Meeting of the Parliament 08 May 2019
I thank Monica Lennon for highlighting the international day of the midwife.
In Scotland, we are very fortunate to have highly educated, skilled and compassionate midwives who lead and deliver the high-quality care that is so valued by women and their families during their pregnancies, as they prepare for birth and their first few precious days and weeks with their babies. Our midwives support a woman’s whole family. That matters, because all the evidence tells us that children’s experience in their early years can make a real difference to their health and wellbeing later in life, and that support for new parents needs to start pre-birth. Therefore, let me repeat the thanks that Jeane Freeman recorded on Sunday, on the international day of the midwife, to every midwife in Scotland and every young midwife in training for their commitment, compassion and dedication to their role.
It is two years since “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland” was published. It describes a new model of maternity and neonatal care that is family centred and focuses on compassion and the best care, with the whole family being involved in the experience. One of the central pillars of the best start plan is the introduction of the continuity of midwifery carer. Under that model, women receive most of their care from a primary midwife and a small team throughout pregnancy, labour, birth and afterwards. That is what women told the best start review that they wanted, and midwives told us that that is how they want to work. The model is also supported by compelling international evidence of its positive impact, including improved satisfaction with care, fewer medical interventions during birth, improved breastfeeding rates, and reductions in pre-term birth and baby loss.
Last year, five early adopter boards were identified and given the task of leading the way across Scotland in implementing the new model of continuity of carer and local delivery of care. The first teams are now delivering continuity of care to local women. Capturing and sharing learning from those early adopters is helping the remaining boards to plan for change in their own areas, which will be tailored to local needs. The underlying principle of delivering individualised care, which is built around a woman and her family, and their circumstances and needs, will be at the centre of every midwife’s practice. Built into the model is the recognition that some women with complex needs will need extra care, and so midwives’ caseloads are reduced to give them the time to provide such care.
We know that the roll-out of the continuity of carer model and the delivery of the range of recommendations in the best start review will need investment in order that they can be delivered. That is why Jeane Freeman announced a funding package of £12 million over two years for implementation across the best start programme. That has allowed boards to invest in infrastructure, training and equipment for staff to be able to make the best start programme a reality. In recognition that the roll-out will take several years, the Government is also looking at future funding.
No one is in any doubt that the model will mean substantial change to ways of working, particularly for midwives, which is why our early implementer boards have invested time and energy in communications and change management, supported by our best start programme board and delivery groups. We expect all boards to roll out the new model in a planned and managed way, with safety at the forefront, and our maternity teams are working hard to deliver that. In addition, boards have been supported by national groups that have developed a range of guidance frameworks and training for staff to support implementation.
To support the roll-out, the best start programme executive team and the RCM are engaging with the early adopter boards and listening to their experience of the continuity of carer model to identify learning so as to improve implementation at national and local levels across Scotland. In March, a best start event was attended by more than 200 maternity staff, who were mainly midwives, from across Scotland; many more watched via a live stream. The event focused on sharing learning and experience of the roll-out of the best start programme, including the continuity of carer model, and giving staff the opportunity to ask questions.