1. 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

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

3. 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

4. National Implementation Structure

5. 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

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

7. 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

8. Barriers to breastfeeding and kangaroo care in neonatal units

9. 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

10. 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:

11. 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.

12. 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

13. 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.

14. 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

15. 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

16. 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.

17. 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.

18. 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.

19. 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.

21. Contact Rebekah.carton@gov.scot thebeststart@gov.scot
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