Revamp of neonatal services in Scotland on the way

The Scottish Government is considering recommendations for a major revamp of neonatal services – including creating three specialist neonatal intensive care units in the next five years.

The Scottish Government is considering recommendations for a major revamp of neonatal services – including creating three specialist neonatal intensive care units in the next five years.

Specialised neonatal units can improve outcomes for pre-term babies. Picture: Getty

Survival rates and longer term neurodevelopmental outcomes would improve because specialist centres can develop highly skilled staff due to the higher volume of intensive care cases, it is believed.

Scotland has 15 neonatal units, which would all be retained, but 12 would be designated as local neonatal units or special care units within five years.

Scotland needs a ‘national framework for practice’ outlining pathways for newborn care and larger units should provide outreach support for smaller local neonatal units, the report says.

Keeping mothers and babies together

Another recommendation is for a ‘new model of person-centred care’ for neonatal and maternity services so that mother and baby are kept together at every stage of the postnatal journey – even for those with complex care needs. Currently, many babies with moderate additional care needs – such as temperature maintenance or treatment for jaundice – are admitted to a neonatal unit when ‘most could be cared for with their mother on postnatal wards or even at home with additional support’, says the report.

These recommendations are among 76 in a government-commissioned report, The Best Start, triggered by a review of the state of maternity and neonatal services by a group including healthcare professionals and families.

Specialised units

Alison Wright, NHS Tayside advanced neonatal nurse practitioner and chair of the Scottish Neonatal Nurses Group, said of the recommendation for three to five specialist neonatal intensive care units initially, reducing to three units within five years: ‘The evidence examined by the review showed that having higher volumes of cases in specialised units brings better outcomes for the very small number of extremely pre-term babies currently cared for in a larger number of neonatal units. It’s the same principle that has led to other specialist areas of healthcare to be centralised.’

Scottish health secretary Shona Robison said: ‘Changes to birth rate, demographics and best practice, as well as advances in clinical care, means the services we provide to women and babies must be adapted and updated.’

Better beginnings

On the recommendation to keep mothers and babies together through improved transitional care and early supported discharge, Ms Wright said: ‘If you keep mothers and babies together then this helps give the best start to the mother and baby relationship. It will support breastfeeding and raises mothers’ confidence.’

Many babies admitted to neonatal units may be near term and may need tube feeds or temperature support, but in the proposed model these babies should be able to stay with the mother so that she and the baby can receive the care they need without admission to a neonatal unit, added Ms Wright.

Why a new model of care is needed

  • The steady rise in the number of older mothers and those with long-term conditions.
  • To improve care for mothers diagnosed with mental health problems.
  • Half of women giving birth in Scotland in 2014/15 were classed as overweight or obese, increasing the need for interventions.

Source: The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland

Dual skills

The report also says that critically unwell women should always continue to receive normal midwifery care and critical care nurses should be given training in midwifery skills. Another section of the report describes how nurses are often too busy to attend training and education courses, saying that staff need protected time to ensure they can go on such courses.

It is not clear yet whether additional funding or staffing will be available to implement the recommendations. Some neonatal professionals interviewed for the review said that staffing shortages meant that neonatal cots were not always available and that there are ‘complexities associated with arranging transfers’ of babies. Staff also called for ‘an improved model of neonatal community care to allow babies to be discharged earlier with appropriate support’.

Staffing issues

The report came out in the same week that Bliss, the charity that supports premature and sick babies, published a report showing that three quarters of Scotland’s neonatal units do not have enough nurses to comply with national staffing standards.

Bliss chief executive Caroline Lee-Davey said: ‘Our report shows that neonatal units in Scotland are understaffed and under-resourced and this is putting babies at risk. Any plans for improvements must provide sufficient funding to address the problems that exist now.’

Christian Duffin is a health writer

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