Neonatal Intensive Care Plan and the Options Appraisal Report: FOI release

Information requested

Relating to the 'Options Appraisal Report' and proposed new model of neonatal intensive care, as part of The Best Start plan for maternity and neonatal care, published by the Scottish Government on 25th July ‘23 you asked for:

• Please provide a copy of the Equality Impact Assessment, in alignment with the Scottish Government’s public sector equality duty, conducted as part of the neonatal intensive care plan detailed in the Options Appraisal Report. Please can you detail when this was conducted.
• Please can you detail how the 7 principles of the ‘Scottish Approach to Service Design’ were considered when the new model of neonatal intensive care was decided upon by the Perinatal Sub Group. Please provide any meeting minutes relating to this.
• Please provide a copy of all meeting minutes recorded during the Options Appraisal process by the Perinatal Sub Group.
• Please provide a copy of reports and correspondence submitted to the Perinatal Sub Group by the ‘early-implementer’ sites detailed in the Options Appraisal Report (University Hospital Crosshouse and Victoria Hospital Kirkcaldy neonatal units).

Response

I enclose a copy of some of the information you requested.

We have withheld the precise number of births in some instances because where a request asks for the number of individuals and that number is so small that release of the information could lead to the identification of individuals and families, we customarily present a number range. This information is exempt under section 38(1)(b) of FOISA. Disclosing it would contravene the data protection principles in Article 5(1) of the General Data Protection Regulation and in section 34(1) of the Data Protection Act 2018. This exemption is not subject to the ‘public interest test’, so we are not required to consider if the public interest in disclosing the information outweighs the public interest in applying the exemption.

A full EQIA was carried out, covering the implementation of The Best Start as a whole thematically, as some of the individual recommendations are more complex and multi-faceted than others. In this way, implementation of each of the 76 recommendations is considered in a proportionate manner.

• Continuity of carer.
• Person-centred maternity and neonatal care.
• Multi-professional working.
• Safe, high quality and accessible care.
• Re-designing neonatal care and services.
• Supporting the changes.
• Wider implications.

It should also be noted that, for the implementation of recommendations which are being led locally, it is expected that Health Boards will undertake their own Impact Assessments to satisfy their local requirements. This EQIA therefore takes national implementation as its primary focus. The EQIA was commenced in 2020 and remains a live document as implementation of the Best Start continues.

Please note the updated link to the efficient evidence review: Maternity and neonatal services: efficient evidence review - gov.scot (www.gov.scot)

Regarding your request to detail how the 7 principles of the ‘Scottish Approach to Service Design’ were considered when the new model of neonatal intensive care was decided upon by the Perinatal Sub Group.

At the time when Perinatal Subgroup conducted the Options Appraisal in 2018, this framework had not yet been published.

The introduction of the New Model of Neonatal Intensive Care was recommended by The Best Start report following evidence that providing specialist care in units that care for higher numbers of very preterm babies gives the best survival chances and clinical outcomes.

You can find more information on the extensive engagement process that informed the review of maternity and neonatal services, which led to publication of The Best Start report in chapter four of The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland (www.gov.scot)

The Best Start: A five Year Forward Plan for Maternity and Neonatal Care was published in 2017 and remains a Government commitment. It sets out a future vision for maternity and neonatal care which focuses on putting women, babies and families at the centre of maternity and neonatal care to ensure they receive the highest quality of care according to their needs.

The engagement process throughout the review with mothers, partners and families provided significant insight into the current service provision. It also identified areas where improvements should be made. Staff highlighted many examples of innovative practice and service provision where teams across NHSScotland were working together to provide high quality, person centred care. They also outlined opportunities for improvement. Listening to the views of service users, staff and service providers was critical to the Review and an extensive engagement programme was undertaken in all of Scotland’s NHS territorial Board areas.

The Best Start recommended that Scotland should move from the current model of eight Neonatal Intensive Care Units (NICU) to a model of three units within five years supported by the continuation of current NICUs redesignated as Local Neonatal Units (LNU). These Local Neonatal Units will continue to provide a level of neonatal intensive care, but the care for the most preterm and sickest babies receive specialist complex care in fewer NICUs, while returning babies to their local area as soon as clinically appropriate.

The recommendations for the new neonatal model of care are underpinned by strong evidence that population outcomes for the most premature and sickest babies are improved by delivery and care in units looking after a “critical mass” of these babies. These include access to on site paediatric, surgical, laboratory and radiology services, which is beneficial for the most preterm babies.

In advance of these changes, we have also tested the model in two early implementer areas, involving four units, to ensure that we get the approach and transition right for clinicians and families. The first is in the west between Glasgow’s Royal Hospital for Children at the Queen Elizabeth University Hospital and University Hospital, Crosshouse in Kilmarnock. The second is in the east between Simpson’s Centre for Reproductive Health at the Edinburgh Royal Infirmary and the Victoria hospital in Kirkcaldy.

The testing phase of the new model, including transfer pathways and repatriation is operating well, with only a very small number of out of pathway transfers. Learning from the testing continue to inform change as we move forward with full implementation of the model across Scotland.

Furthermore, the Chief Executive of Bliss sits on the Best Start Programme Board and was a participant in the options appraisal process, representing the views of neonatal families.

In the next phase of implementation, the Scottish Government will be consulting with families in the affected areas, so that we can take account of their concerns when the pathways and processes for the new model of care are designed. This will affect a very small number of families, however, it is important that we hear the voices of those families to input into design of service delivery.

Neonatal units will also continue to seek parent feedback locally to ensure opportunities to improve experiences of care for families are identified.

A copy of all meeting minutes recorded during the Options Appraisal process by the Perinatal Sub Group that you have requested is available from Information relating to Options Appraisal Report: FOI release - gov.scot (www.gov.scot)

Under section 25(1) of FOISA, we do not have to give you information which is already reasonably accessible to you. If, however, you do not have internet access to obtain this information from the website(s) listed, then please contact me again and I will send you a paper copy.

Regarding your request for a copy of reports and correspondence submitted to the Perinatal Sub Group by the ‘early-implementer’ sites detailed in the Options Appraisal Report (University Hospital Crosshouse and Victoria Hospital Kirkcaldy neonatal units), you will find these attached.

About FOI

The Scottish Government is committed to publishing all information released in response to Freedom of Information requests. View all FOI responses at http://www.gov.scot/foi-responses.

FOI 202300382300 - Information released - Annex

File type

69 page PDF

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2.6 MB