Neonatal Care in Scotland: A Quality Framework

3.3 Efficient

A high quality neonatal service in Scotland will provide an efficient service which maximises the resource available to patient care through the avoidance of waste and reducing duplication. This will be demonstrated by regional collaboration to develop service models which maximise the use of available clinical expertise; and supporting units to provide an appropriate level of care. The use of telehealth and e-health solutions wherever possible will also contribute to the improvement of efficiency.

3.3.1 Service Model

A high quality neonatal service will be delivered through a service model which takes account of the need for differing levels of care across the region and ensures the appropriate level of resource is available in the right location.

This will be evidenced by:

• Participation in the implementation of regional collaborative working to implement agreed pathways.^[8]
• Compliance with national, regional and local guidelines.^[9]
• Provision of care in line with the designated level of service. This includes provision of appropriate facilities.
• Supporting the availability of clinical staff with appropriate skills.

3.3.2 Levels of Care

A high quality neonatal service will provide care according to the needs of the patient and resources available.

The exact number of each type of unit and the precise definition of their role will vary between networks but each network will have at least one Neonatal Intensive Care Unit. A neonatal service will have access to a specialised transport service. The transport service will facilitate not only the transfer of babies needing urgent specialist support but also enable the timely return of babies to their "home" unit as soon as clinically possible.

This will be evidenced by care being categorised into the following levels of service delivery:

• Special Care/Level One Units (SCU):
  The provision of special care for the local population. High dependency services may also be provided through agreement with the regional neonatal network.
• Local Neonatal/Level Two Units (LNU):
  The provision of special care and high dependency care and a restricted volume of intensive care (as agreed locally). Babies who require complex or longer-term intensive care^[10] will be expected to transfer to a Neonatal Intensive Care Unit.
• Neonatal Intensive Care/Level Three Units (NICU):
  The provision of the whole range of medical (and sometimes surgical) neonatal care for the local population from a larger intensive care unit. Additional care will be provided for babies and their families referred from the neonatal network in which they are based. Admission of babies from other networks may occur to deal with peaks of demand or requests for specialist care not available elsewhere. Many will be sited within perinatal centres that are able to offer similarly complex obstetric care. These units will also require close working arrangements with all of the relevant paediatric sub-specialties.