Sustainability and Seven Day Services Taskforce Interim Report

Maternity & Neonates

Maternity

Births in a hospital setting in Scotland, generally take place in one of 38^[9] maternity units, which may be consultant led or community maternity units. In addition women may give birth outside a hospital setting such as at home or in a private hospital.

The national Framework for Maternity Care in Scotland was refreshed by the Maternity Services Action Group on behalf of the Scottish Government in January 2011^[10]. It sought improvements in maternal and infant wellbeing by supporting the planning and provision of high quality outcome focussed services. A key driver for the Framework was to ensure that women and their babies were cared for by the right team of people, with the right skills in the right place. The provision of high quality maternity services is also supported by the Maternity & Children Quality Improvement Collaborative (MCQIC) which was launched nationally in March 2013 and also encompasses neonatal and paediatric activity.

All NHS Boards have adopted the framework and have integrated it into their planning for Maternity Services, prioritising and adapting the principles and service standards to reflect existing local practices and particular service requirements in their area. Scottish Government funded Maternity Champions are in place in each NHS Board area to drive and co-ordinate improvement activity associated with the Framework and the MCQIC.

Given that the Maternity Framework and MCQIC already exist and describe a high quality seven day maternity service, our next steps will be to review the implementation of the framework and the programme and identify areas where further actions might be needed to support a sustainable seven day service across Scotland. In light of the changing pattern of demand for maternity service - with an increase in the age of average mother, more multiple births and more caesareans - we will wish to consider whether the current acute care model is supporting women and their babies to be cared for by the right team of people, with the right skills in the right place.

To take forward this strand of work a Neonates and Maternity Working Group has been set up, which will report to the Taskforce. In light of the recent Scottish Government announcement of an assessment and refresh of the model of care for maternity and neonatal services, we will consider how best to link these two pieces of work together.

Neonates

Specialist neonatal services are provided across 16 sites in Scotland^[11]. The level of service each neonatal unit provides is categorised into three levels:

• Special Care / Level One
• Local Neonatal Level Two - High dependency care and short‑term intensive care
• Neonatal Intensive Care / Level Three.

The Scottish Government published Neonatal Care in Scotland: A Quality Framework in February 2013^[12]. This Framework defines the approach and the requirements for delivering high quality care for newborn infants who require care at a level greater than standard perinatal care. It describes a service model which includes regional collaborative working to implement agreed patient pathways, maximising the use of available clinical expertise and supporting units to provide the right level of care.

NHSScotland is committed to the delivery of the Framework and while each Board is responsible for implementing the Framework, the three regional Managed Clinical Networks (MCNs) are facilitating co-ordination for their regions. The Units and MCNs are now implementing plans to drive forward improvements and working on delivery of the Framework.

Given that such a framework already exists, our next steps in this phase one area will be to review the implementation of the framework and identify areas where further actions might be needed to support a sustainable seven day service across Scotland. Areas we will consider include the availability of appropriate decision makers and supporting diagnostics across seven days, ensuring that preterm babies are being cared for in the most appropriate level of facility and looking at the national and local transport arrangements that support the return of babies and their mothers, when it is clinically appropriate, to their local units.

As described above we will consider how best to link this work with the recently announced assessment and refresh of the model of care for maternity and neonatal services.