Refreshing the Framework for Maternity Services in Scotland

Mags McGuire Deputy Chief Nursing Officer

Christine Duncan Change Manager, Maternity Services

Why refresh the framework? • Policy landscape, evidence and knowledge has moved on

since 2001

We need a strategic framework that meets a number of challenges, including……

• Unequal access, care and experience• Unequal maternal and infant outcomes – for key groups

across the life course• Unequal involvement and engagement of women

• Emerging demographic and epidemiological challenges• Scotland’s diverse geography and demography- remote

and rural, urban, mixed, small populations, concentrated populations, homogenous communities, diverse communities…….

??

The Approach so far….Synthesising ‘old’ and ‘new’- applying the key

dimensions of Healthcare Quality - person centred, safe and effective

Nothing taken out but some merging and some key additions needed, for example-– addressing inequalities in access, experience and

outcomes – health improvement gaps- maternal and infant

mental health, parenting capacity– Performance/service improvement measures

Being clear about the unique contribution of maternity services

2 specific roles

– As a partner with other NHS services and other public and third sector services

– In providing quality services that are sensitive to inequalities- using the 6 dimensions and 7c’s of quality

Not starting from scratch- it’s a busy

landscape!……• KCND and Maternity Pathways• Neonatal services-expert group and MCNs • Antenatal inequalities working group- evidence into

action guidance for NHS Boards- • Caesarean section review of trends- expert groups

recommendations-into practice?• Patient and user involvement report• Health improvement gaps• Workforce- development and planning• Evaluation of SWHMR…• Antenatal education-mapping and curriculum

development• Vulnerable families …………………

What do we need to strengthen?

• Skills for assessment and response to multiple and complex needs- (assessing and managing risk)

• KCND ↔Vulnerable pathways • Mechanisms for tailoring of services-planning,

workforce etc • Measuring service improvement- looking at

technical and quality measures-for example-caesarean section rates, access data, patient experience feedback, complaints…….

• Embedding the Girfec practice model

GIRFEC PRACTICE MODEL

Shifts in perspective?

•Thinking about maternity services as part of the bigger NHS and Public Service picture•Thinking about the relationship between medical and social risk•Taking a life course perspective not a service perspective•Using women’s experience of care to improve service quality

Thinking about equity in the quality of care, effective and person centred for every woman and her baby

The Cultural Challenge• health inequalities are avoidable and can be

reduced• maternity services have a critical role as a universal

NHS service to women and infants

Strengthening Universal services not the same services for everyone

‘Delivering health and other services that are both universal and appropriately prioritised to meet the needs of those most at risk of poor health, and that seek to prevent problems arising, as well as addressing them if they do.’

(Equally Well 2008)

Tailoring works…

For example-

• Age specific antenatal care has been shown in studies from the USA, Australia and the UK to significantly reduce the preterm delivery rate (12% vs 26%),

• the incidence of low birth weight babies (5% vs 14%), • increase the uptake of post natal contraception (77% vs

36%- up to 1/5 of teenagers are pregnant again within 3yrs)

• breastfeeding (20% vs 2%).

Ref: NICE draft guidance on socially complex pregnancies

Equity in the quality of care-every woman, every baby, every time

• Caring and compassionate staff and services• Clear communication and explanation about

conditions and treatment options• Effective collaboration between clinicians,

patients (and others involved in providing care and supporting the patient)

• A clean and safe care environment

• Continuity of care and good access to care

• Clinical excellence

Applying the 6 dimensions of healthcare quality

Dimensions Description of key measures

Data source

Safe

Effective

Person centred

Timely

Efficient

Equitable

Format (at present….)

• Evidence base

• Overarching principles

• Service descriptors: pregnancy- birth- post natal care

ExamplePrinciple 4 Practice/activity Performance measure

Women have equity of access to and experience of maternity services that are -woman centred, safe and effective.

•Inequalities relating to access, care experience and health outcomes are identified and proactively and effectively addressed.•Antenatal services are promoted through all appropriate NHS services including sexual health services, mental health services, community addiction services etc

•Identified dataset enables capturing of data on screening/gestational age uptake •Evidence of referral activity and integrated work•Patient experience feedback

Exampleservice descriptor 4 Practice/activity Performance measure

Medical, obstetric and social needs are assessed as early as possible in pregnancy so as to identify women and families in need of additional support, linking them into appropriate

pathways of care

•SWHMR is completed for all women•KCND and NHS QIS Pathways for Maternity Care utilised •GIRFEC Practice model is utilised•The NHS QIS Best Practice Statement on maternal history taking is reflected in practice.

•Identified dataset enables capturing of data on screening/gestational age uptake •Evidence of referral activity and integrated work•Patient experience feedback

Feedback so far

• Right direction• Need to emphasise maternity services as part of

a bigger system- joins between pre-conceptual children and adult services

• Performance measures are welcome• Tension between choice/want v need- needs to

be explicit• New clinical challenges need to be highlighted-

maternal age, obesity, neonatal care etc

Next Steps

• Writing group meeting on 15th June

• Further feedback gathered over the summer

• Consensus day in October

• Circulated with ministerial approval- November/December

• Development of implementation plan post- December

Thank You…

We look forward to your feedback!