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 examplecaesarean 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
Safe
Effective
Person centred
Timely
Efficient
Equitable
Description of key
measures
Data source
Format (at present….)
• Evidence base
• Overarching principles
• Service descriptors: pregnancy- birth- post
natal care
Example
Principle 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
Example
service 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
•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
pathways of care
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 highlightedmaternal 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 approvalNovember/December
• Development of implementation plan postDecember
Thank You…
We look forward to your feedback!