‘Putting families at the centre of care’: Review of maternity and neonatal services published

76 recommendations on enhancing maternity and neonatal care

Every woman will have continuity of care from a primary midwife, who will provide the majority of their antenatal, childbirth and postnatal care as part of a new model of care for maternity services in Scotland. The proposal is one of 76 recommendations made in a review of maternity and neonatal services, published yesterday.

They are based on the views of women and families, professionals and key stakeholders, as well as best available evidence and current good practice.

The review group was asked to refresh Scotland’s approach to maternity and neonatal services, to ensure every mother and baby gets the best possible care from the health service.

Other recommendations presented in the report include:

• A new model of neonatal care that sees arrangements in place to keep mothers and babies together as much possible – including wraparound care in the community to enable babies to get home as soon as possible.
• Each NHS board to ensure they are able to provide the full range of choice of place of birth, including at home, in a midwifery unit, or in a obstetric unit.
• Re-designing the model of neonatal care to ensure babies and mums get the best care possible, with all neonatal units in Scotland continuing to offer high quality care for sick babies. The very smallest and critically ill babies in need of the most complex and specialist care (which account for a few hundred of births in Scotland each year) should be cared for in up to five enhanced neonatal intensive care units.
• In maternity care, women with the most complex vulnerabilities should have access to a specialist team, with seamless care constructed around the woman’s needs.
• The model also sees parents fully involved in the care of their baby, and accommodation and support provided across Scotland for parents, to make sure families can stay together.
• Developing and training staff to work in high performing, multi-professional teams, providing seamless care for women and babies.

Health Secretary Shona Robison (above) said: “The NHS already provides an exceptional maternal and neonatal service to thousands of women and babies across Scotland every year. This review has provided an excellent opportunity to identify best practice and also outlines where we can make improvements to our services in Scotland to create world class maternity and neonatal care.

“I would like to thank the Chair and the members of the review group for this comprehensive report. I welcome the 76 recommendations, subject to more work being done to understand the scope and complexity of implementation. I will provide a more detailed response to Parliament on realising these recommendations in the near future.

“I want to focus in particular on the key recommendation on continuity of midwifery care and we will be moving forward with this quickly with early-adopter Boards. This move will help build relationship-based care between women and midwives, and will improve outcomes for women.

“Changes to birth rate, demographics and best practice, as well as advances to clinical care, means the services we provide to women and babies must be adapted and updated. The clinical evidence shows us that, for the most critically ill babies, delivering highly specialist care in up to five enhanced neonatal intensive care units in Scotland will ensure better outcomes for them and their families.

“We will also be prioritising the recommendations around transport and accommodation for parents of babies in neonatal care, to help ease those pressures during a difficult time for families.

“Our next steps will be to set up an implementation group to develop how best we can take forward the recommendations in partnership with the NHS and with service users.”

Jane Grant, Chair of the Maternity and Neonatal Review Group, said: “As part of the Review I visited maternity units within every Health Board area across the country and I would like to take this opportunity to thank the hundreds of staff, parents and voluntary groups who made the time to share their views and experiences.

“This feedback helped to identify the issues which matter most to women and their families and played a key role in shaping the report findings and recommendations.”

Mary Ross-Davie, Director for Scotland at the Royal College of Midwives (RCM), said: “This is a very welcome report and one that has the full support of the RCM. This is a defining moment for maternity services in Scotland and will be a seismic shift for our maternity services. The plan has the potential to revolutionise maternity care, to deliver safer and better services for women, babies and their families, and to improve the health of our population.

“What is so important is that this puts women and their families at the centre of care. The focus on continuity of care and carer – that is the woman seeing the same midwife or small group of midwives – is very welcome. There is very strong evidence that better continuity of care leads to better outcomes for the mother and baby.

“I know that there are many midwives who will welcome these changes as an opportunity to work in a way that will allow them to provide better quality care.  We know that working in a system that enables midwives to get to know the women and families they are caring for can greatly improve job satisfaction for midwives. We believe this report heralds the development of a new maternity care system that can work for women and can work for midwives and the wider maternity team.”

The review can be accessed at:

• http://www.gov.scot/isbn/9781786527646 – The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland – Executive Summary Report
• http://www.gov.scot/isbn/9781786527127 – The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland