1. Refreshing the Framework for Maternity Services in Scotland Mags McGuire Deputy Chief Nursing Officer Christine Duncan Change Manager, Maternity Services

2. 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……. ?

3. 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

4. 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

5. 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 …………………

6. 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

7. GIRFEC PRACTICE MODEL

8. 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

9. 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

10. 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)

11. 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

12. Equity in the quality of care-every woman, every baby, every time C aring and c ompassionate staff and services Clear c ommunication and explanation about conditions and treatment options Effective c ollaboration between clinicians, patients (and others involved in providing care and supporting the patient) A c lean and safe care environment C ontinuity of care and good access to care C linical excellence

13. Applying the 6 dimensions of healthcare quality DimensionsDescription of key measures Data source Safe Effective Person centred Timely Efficient Equitable

14. Format (at present….) Evidence base Overarching principles Service descriptors: pregnancy- birth- post natal care

15. Example Principle 4Practice/activityPerformance 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

16. Example service descriptor 4Practice/activityPerformance 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

17. 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

18. Next Steps Writing group meeting on 15 th June Further feedback gathered over the summer Consensus day in October Circulated with ministerial approval- November/December Development of implementation plan post- December

19. Thank You… We look forward to your feedback!