Maternity and paediatric services at Dr Gray's Hospital: report by CMO Advisory Group

Annex 1: CMO Advisory group - Terms of Reference

Provision of advice for maternity service at Dr Gray's Hospital Elgin and improving links with Aberdeen maternity hospital and Raigmore hospital Inverness

Membership:

Dr Rennie Urquhart - retired Obstetrician, NHS Fife
Justine Craig - Chief midwife, NHS Tayside
Una McFadyen - retired Paediatrician, NHS Forth Valley
Margaret McGuire - Executive Director of nursing NHS Greater Glasgow and Clyde

Background:

The Cabinet Secretary has agreed several priority actions for Dr Grays Hospital, Elgin (DGH) with NHS Grampian:

1. Reinstating elective caesarean sections

2. Increasing number booked for birth at CMU to 35% of total bookings (currently 25%)

3. Reducing unnecessary transfers to AMH by reviewing reasons for maternal transfer.

4. Increasing antenatal care delivered at DGH by reviewing what specialist antenatal/postnatal services currently provided in Aberdeen Maternity Hospital (AMH) can be delivered locally.

5. Working with NHS Highland to increase capacity in Raigmore to allow more women from Moray to receive care there in addition to the emergency transfers which have already been agreed.

6. Working to improve historically poor experience of trainees in O&G/Paeds at DGH.

The Ask:

This is a light touch intervention by experienced clinicians working outside NHS Grampian and NHS Highland. The group will sense check the measures proposed by NHS Grampian to maximise the maternity care which can be provided in DGH following the change in service to a Community Midwifery Unit (CMU) in August 2018.

As part of their investigations, the team should work with NHS Grampian management and local clinicians- doctors, midwives, nurses. The group should also engage with the maternity services liaison group and the KeepMUM campaign group.

The CMO would expect this to include:

1. Exploration of the points set out above and agreed with the Cabinet Secretary. This will include the feasibility and likely success of these additional measures and any advice which can be given to ensure success and/or improve upon the plans. Your experience with successful CMU in other HBs will be invaluable here.

2. Further recommendations to improve the care provided locally for women in DGH in the CMU setting including obstetric emergency triage, antenatal and postnatal care.

3. Review of clinical pathways for the CMU, for transfer (both emergency and elective), and for antenatal care, and comparison with national/professional body standards and experience in other parts of Scotland.

4. Engagement with local clinical staff to allow inclusion of local solutions and to break down barriers to different ways of working and to build on communication with NHSG staff in Aberdeen.

4. Engagement with and feedback to NHSG management

5. Exploration of NHS Highland capacity and referral pathways to increase number of women able to travel to Raigmore for antenatal care or birth if this is a shorter journey for them.

6. A short report covering the above points to be send to CMO by mid-October.