Moray Maternity Services Review: report

3 Establishment of the 2021 Review Group

Clearly, in the time since these two previous reviews were published, we have seen the Covid Pandemic fundamentally impact the NHS as well as our communities. This has also limited the ability of NHS Grampian to make progress with those recommendations.

The outcome, however, is that women and their families within the area have continued to raise safety concerns and asked for clarity on the provision of maternity care for the area. In particular, there remain issues in relation to transfers of care to Aberdeen, especially during labour, and confusion on the limits of care provided at Dr Gray's.

The current situation is, therefore, viewed as unsatisfactory by all concerned, including women and their families, members of staff and local health service leaders in Moray, NHS Grampian and NHS Highland, as well as the wider community and political representatives.

As a result, the then Cabinet Secretary for Health and Sport, Jeane Freeman, requested an independent review of the Maternity Service being delivered to the women and families of Moray. A multi-disciplinary Review Group was identified; its members chosen due to their experience of working in remote and rural settings, leadership and management experience, clinical knowledge, and their independence from NHS Grampian and NHS Highland.

3.1 Objectives of the Review

This Review Group was commissioned to:

"Work with NHS Grampian, NHS Highland and stakeholders with an interest in local Maternity Services to describe the best Obstetric model that will provide safe, deliverable, sustainable and high quality Maternity Services for the women and families of Moray in line with the Scottish Government ambition described in 'The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland (2017)'."

The best start: five-year plan for maternity and neonatal care - gov.scot (www.gov.scot)

The Best Start Plan states:

"Maternity and neonatal care and services matter to the health and wellbeing of Scotland's people. The health, development, social and economic consequences of childbirth and the early weeks of life are profound, and the impact both positive and negative, is felt by individual families and communities as well as across the whole of society".

3.2 Commission Brief and Terms of Reference

The Commission Brief^[5] incorporating Terms of Reference for the latest Review was agreed with Scottish Government in March 2021.

The key requirements were:

• It should examine the requirements for establishing a safe and sustainable consultant-led intrapartum obstetric service at Dr Gray's Hospital.
• It should examine the requirements for establishing a safe and sustainable midwife-led intrapartum service at Dr Gray's Hospital.
• It should involve services in Raigmore Hospital (NHS Highland) and Aberdeen Maternity Hospital (NHS Grampian) as well as Dr Gray's Hospital, Elgin.
• It should consider rurality, transport and local support whilst aiming to provide services as close to home as possible.
• It should be deliverable and sustainable in the context of other health and social care services in Moray, with reference to the local healthcare landscape and economy.
• It must be carried out in partnership with local stakeholders with an interest in Maternity Services that would be affected by the recommendations.
• It will involve NHS Grampian and NHS Highland staff including the respective leadership teams, Obstetric specialists (Medical and Midwifery), Paediatric Specialists (General and Neonatal, Medical and Nursing), Anaesthetics Specialists (General and Specialist) and Scottish Ambulance Service.
• It should reference national standards and guidelines for maternity service provision to ensure the recommended option is safe and of high quality.
• Recommendations should reflect the provision of choice for women in line with 'The Best Start: A Five-Year Forward Plan for Maternity and Neonatal care (2017)'.
• It should examine and review the chronology of events to stabilise services since July 2018, and offer reflection on what can be learnt from this.

3.3 Governance Arrangements

The Moray Maternity Services Review is an independent and standalone piece of work.

The Moray Maternity Services Review Group (the Review Group) has been commissioned to be independent from the maternity services under review. The Review Group has been tasked with ultimately producing a report for the Cabinet Secretary for Health and Sport.

This report will be submitted via the Maternal and Infant Health team within the Health and Social Care Directorate at the Scottish Government to the Minister for Public Health, Women's Health and Sport, and the Cabinet Secretary for Health and Social Care.

3.4 Governance Chart

The following chart lays out the governance arrangements for the purpose and duration of this Review:

3.5 The Review Group Principles:

• To identify and agree the nature and scope of the activity required to meet the remit of the Review Group and to achieve the desired objectives of the Review.
• To ensure the objectives set for the Review Group are achieved in a collaborative and transparent manner, to involve all relevant partners and stakeholders.
• To develop outputs for all deliverables collaboratively with relevant partners and stakeholders, and ensure required consultation takes place, responding
• appropriately to feedback received.
• To be aware of any operational plans in place to ensure alignment and
• dependencies are identified and effectively managed.
• To ensure the deliverables are achieved in a timely manner, tracking delivery against time-frames agreed.
• To liaise closely with, and report progress regularly to, the key contact at Scottish Government for onward communication to the Cabinet Secretary for Health and Sport^[6], and provide written updates e.g. via a highlight report or an interim report, as directed.
• To contribute to the development of the Review plan, identifying activities and timelines for delivery with agreement of member(s) responsible for the delivery of each activity.
• To ensure all risks and issues identified are tracked and managed effectively.
• The review process and final report should take account of the operating principles for invited reviews in health care as recommended by the Academy of Royal Colleges, 2016.

3.6 Expected Outcome

A report detailing the best service model or options that offer deliverable, sustainable, safe and high-quality maternity care for the women and families of Moray. The report should also offer a recommended action plan that takes the service from its current position through a series of safe, interim keys steps before reaching its final configuration.

3.7 Approach of the Review Group

The challenges facing the services in NHS Grampian, and Dr Gray's in particular, are well documented in the two previous reviews. It was not the purpose of this Review to revisit what has already been recorded and commented upon. Rather, this Review has looked to the future, and considered what could be achieved within a sensible time-frame. The information from the previous reviews has, however, assisted the Review Group in its discussions and deliberations with regard to where services are now, and how they have arrived at this stage.

As requested, in undertaking this Review, the Review Group has taken cognisance of the ambition described within the Best Start Plan, which states that:

"Wherever women and babies live in Scotland, and whatever their circumstances, all women should have a positive experience of maternity and neonatal care which is focused on them, and takes account of their individual needs and preferences.

All women, their babies, their partners and their families should be aware of the support and choices that are available to them in order that they can be partners in care and achieve the best outcomes for them and their family."

The Best Start Plan makes a number of recommendations that will transform the way that maternity services are organised across Scotland. It describes the future vision of maternity and neonatal services across Scotland where:

• All mothers and babies are offered a truly family-centred, safe and compassionate approach to their care, recognising their own unique circumstances and preferences;
• Fathers, partners and other family members are actively encouraged and supported to become an integral part of all aspects of maternal and newborn care;
• Women experience real continuity of care and carer, across the whole maternity journey, with vulnerable families being offered any additional tailored support they may require;
• Services are redesigned using the best available evidence, to ensure optimal outcomes and sustainability, and maximise the opportunity to support normal birth processes and avoid unnecessary interventions;
• All staff are empathetic, skilled and well-supported to deliver high quality, safe services, every time; and,
• Multi-professional team working is the norm within an open and honest team culture, with everyone's contribution being equally valued.

Best Start provides a direction for the future of maternity services with an aim to have a single Maternity Network for Scotland alongside the current single Neonatal Managed Clinical Network for Scotland.

The Review Group are a multi-disciplinary independent team of NHS professionals with expertise of working in remote and rural areas of Scotland, in specialties and functions related to the Review scope. The members of the Review Group come from a range of disciplines; with none of the members currently working for NHS Grampian^[7].

The Review Group includes representatives from the following specialities and disciplines^[8]: anaesthetics, midwifery, obstetrics, paediatrics, medical director, general management and executive leadership, planning and person-centred care and engagement.