Meeting of the Parliament 21 February 2017
I am pleased to update Parliament on our response to the publication of the report of our review of maternity and neonatal services.
Every day, our maternity services deliver an excellent service to families across Scotland. In our maternity care experience survey, women reported over 90 per cent satisfaction with the care that they had received. We also continue to reduce rates of maternal mortality, stillbirth and neonatal mortality in Scotland to record low levels. The number of neonatal deaths has reduced by 40 per cent since 2007, which means that, in 2015, 76 more babies’ lives were saved by the high-quality care that was provided by staff in neonatal units across Scotland. It also means that there were 76 fewer bereaved families. That improvement is a testament to the hard work of the staff who look after sick babies in Scotland.
Our maternity system secures high satisfaction ratings among women and continues to improve care and outcomes for the sickest babies. We are in a position of strength, but we are not complacent and know that there is much that we can do to make further improvements. That desire to improve and transform in part inspired the review. The report is a landmark publication that represents a major opportunity to improve services even further, and its recommendations will transform service delivery in Scotland.
For example, some women currently experience no continuity of maternity care and can see numerous different midwives and obstetricians throughout their care journey. That is not what women or staff want, and evidence tells us that it is not good for care. To give women and staff what they tell us they want—which the report describes as family-centred care—will require a radical shift in how we deliver care. There is no doubt that such change will be challenging to deliver and, for many of our midwives and obstetricians, will represent a significant change in ways of working, but it will ensure better care.
This important review, with its far-reaching and considered recommendations, is down to the leadership of the chair, Jane Grant, and the work of the members of the review group, and I place on record my thanks to them for carrying out the commission. Their hard work and commitment have produced a report that is based on evidence and grounded in the views of the families who use the services and the staff who deliver them. The breadth of engagement that was undertaken by the review team, which was supported by the Scottish health council, was truly impressive and I welcome a report that is so strongly anchored in the views of the hundreds of service users and staff across Scotland who contributed.
I will outline the next steps on implementation and highlight some of the key principles and recommendations in the report.
It is my pleasure to announce that Jane Grant has agreed to chair the implementation of the review’s recommendations. It was Jane’s drive, commitment and inclusive approach that produced such a well-researched and thorough report. As an experienced national health service chief executive, she is the right person to chair the major programme of implementation that we will now embark on. Over the coming weeks, Jane will appoint the implementation group to drive forward delivery of the recommendations. Chaired by Jane, the group will be tasked with progressing quickly with the priority recommendations and providing a detailed plan and timetable for implementation over the five-year delivery period that is envisaged. I will ask the group to get under way quickly and to report back to me at regular intervals on its progress.
It will take time to implement all 76 recommendations, but they are important. I will highlight a few of them. First, there is a need for continuity of care. The report highlights at length the importance that women and families attach to forming a relationship with the professionals who care for them and having continuity. As the report acknowledges, the recommendation challenges traditional NHS approaches. It recommends identifying a number of early adopter boards to lead the change in practice, which are to be supported by proper training and development for staff who require it. I am pleased that a number of boards have already volunteered to do that. We will announce shortly which boards will lead the first phase of implementation, and we will work carefully with boards to scope out the scale of the task and ensure that the early adopter boards can properly test the challenges of implementation.
Secondly, I want to move quickly with the proposals to implement the range of recommendations on person-centred maternity and neonatal care that are aimed at keeping families together. Those include recommendations to keep mothers and babies together, to involve parents more in the delivery of care and to provide accommodation and a national approach to expenses for families with babies in neonatal care. I underline how important it is that families stay together. No mother wants to be separated from her new baby even for a very short time, and we should never underestimate the importance of the early days of life for family bonding, breastfeeding and attachment. I want that to be a core feature of our services in the future. I will ask the implementation group to prioritise those recommendations.
Thirdly, there is the redesign of maternity services with a focus on local care and multidisciplinary community hubs. We all know that women want care to be delivered as close to home as possible. Again, I would like boards to move quickly on the assessment of the potential for hubs in their local areas to allow local delivery of the majority of maternity care as soon as possible.
Finally, there is the model of neonatal care. The model that is described in the report aims to reduce the number of babies who need to spend time in neonatal units by keeping mothers and babies together in postnatal wards with in-reach support from neonatal staff and by putting in place wraparound community support to allow babies to be cared for at home by their parents sooner than they can be currently.
All 15 neonatal units will remain and continue to care for babies in their areas. The clinical evidence shows that the outcomes for the very smallest and the very sickest babies will be better if they are cared for in up to five enhanced neonatal units delivering highly specialist care, moving to three such units in the longer term if possible, based on the experience of operating in up to five.
The new model is based on evidence and emerging good practice from Scotland and the rest of the world, and I want the implementation group to outline clear plans to allow the neonatal community to make progress quickly with the implementation of those recommendations. Again, that will be a priority for the implementation group.
I have already outlined the strength of the engagement with women, families and staff in NHS boards that underpins the report. I want that partnership and co-production for delivery to be a core feature of implementation. I am sure that we all agree that solutions that are developed in partnership will have far more chance of success and sustainability. They will also require time and space to ensure that the beginnings of the transformational shift are right. That is why I will continue to keep Parliament and spokespeople informed of progress, particularly on neonatal units and pathfinders.
Proceeding on the basis of co-production and partnership will take care and time. Although the report has been warmly received across Scotland and discussions are already under way with the NHS community about the recommendations, implementation will be challenging and complex. I will request the chair of the implementation group to build partnership into delivery from the start and I am prepared to give the implementation group the time to do that properly. Similarly, I am keen to work in partnership across the chamber on this.
Although much of what is in the report is about the redeployment of existing resource, it is also clear that some of the recommendations will need investment to deliver. All boards are at different starting points in terms of delivery, and we will work closely with them, learning lessons from early adopters and existing good practice to quantify what additional resource will be required. In many cases, it is hoped that this investment will realise savings over time, although improved outcomes for women and babies is ultimately the real prize.
Finally, I will ask the implementation group to instigate a detailed piece of work on staffing. The review was firmly grounded in the views of staff, and the review report describes some of the challenges that they face. Those have also been reflected in recent reports by Bliss Scotland and the Royal College of Midwives. I will ask the implementation group to undertake some early modelling work with NHS boards so that we can get a better understanding of the workforce changes that are required to take forward the package of recommendations. That work will align with the workforce strategy.
The shift in care that the report describes sits within the overarching strategic context of our reform agenda for health and care services, as outlined in the national clinical strategy and “Realistic Medicine”, the chief medical officer’s annual report for 2014-15, and tackling inequalities.
The Royal College of Midwives described the report as having
“the potential to revolutionise maternity care, to delivery safer and better services for women, babies and their families”,
and Bliss Scotland described it as
“an ambitious and progressive vision for family-centred care and good news for the future of Scottish neonatal services”.
The report makes a clear case for change in our maternity and neonatal services and its recommendations and aims are supported by professionals, practitioners and, importantly, parents. Our aim is to make Scotland the best place to grow up, and that journey starts with excellent maternity care and giving all babies the very best start in life. Our job now is to implement the recommendations strategically and to take the time needed to ensure that this unique opportunity to transform the way that services are delivered makes good on our ambitions and visions.
I welcome questions on this statement.