Hansard

I committed to come back to the chamber to provide an update on Moray maternity services, and I am pleased to be able to do that today. I intend to set out the progress that has been made to date, my initial response and, crucially, what the next key milestones will be. Before I do that, however, it is important for me to reiterate this Government’s absolute commitment to the delivery of a consultant-led maternity service in Dr Gray’s hospital. While model 4 will deliver improvements for families in Moray, it is model 6 that very firmly remains the destination.

Members will be aware that I started this process in December last year when I was considering the report of the independent review of Moray maternity services. I proceeded to meet and engage with senior teams in boards, clinicians, local community campaign groups and elected members from right across the political spectrum. It was important to do that and it helped me to come to my final decision, which I announced in the chamber in March. That was to progress with model 6, which is a full consultant-led maternity unit at Dr Gray’s, with model 4, which is a networked maternity model linked primarily with Raigmore hospital, as part of the development towards that final destination.

I also announced, in line with the recommendations of the independent review, that I would bring some level of independent assurance to the process, and I was delighted to announce in July that Professor Linda de Caestecker would lead that work. Since then, Professor de Caestecker has identified further clinical support and expertise to work with her to provide that external assurance. The team that is working with Linda includes representatives from relevant specialties such as paediatrics, anaesthetics, obstetrics and midwifery.

The external panel will be a sounding board and a critical friend to both NHS Grampian and NHS Highland and, crucially, it will provide assurance and reassurance to the community and to me in Government. That has already begun through meetings and email exchanges, providing me with a further level of scrutiny and advice on progress and plans.

Members are aware of the NHS Grampian and NHS Highland draft joint plan, which was submitted to me on 1 July. I welcomed the plan, but at that time I expected further information before giving my response to it. The model 4 plan is an important step in the journey towards model 6 and I was pleased to see the ambitious timescales in it. What I can say here today is that I am very clear that further work is required before I give approval to model 4 plans, and there are elements to be worked through locally and nationally to deliver for families in Moray.

At local level, clinical teams in Highland and Grampian need to develop the safe pathways of care to bring reassurance both to the women involved in Moray and to clinicians. At national and local levels, there is work to be done to address the on-going challenges of recruitment. I have asked both NHS Highland and NHS Grampian to share their recruitment plans to meet the 2023 deadline in the model 4 plan.

There are key elements in the model 4 plan to which I wish to draw the Parliament’s attention. First, the intention for NHS Grampian to introduce increased obstetric antenatal care to Dr Gray’s is welcome. It could result in at least 1,000 antenatal appointments a year being delivered in Dr Gray’s, thus reducing the amount of travel for pregnant women.

The other element that I want to highlight today is planned caesarean sections. As we know, that is not included in the model 4 plan due to its dependency on other services and skilled staff being available. I expect planned caesarean births in Dr Gray’s to be covered as part of the model 6 plan, which I expect at the end of this year, and I expect ambitious progress to be made to deliver that. I will ask Linda de Caestecker and her external assurance panel to look at that issue in further detail.

Essentially, we should view the interactions between models 4 and 6 as a continuum. We will not wake up one day and suddenly switch from model 4 to model 6. I expect model 6 to be phased in over time. I am clear that elective sections should be given priority within that phasing process.

Concerns have been raised with me by local campaign groups and by clinicians about the projected numbers in the NHS Highland draft business case for women giving birth in Raigmore. I have asked the external assurance panel that I have just spoken about to take that forward and to investigate with boards, and clinicians, at pace. The ambition is to achieve choice for women living in Moray to birth in Raigmore if they wish to go there, where clinically appropriate.

I understand that there are concerns, including that progress is not being made quickly enough and that clinicians do not feel that the proposed changes are safe. I hear those concerns and I take them very seriously. I commend the steps that NHS Highland is taking to engage with the clinical teams to identify and address those concerns. That takes time, and I have always been clear that change will not happen overnight. We must work with clinicians in Grampian and Highland and, where there are legitimate concerns, those must be addressed.

I understand that the priority for women in Moray is that they have access, as soon as possible, to the widest range of maternity services that can safely and realistically be delivered as close to home as possible. The independent review of maternity services in Moray proposed, and I agree, that the first step in achieving that is to implement a networked maternity model, linked mainly to Raigmore.

I have already announced funding of £5 million to support improvements in Raigmore. To be clear, when I visited Raigmore earlier this year, I saw for myself that investment was much needed. The investment in Raigmore was not contingent on taking women from Moray. However, improved maternity services at Raigmore will benefit all women who give birth there. The redevelopment in Raigmore is key to improving the environment both for women giving birth and for the clinicians who work there.

I know that there are doubts around model 4. I have heard them from clinicians and from community members and campaign groups. However, the real prize from implementing model 4 will be in opening up scope for more pre and post-birth appointments at Dr Gray’s, and enabling more women to have their labour and birth in a hospital closer to where they live. That will be delivered by having the clarity of a safe model 4 as an interim solution, with robust pathways of care, providing care closer to home and an increased choice of place of birth. Until consultant-led services are returned to Dr Gray’s, women who need obstetrician-led care will have the choice of Raigmore or Aberdeen for the birth of their baby, and it is critical that we continue to have a parallel focus on the implementation of model 6 as the final destination. National health service care should be not about board boundaries but about working across boundaries to deliver the best care for all women who choose to birth in a given area. That is key to a networked model.

Back in March, I was clear that I expected plans for model 4 and model 6 to run concurrently. NHS Grampian has begun the process of planning what it requires for model 4, and to lay the foundations for model 6. As I have already made clear, I view model 6 as a continuum from model 4—an improvement journey that has a focus on safety and is led by clinicians. Oversight of that work is provided through the chief officers group, which is jointly chaired by NHS Grampian and NHS Highland. I expect the model 6 plan by the end of December. I expect to see evidence of collaborative working and joint plans from boards—for example, around the pathways of care. As part of the next phase of the work, monthly meetings will take place between the boards, Professor Linda de Caestecker and my officials.

I will talk a little about engagement. I reinforce in particular the importance of on-going engagement. I am pleased to note that connections are already being made with the external assurance lead, and that that includes community groups such as Keep MUM and the Moray and Banff maternity voices partnership. Their views have been instrumental in getting us to this point, and their challenge will help us to shape the way ahead. I have spoken to the Keep MUM campaigners just this week, and have given them a cast-iron guarantee that I remain absolutely committed to model 6: a return to a consultant-led midwifery unit at Dr Gray’s.

Finally, I would like to outline what I see happening over the next six months or so. In November, I expect to have advice from the external assurance panel on the NHS Highland business case and on the numbers of women giving birth in Raigmore, which I know is causing some concern.

In December, I expect to meet NHS Highland and NHS Grampian to discuss my expectations for the model 6 plan and its interaction with model 4. I expect to receive the model 6 plan by the end of December. Of course, I will keep Parliament updated in that regard.

For all our differences, I am certain that everyone in this chamber wants to see women in Moray being able to give birth as close to home as possible. We will endeavour to make that a reality and always ensure that the priority is the safety of women and their unborn children.

From January to February, I expect to have a response from the external assurance panel on all the plans received. That will be fed back to NHS Highland and NHS Grampian.

I hope that my statement gives some reassurance to members, clinicians and the community groups who have raised concerns. Work to return consultant-led maternity services to Dr Gray’s is progressing. Yes, Covid-19 has undoubtedly impacted on delivery timescales, and the context continues to be the most challenging time that our NHS has faced since its creation. However, the chairs, chief executives and executive teams at NHS Grampian and NHS Highland continue to assure me of their commitment to deliver both model 4 and, crucially, model 6—the final destination.

I reiterate my and this Government’s absolute commitment not just to model 6 but to ensuring that we return to consultant-led midwifery care at Dr Gray’s, to ensure that as many women as possible in Moray can give birth as close to home as possible.