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

Conclusions and Recommendations

Conclusion

68. Following consideration of the aforementioned data on the number of extreme pre-term deliveries in Scotland which is attached at Annex C, and the outcome of planning and implementation discussions, the Perinatal Sub-Group agreed that:

a. The data strongly suggests that we should continue with the current direction of travel for implementation and that it should continue to be monitored moving forward.

b. Further modelling, and implementation planning information be commissioned which will be worked up with planning experts, and which should take account of any operational challenges.

c. The outcome of the options appraisal process is not publicly known and limited planning can be undertaken until the decision is ratified and made public by Scottish Ministers.

d. The default destination for babies due to be born in Tayside requiring transfer under the new model should be Grampian, whilst allowing for fully informed parental choice, with accurate information for families and clinicians being key to support that choice.

e. The neonatal criteria paper should be published as a resource for clinicians, at the same time as the announcement about the location of the NICUs.

Recommendations

69. That the outcome of the options appraisal process is now concluded and Ministers are invited to agree to the recommended final three units and that detailed modelling and phased implementation planning can now be be commissioned.

70. Those three Neonatal Intensive Care units for Scotland would be located in the Royal Hospital for Children, Queen Elizabeth University Hospital in Glasgow, Simpson’s Centre for Reproductive Health, Edinburgh Royal Infirmary and Aberdeen Maternity Unit. The new model of neonatal intensive care should now be fully implemented on this basis, with consideration given to phasing roll out over the next two financial years, informed by capacity and staff planning and modelling work.

71. The smallest and sickest babies should be born in maternity units collocated with a Neonatal Intensive Care Unit where possible. That care should be delivered in the unit closest to their home and babies should be repatriated to their local neonatal unit as soon as clinically appropriate.

72. Based on historical patient numbers, of the three units recommended as NICUs, the unit in Aberdeen is currently admitting the fewest babies with birth weights <1500g. Even with the planned changes to service Aberdeen is not likely to reach the benchmark of 100 of these babies per year, the number considered necessary to demonstrate improved outcomes. The subgroup does however recognise the geographical advantages for women of having a unit located in the North and recommends that enhanced monitoring and opportunities for shared learning and skills maintenance be considered for that unit.

73.NHS Directors of Finance should be commissioned to develop a cross boundary flow of recurrent funding that sees a transfer of resource so that the funding follows mothers and babies.

74.Transformational change funding should be identified to bridge any gap in funding to support capacity building in the final three Units until, until a sustainable funding model is in place.

75. The Best Start Programme Board should drive development of this sustainable funding model.

Communications

76. The Criteria Framework and parent information leaflets have been signed off by the Perinatal Sub Group and should be published alongside the announcement of the outcome of the options appraisal process. There should be a clear process of communications with families, professionals and Boards to support the announcement.

Wider Considerations

77. Work to progress recommendation 55 on development of a standardised risk assessment tool in relation to in-utero transfer is well underway to support wider roll out of the new model of care. This work is being led by the Scottish Perinatal Network.

78. Families who have to travel to be with their baby in a Neonatal Intensive Care Unit will be eligible to claim expenses to help with the cost of travel, meals and accommodation through the Young Patient’s Family Fund.