Maternity and neonatal care - Best Start implementation: equality impact assessment

The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland

Following this, in January 2017 the Scottish Government published The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland. The report contains 76 recommendations which focus on putting families at the centre of maternity care so that all women, babies, and their families get the highest quality of care according to their needs. This is intended to ensure that mothers, babies, and families are at the centre of service planning and delivery and that mum and baby are kept together as much as possible.

Implementation of The Best Start will contribute to the delivery of the Scottish Government’s National Outcomes 5, 6, 7 and 16.

• Our children have the best start in life and are ready to succeed.
• We live longer, healthier lives.
• We have tackled the significant inequalities in Scottish society.
• We have improved the life chances for children, young people and families at risk.
• Our public services are high quality, continually improving, efficient and responsive to local people's needs.

Implementation of the recommendations contained within The Best Start is fundamental in ensuring that all children and their families have the best possible start in life.

Recommendations

The main recommendations and themes of The Best Start are:

• Continuity of Carer: all women will have continuity of carer from a primary midwife, and midwives and obstetric teams will be aligned with a caseload of women and co-located for the provision of community and hospital-based services. Early Adopter Boards (EABs) will be identified to lead change.
• Mother and baby at the centre of care: Maternity and Neonatal care should be co-designed with women and families from the outset and put mother and baby together at the centre of service planning and delivery as one entity.
• Multi-professional working: Improved and seamless multi-professional working.
• Safe, high quality, accessible care, including local delivery of services, availability of choice, high quality postnatal care, colocation of specialist maternity and neonatal care, services for vulnerable women and perinatal mental health services.
• Neonatal Services: proposes a move to 3-5 neonatal intensive care services in Scotland in the short term, progressing to 3 within 5 years. Note: report does not recommend closing any neonatal services but reducing the number who care for the very smallest and sickest babies (currently managed in 8 units across Scotland).
• Supporting the service changes: Report also includes a number of recommendations about transport services, remote and rural care, telehealth and telemedicine, workforce, education and training, quality improvement and data and IT.

Implementation

An Implementation Programme Board chaired by Jane Grant, Chief Executive of NHS Greater Glasgow and Clyde was established with representation from across the maternity and neonatal community in Scotland, as well as service user representation via the National Childbirth Trust (NCT) and Bliss.

The 76 recommendations were split into those suitable for local implementation and those requiring national implementation. A Local lead was appointed in each of the 14 NHS Boards, and they are currently progressing 23 recommendations.

Four subgroups were established to drive forward many of the nationally led recommendations. The subgroups are Continuity of Carer and Local Delivery of Care, Perinatal Services, Evidence and Data and Workforce and Education. The remaining nationally led recommendations sit with the Scottish Government for implementation.

Who will it affect?

Implementation of The Best Start targets pregnant women, babies, and their families. It will also have an impact on service delivery, and so on the maternity and neonatal workforce including midwives, obstetricians, neonatologists, neonatal nurses, and healthcare support staff. This means that it has the potential to impact on anyone who interacts with maternity and neonatal services in either a personal or professional capacity.

Equality legislation covers the protected characteristics of age, disability, gender reassignment, gender including pregnancy and maternity, race, religion and belief, and sexual orientation. Implementation of The Best Start has the potential to affect women, their babies, and their families so the scope of this equality impact assessment (EQIA) is extended beyond the list of protected characteristics to include wider socio-economic considerations, including people living in low-income households and people living in remote rural areas.

What might prevent the desired outcomes being achieved?

Achievement of the desired outcomes will be dependent on a number of factors. The implementation landscape is complex and there are various opportunities and risks across workstreams towards implementation of the recommendations. Close working with service providers, including multidisciplinary health professionals, third sector and service users, is critical.

• Workforce considerations: movement to the new models of maternity and neonatal care is a departure from previous models of care, with potential implications for health professionals across a variety of settings, from primary to tertiary care.
• Infrastructure considerations: including development of community hubs and facilities to allow health professionals to deliver care closer to home, development of transitional care facilities; provision of full range of places of birth, as well as provision of space for partners to stay nearby and provision of emergency overnight accommodation for parents with babies in neonatal care.
• Education: for both workforce and prospective parents.
• Cross-cutting policy work, including work being delivered by other policy teams (e.g. Perinatal Mental Health).