THE BEST START A Five-Year Forward Plan for Maternity and Neonatal Services Supporting change and overcoming barriers in Neonatal units Rebekah Carton Maternity and Neonatal Policy Lead Scottish Government

Objectives : Overview on Best Start How does Best Start deal with some of the barriers to breastfeeding and kangaroo care in Neonatal Units

Best Start - Background The Best Start review of maternity and neonatal services commenced 2015 Five Year plan published 20 January 2017 76 recommendations National Implementation Programme Board established – reps from across the service, professional bodies and service users Chaired by Jane Grant, Chief Executive of NHS Greater Glasgow and Clyde

National Implementation Structure

Sub Groups - Perinatal Services Neonatal Intensive Care Unit locations Risk Assessment Tool Pathways Cot locator system Cot availability protocol Neonatal transfer staffing model Medical care outwith maternity setting

Early Adopter Boards NHS Forth Valley NHS Highland NHS Lanarkshire NHS Lothian NHS Greater Glasgow & Clyde (Clyde only)

Locally Led recommendations NHS Boards will be empowered to drive forward many of the recommendations at local or regional level where possible and practical to do so 23 out of 76 recommendations suitable for delivery at a local level Local area implementation leads have been identified in all geographic NHS Boards

Barriers to breastfeeding and kangaroo care in neonatal units

Length of parental visits, travel distance & cost You can’t breastfeed or give kangaroo care if you’re not there!! Recommendation 8 - To reduce variation, an urgent review of the approach to expenses for families of babies in neonatal care should be undertaken to develop a nationally agreed policy

Length of parental visits, travel distance & cost Neonatal expenses fund Launched on 1st April £1.5M Travel costs and meals Accommodation being considered Full details at: www.mygov.scot/neonatal-expenses-fund

Inconsistent information & communication Recommendation 74: There should be a single Neonatal Managed Clinical Network for Scotland with the new model to ensure integrated working across NHS Board boundaries, including input from service management and clinical staff. The maternity and neonatal networks should come together formally on at least an annual basis to promote integrated services.

Single Neonatal MCN Three regional neonatal MCNs; West, North and SEaT, established in 2010/2011 Move to Single MCN led by NSD as part of National Network Management Service. Sept/Oct 2018 Benefits: Reduce variation and duplication Leading/supporting Innovation; Seamless patient pathways across network; Supporting implementation of The Best Start model of neonatal care in Scotland. Strong links with the National Maternity Network

Lack of facilities and empowerment Recommendation 43: - Parents should be involved in decision-making throughout and involved in practical aspects of care as much as possible. This includes the provision of facilities for overnight accommodation, encouraging kangaroo skin-to-skin care and early support for breastfeeding.

Empowering Parents Local recommendation – Boards have committed, by December 2018 to: provide facilities to support kangaroo care, support for breastfeeding and breast milk feeding. demonstrate implementation of neonatal quality framework section 3.1 on person centred care. UNICEF Breastfeeding friendly Bliss Baby Friendly accreditation

Quality Framework Parents will be encouraged and supported to participate in the planning and decision-making about the care and treatment of their baby. Families will be provided with information and support to access appropriate professional help. dedicated facilities available for parents and families of babies receiving neonatal care

Keeping mothers and babies together Recommendation 5: Maternity and neonatal services should be redesigned to ensure mothers and babies stay together. Increasing provision for postnatal-neonatal care. Keeping mother and baby together where ever possible. Moving babies with complex needs back to their local neonatal or special care unit. Early discharge into community care.

Redesign of Neonatal Services Recommendation 45: The new model of neonatal services should be redesigned to accommodate the current levels of demand, with a smaller number of intensive care neonatal units, supported by local neonatal and special care units. Formal pathways should be developed between these units to ensure that clear agreements are in place to treat the highest risk preterm babies and the sickest term babies in need of complex care in fewer centres, while returning babies to their local area as soon as clinically appropriate. Three to five neonatal intensive care units should be developed, supported by 10 to 12 local neonatal and special care units.

Redesign of Neonatal Services Perinatal Subgroup agreeing the options appraisal process and hope to complete this before the summer. IPB will provide a recommendation to Cabinet Secretary Final decision expected by the Cabinet Secretary later this year.

Redesign of Neonatal services Part of the redesign will consider aspects such as parental accommodation and facilities National pathways for referrals improved staff competencies and best clinical practice in these units and safer care for the babies most at risk.

Contact Rebekah.carton@gov.scot thebeststart@gov.scot Blog - https://blogs.gov.scot/child-maternal-health/ Newsletter (email BS mailbox) Twitter - @SGChildMaternal