Implementing A Framework for Maternity Services in Scotland
Provision of Acute Maternity Services
Regional services
1. The Framework for Maternity Services in Scotland set out that maternity care should be organised to provide a comprehensive, clinically effective, safe, flexible, integrated, multi-disciplinary, seamless and accessible service tailored to meet the needs of women and their families within a safe and secure environment. The Framework asks NHS Boards to develop Maternity Services Strategies and Local Implementation Schemes within a local and regional context, taking account of the Framework guidance.
2. The EGAMS concluded that a regional approach to managing and delivering maternity services offers the best opportunity to provide high-quality women and baby-centred services that are clinically effective and make best use of skilled staff resources. Regional Service Planning Groups (RSPGs) - existing groupings of NHS Boards which develop plans for health services across Board boundaries - should plan and commission services which provide local access to appropriate levels of maternity care, and ensure that care complies with core principles of service delivery (Box 1).
Core principles of delivery in maternity services
Box 1 |
Care should be high quality and based on the best available evidence. Care should be offered as close to the woman's locality as possible. Continuity of care is a key goal. Services should be planned to strike a balance between women's choices, risk and quality of care. All women should be 'booked' by a midwife and assigned to the appropriate level of care, as defined by risk assessment and management principles. A 'lead professional' for the woman's care should be identified. This can be any professional. Midwives are likely to be the lead professionals for 'normal' pregnancies and births. Women should receive one-to-one care when in labour. Services should be based on a multi-disciplinary approach to care.
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Principles |
1.1 Acute maternity services in Scotland should be planned and commissioned on a regional basis by Regional Service Planning Groups, taking account of NHS Boards' local plans. The RSPGs should monitor implementation of regional plans by NHS Boards and Trusts. They should also work in alliance with other regions. 1.2 Regional Service Planning Groups should set up appropriate mechanisms to involve stakeholders in planning and commissioning maternity services within regions, led by dedicated Regional Maternity Services Co-ordinators. |
3. Regional networks of acute maternity services should be underpinned by robust and effective multi-disciplinary and cross team working. They should become key centres for innovation, change and practice development, pursuing clinical excellence in all aspects of care and driving forward policy and research agendas. They should be exploring new ways of delivering services to meet their population's needs, and should be in the vanguard of new and extended roles for clinical practitioners. Ultimately, they will set the standard for maternity services in Scotland.
4. But it is vital that they do not operate in isolation. Alliances, partnerships and networks with other regions will be necessary to ensure consistency in the standard of care delivered throughout Scotland. The EGAMS concluded that regional service networks should consider how best to ensure co-ordination and co-operation across regional services. Arrangements should be made to ensure that Regional Maternity Co-ordinators throughout Scotland meet on a regular basis.
Care networks
5. Good communication and the integration of services are central to the provision of quality maternity care throughout Scotland. Local, regional and national networks provide a vehicle through which this can be achieved.
6. Networks allow maternity care professionals from different levels of service to work together to ensure the provision of high-quality, clinically effective services throughout Scotland. They enable professionals to look beyond the constraints of professional, organisational and geographical boundaries to develop services which are of a consistently high quality across the country, and foster a genuine multi-disciplinary approach. They also provide an infrastructure on which to base a framework of tiered care in maternity services with clear and explicit communication and referral pathways.
Principles |
1.3 Networks of maternity services should be developed throughout Scotland at local, regional and national level. 1.4 Networks should devise a framework of tiered care for maternity services in Scotland through mechanisms for regional planning. |
7. An effective maternity network, operating at local, regional or national level, will develop systems to provide:
ongoing professional advice to maternity care professionals
vehicles for good communication between professionals
clear and consistent advice on key clinical topics, such as resuscitation and stabilisation procedures (appropriate for different kinds of maternity unit)
criteria for care and for transfer of care
criteria for escalation to high levels of intrapartum or postnatal care
criteria for access to specialist neonatal services
criteria for access to adult intensive care and high dependency settings
support for transport and transfer systems
comprehensive specialist outreach antenatal and postnatal care services.