Independent Review of Moray Maternity Services: ministerial statement

Thank you Presiding Officer, I welcome the opportunity to update Members on the Scottish Government’s response to Ralph Roberts review of maternity services in Moray.

As a result, I’m delighted to set out the next steps for the re-introduction of consultant-led maternity services at Dr Gray’s Hospital in Elgin. This will not be easy but, with effort and targeted investment, I believe it can be delivered.

I understand the urgency and the importance of this issue. It has been imperative for me to hear directly from those most affected - namely local people and the clinicians working in both Dr Gray’s and Raigmore hospitals, and indeed of course the local elected members, before making my decision.

I know across this chamber we all want maternity services across Scotland to be delivered safely and as close to home as practicable.

The Moray Maternity Independent Review, commissioned by my predecessor Jeane Freeman, was carried forward with a thorough and consultative approach. I want to again record my thanks to Ralph Roberts and the review team for their excellent work.

These have not been decisions I have taken lightly. I have taken time to consider the recommendations in discussion with a range of interested individuals and groups. I started that process in December when the review was first published, and concluded it last week with a visit to both Raigmore and to Dr Grays - where I met senior teams, clinicians and local people and elected members. I would like to thank everyone for taking the time to provide their thoughtful contributions to the discussions and welcome the wide-ranging views that were presented to me.

Ralph Roberts team explored six potential models of service delivery for Maternity services in Moray and made 37 recommendations for improvement to care. The report recommended that in the short term NHS Grampian and NHS Highland move, to a Community Maternity Unit in Dr Grays networked primarily with Raigmore for consultant-led care, but with women requiring tertiary maternity care or neonatal care going to Aberdeen – this was titled as model 4 in the aforementioned report.

It went on to recommend that NHS Grampian undertake a review of the role of Dr Grays hospital, potentially moving to a ‘rural’ consultant-supported maternity unit in Dr Grays – this was titled as model 5 in the report. Mr Roberts also made a number of recommendations in relation to short term changes, they were around leadership, culture and workforce and indeed on recruitment.

As I have talked to people over the last three months, I have heard the full range of very different opinions about the future for maternity services at Dr Grays – and there are differences in opinion on the way forward.

What I intend on doing today is setting the destination of where we want to get to, and in doing so I will be upfront about the scale of the challenge ahead of us.

Presiding Officer, I have concluded that we will progress with Model 6, a full Consultant-led Maternity Unit at Dr Gray’s, with Model 4 as part of the development towards that final destination.

I hope this will see 80 to 90% of Moray births taking place at Dr Gray's on the realisation of a consultant-led model - similar to the numbers that were taking place prior to the changes made in 2018.

Presiding Officer, I said at the beginning of this statement delivery of a consultant-led service will not be easy and it will require significant investment both in infrastructure and workforce. It will involve us, collectively, having to find solutions to complex systemic problems that have challenged the Grampian region for many years, such as recruitment and retention.

The priority for women of Moray is that they have access, as soon as possible, to the widest range of maternity services that can safely and realistically be delivered as close to home as possible. Let me be clear, I expect work on model 6 to begin immediately. The first step in that journey is working through the detailed timeline of what is required  by when. That will be done with independent oversight and clinical input. As I have said model 4 will be a critical component on the journey towards realising model 6, a consultant-led maternity unit. Model 4 includes enhanced specialist ante-natal and post-natal care in Dr Gray’s to vastly reduce the need for women from Moray to travel to access these services. The additional infrastructure and resource that will be invested to achieve this goal will act as a bridge to the delivery of a Dr Gray’s consultant-led service, and accompany a wider plan for the regeneration of services beyond maternity services at Dr Gray’s.

As Ralph Roberts report recognised, it is essential that a consultant-led service is taken forward within the context of a revitalised vision for Dr Gray’s, and this extends beyond maternity services to include increasing services at Dr Gray’s for the whole population of Moray. NHS Grampian have already outlined plans to their Board for development of a strategic vision and future plan for Dr Gray’s, developed in collaboration with local communities, and to re-establish the public faith in the sustainable future of Dr Grays.

However we know this won’t happen overnight. I know local people understandably want these services back as quickly as possible. We’re committed to investing in the staff, and delivering the required infrastructure to put these services in place on a secure and stable footing as quickly as possible.

Now that I have stated clearly our intention to restore a Consultant-led Maternity Unit at Dr Gray’s, it is imperative that we develop deliverable timescales for the interim  service provision at Raigmore and of course the full service at Dr Grays.

Having listened to clinicians I understand the importance of making changes in a phased manner to ensure safety for the women of Moray and for the women of the Highlands. I also recognise that facilities in Raigmore and Dr Gray’s will need significantly improved to support this move.

That’s why, as a starting point, I will make £5 million available to invest in Dr Gray’s to support moving forward with the changes in Moray. 

Presiding Officer, it is clear that clinicians in Raigmore have concerns about the current facilities within which they are operating. With this in mind we have made an initial provision for a further £5 million for redevelopment of Raigmore within our capital plan. This will allow plans to be brought forward to redevelop the maternity unit in Raigmore to provide an improved environment for the women of the Highlands, and in the interim for the women of Moray who choose to have their baby there. Once planning is further developed we will also look at what additional funding may be required, and I again repeat my commitment to providing the necessary resources to support this change.

This is an immediate commitment of £10m from this government to enhance maternity services in Dr Gray’s and Raigmore.

The interim networked service will be developed with service users and will include delivery of the maximum possible amount of consultant supported antenatal and postnatal services at Dr Gray’s - reducing the need for women to travel to Aberdeen or Raigmore to an absolute minimum, and also delivering continuity of care for women in Moray.

Having the clarity of a safe model 4 will enable us to focus on maximising the number of women that choose to deliver in Dr Gray’s by building trust, confidence and of course understanding of choice. This has the potential to significantly increase the number of women who can give birth at Dr Gray’s. Those women who need obstetric-led care will have the choice of Raigmore or Aberdeen for their care until such time as consultant led services are returned to Dr Gray’s. The Chair, Chief Executive and Executive Team at NHS Grampian have sought to assure me of their focus and unstinting commitment as a Board to delivery of this model.

I know there are concerns, and I heard this very clearly from  campaign groups in Moray, that once Model 4 is in place there will be no desire for further change. I heard this from not just local campaigners but I also heard this from elected members in Moray too.

Let me be clear, Model 6, a Consultant-led Maternity Unit at Dr Gray’s is what we will deliver, and no one has been left in any doubt about my decision. Implementing Model 4 will be of coruse a key component to achieving a consultant-led service, not an alternative to it. In addition providing choice for Moray women, will also significantly improve the birthing environment for Highland women.

NHS Grampian and NHS Highland have already started to pave the way for change, and with a clear destination can start work immediately on the progression of planning and developing implementation plans. A process of accelerated planning will begin now, and will conclude in the summer in relation to Model 4 changes and we will aim to have a clear timetable for the restoration of a full Consultant-led unit as soon as possible thereafter. The plans will provide a timetable with milestones for delivery of both model 4 and model 6.

Ralph Roberts made a number of other recommendations within the Moray Maternity Review on leadership, on workforce and recruitment and on culture. I accept all of those recommendations in his report and action will begin to take these forward, including in particular work to improve remote and rural staffing, to support delivery of the staffing requirements for both model 4 and model 6 as they emerge, and commitment to providing the necessary funding to support delivery of these models.

There will be an external assurance process built around this, which will include expert clinical input. I know how important this is in particular to the local community groups and indeed to elected representatives I have spoken to.

In conclusion Presiding Officer,  having made this decision, we will waste no time, no time at all, and work to progress with implementation which will begin immediately and we will urgently drive forward our work to restore consultant-led maternity services at Dr Gray’s. I would be happy to keep Parliament updated of course when I have further detail on milestones and timescales.