (attached at Annex B)

19. The Perinatal Sub Group reviewed the short list criteria, definitions and weighting, and the site information and agreed to use this as the basis for the options appraisal process. The Group then scored the eight level 3 neonatal units against the short list criteria, using the definitions and weighting provided, and using the information provided by the Boards.

20. The scoring sheets were collected and the scores logged, and overall marks presented to the group. The group then discussed the markings. The outcome of the scoring process ranked the existing Level 3 neonatal units in the following order (scores out of a possible 100 in brackets):

Queen Elizabeth University Hospital, Glasgow (99)

Edinburgh Royal Infirmary (93)

Aberdeen Maternity Hospital (82)

Ninewells, Dundee (53)

Princess Royal Maternity, Glasgow (34)

Wishaw General (30)

Victoria Hospital, Kirkcaldy (24)

Crosshouse Hospital, Kilmarnock (18)

21. The group discussed the results and agreed the following:

• The three long term NICU’s were clearly identifiable from the table.
• However more work was required with Boards on patient flows in order to identify whether the three units would each be able to deliver care for more than 100 very low birth weight babies /annum as per the evidence for improved outcomes.
• The 4^th and 5^th short/medium term units would be Ninewells and PRM. The group had an extensive discussion over the two units ranked 5^th and 6^th as their scores were close, however it was felt on balance due to PRM’s proximity to other critical services in GG&C and potential for cross-working with QEUH to facilitate management of capacity, then it should be the fifth unit in the short/medium term.
• The group agreed capacity should only be built in the top three units, and the fourth and fifth would remain as they are only in the short/medium term until such time as capacity has been built in the three larger units.
• The group agreed that the next step should be meetings with NHS GG&C, Lothian and Grampian to discuss the results, consider patient flows and staffing, capacity and timing, before making a recommendation to the IPB.
• The group agreed that the outcome would be kept confidential whilst the testing the feasibility of the initial findings of the options appraisal was still in progress until final conclusions had been reached.