Title: Refreshing the Framework for Maternity Services in Scotland Mags McGuire Deputy Chief Nursing Officer Christine Duncan Change Manager, Maternity Services
1Refreshing the Framework for Maternity
Services in ScotlandMags McGuire Deputy Chief
Nursing OfficerChristine Duncan Change
Manager, Maternity Services
2Why 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 - Scotlands diverse geography and demography-
remote and rural, urban, mixed, small
populations, concentrated populations, homogenous
communities, diverse communities.
?
3The 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
4Being 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 7cs
of quality
5Not starting from scratch- its 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
7GIRFEC PRACTICE MODEL
8Shifts 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 womens 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
9The 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
10Strengthening 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)
11Tailoring 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
12Equity 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
13Applying the 6 dimensions of healthcare quality
14Format (at present.)
- Evidence base
- Overarching principles
- Service descriptors pregnancy- birth- post natal
care
15Example
16Example
17Feedback 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
18Next Steps
- Writing group meeting on 15th June
- Further feedback gathered over the summer
- Consensus day in October
- Circulated with ministerial approval-
November/December - Development of implementation plan post- December
19Thank You We look forward to your feedback!