Meeting of the Parliament [Draft]
Meeting date: Wednesday, September 20, 2023
Agenda: Portfolio Question Time, Scotland’s Nature, Neonatal Services (Lanarkshire), Business Motion, Parliamentary Bureau Motions, Decision Time, Maternity Services
- Portfolio Question Time
- Scotland’s Nature
- Neonatal Services (Lanarkshire)
- Business Motion
- Parliamentary Bureau Motions
- Decision Time
- Maternity Services
The final item of business is a members’ business debate on motion S6M-10307, in the name of Meghan Gallacher, on maternity services in Scotland. The debate will be concluded without any question being put.
That the Parliament notes with regret the recent reported decisions taken by the Scottish Government to downgrade or remove what it considers to be vital maternity services in Scotland, following the publication of the Five-year Forward Plan for Maternity and Neonatal Services options appraisal report; understands that the neonatal ward at University Hospital Wishaw will be downgraded from level 3 to 2, and that newborn babies requiring specialised care will be transferred to the Queen Elizabeth University Hospital in Glasgow, Simpsons Centre for Reproductive Health at the Royal Infirmary of Edinburgh, or Aberdeen Maternity Unit; notes reports that NHS Lanarkshire has expressed disappointment that the neonatal unit at Wishaw General, which, alongside other hospitals such as Ninewells in Dundee and Victoria Hospital in Kirkcaldy, would not form part of the specialist intensive care neonatal units; considers that this decision is particularly disappointing given that Wishaw General’s Neonatal Multidisciplinary Team was named UK neonatal team of the year in 2023; recognises the upset and worry that these decisions have reportedly had on expectant mothers as, should their newborn baby require additional care, they would need to travel up to 100 miles away from their families and support network; notes the petition raised by a local Lanarkshire woman, which has now received nearly 12,000 supporting signatures; considers that this is just the latest maternity service to be downgraded, with consultant-led maternity clinics at Dr Gray’s and Caithness General Hospital being closed, which, it believes, is putting expectant mothers in rural communities at significant risk while making dangerous journeys to Inverness or Aberdeen to give birth, and notes the calls urging the Scottish Government to rethink its reported conclusion to downgrade or close what are considered to be vital maternity clinics, to support the petition, and to reassure expectant mothers and their families that they will not have to make long journeys should their babies require specialist care.17:32
I thank those in the public gallery along with those members who have stayed on tonight to take part in a wider discussion about maternity services in Scotland. It is greatly appreciated.
I am shocked, however, not to see Collette Stevenson in the chamber. She said in the debate on neonatal services earlier today that she wanted “more time” to debate the issue, and participating in this debate would have been the ideal opportunity for her to do so. Having not one but two debates on the same issue shows how strongly MSPs feel about maternity services being removed or scaled back.
As I mentioned earlier, the Scottish National Party does not have a good track record on maternity services. Since 2016, this Government has downgraded or closed maternity or neonatal services at Caithness general hospital in Wick; Dr Gray’s in Moray; University hospital Wishaw; Ninewells in Dundee; and Victoria hospital in Fife. Expectant mums and newborn babies up and down the country have been impacted by those decisions, and many have started campaign groups to voice their anger and frustration.
Members have heard previously in the chamber about the issues that rural mums face when travelling more than 100 miles to give birth in hospital, especially during the harsh winter months. There have been many debates on the subject, but we have yet to see maternity services fully reinstated at either Caithness or Dr Gray’s. I find it staggering that more than 90 per cent of children born in the Caithness area were delivered at Raigmore hospital in Inverness, despite there being a maternity ward in Caithness general.
The process for a mother who goes into labour in those areas is even more questionable. The general instruction is to get in the car—that is no easy task when you are having contractions—with your partner, if they happen to be with you at the time, and travel 105 miles down the one and only road to Inverness: the A9. That is the exact road that this Government has failed to dual, and it seems to think that it is safe for mums to give birth at the side of that road.
Once the expectant mother arrives at the hospital, they should admit themselves to the maternity ward at Raigmore—that is, if it is time to be admitted. As mums will understand, having contractions does not automatically mean admission to hospital, and any false alarm would result in a 210-mile round trip. Does the Government seriously think that that is a comfortable and acceptable journey for women who suspect that they are in labour to make? No expectant mum should ever have to face a journey like that, yet it still happens.
Campaign groups in the Highlands have rightly been angered by that, and it appears that they have been given no support by this Government to provide them with better maternity care. They have been forgotten about by this Government, and the SNP should feel ashamed of the journey that rural mums need to make in order to give birth in a maternity ward.
The reason that I brought this members’ business debate to the chamber is because I am a mum. When the news broke about Wishaw general hospital neonatal department being downgraded, I could not sit back and let it happen, because I gave birth to my daughter there just over a year ago. I met the wonderful midwifery team at the hospital; the care and support that they give to families and newborn babies are second to none.
I could not, and still do not, understand why Wishaw general or any of the other areas were selected for downgrading, but that is part of the problem. The plan to reduce the number of maternity services in Scotland has been shrouded in secrecy, and many questions have been left unanswered.
In the case of Wishaw neonatal department, babies who need specialised care could be transferred to Glasgow, Edinburgh or Aberdeen—the three major cities—instead of being closer to home. For the benefit of those who say that Glasgow is close by to Wishaw general, I say that the transfer could be to Aberdeen, which is roughly 150 miles away from Wishaw.
What message does it send to mums, who are already going through an exceptionally stressful time, to say that they will need to make a substantial journey in order to access specialised care, when they could receive care in the hospital that they are due to go to? The decision makes absolutely no sense—to go back to what Monica Lennon said in the earlier debate, the Government must make sense.
The Minister for Public Health and Women’s Health spoke earlier about a fund that parents can access to help with costs for travel and food, but I must say that £8.50 will not go far if they have to travel to Aberdeen.
The decision is centralisation for centralisation’s sake at the expense of vulnerable mothers and babies. Has the Government thought about how traumatising it could be for a new mum and her baby to be put in an ambulance and told that they need to go to another hospital because the one that they are currently in can no longer help them?
I get that the minister said that journeys would happen before labour started, but babies do not always work that way. As we heard in the case of Mark Griffin and his family, there are cases in which it would not be safe to move a mother or baby. I thank Mark Griffin for sharing his story, and I understand why he is not able to take part in the debate this evening.
We should not forget that we are talking about giving support to babies who need it most. Surely that should be delivered as close to home as possible.
There are also the logistics. Will the midwives be required to work across several different health boards? If a mother and baby need to be transferred, will the midwife have to accompany them? That would result in less resource in Wishaw general, which is already stretched to breaking point.
Finally, there has been a shocking lack of consultation. The announcement came out of the blue, and that is why a large group of concerned women are in the public gallery this evening: because they will not stand for it, and nor should they.
I have enough time left to thank those who have contacted a wide spread of MSPs about the issue. I especially thank Lynne, who is at the forefront of the campaign to stop the neonatal department at Wishaw general from being downgraded. Lynne has her own story about her son Innes. I have loved seeing photos of him since he appeared on a BBC documentary that highlighted the wonderful support that he received during his stay at Wishaw general while receiving specialised neonatal care.
It is because of Innes and other babies that we will fight this decision every step of the way. Moray mums fought a downgrade and Caithness mums are still fighting the downgrades. What about Lanarkshire mums? We are the feisty type, and we will fight this decision every step of the way.17:39
I welcome that Meghan Gallacher has brought the debate to the chamber, and I note the degree of detail that she described with regard to Dr Gray’s and Caithness hospitals.
I remind members that I am still a registered nurse. As a former clinical educator who provided specific clinical education support for midwives in NHS Dumfries and Galloway, I agree with the member that it is important that expectant mothers are able to deliver their babies as close to home as possible. However, that must be clinically safe, and the right option in each case.
As the minister will know, I have a number of challenges to make regarding maternity services in Wigtownshire and Dumfries and Galloway, and I will focus on some of those.
When mothers have to be transferred further from home to receive the best care for their baby, it is crucial that support is in place to enable parents to be at their baby’s cotside as much as possible. I am aware that the Scottish Government is committed to improving maternity and neonatal services in Scotland in order to ensure that they provide the right care for every woman and baby and give all children the best start in life.
We heard in the previous debate, which I sat through, that in 2015, maternity services underwent a national review, through which “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland” was developed. In February 2017, the Scottish Government appointed the chief executive of NHS Greater Glasgow and Clyde to lead the implementation programme board that will implement the five-year plan. Implementation of the best start programme was remobilised in May 2022, following a pause due to the Covid-19 pandemic.
The plan for maternity and neonatal care in Scotland updates and builds on “Neonatal Care in Scotland: A Quality Framework”, which was published in March 2013. However, while l welcome that work, my constituents in Wigtownshire are not able to deliver their babies locally, at Galloway hospital in Stranraer. That means that many expectant mothers who are not able or who do not wish to give birth at home are required to travel 72 miles to Dumfries infirmary in order to deliver their babies.
In 2011—sorry, I think that the date is wrong there—the Clenoch birthing centre at the Galloway community hospital was operational as a community midwifery unit, providing low-risk, midwifery-led, intrapartum care as a two-baby facility. In 2018, due to sustained and significant staffing pressures, an operational decision to temporarily suspend the birthing centre at Clenoch was taken by NHS Dumfries and Galloway, and the centre is still closed.
Thanks to campaigning by expectant mothers, the Galloway community hospital action group and others, NHS Dumfries and Galloway commissioned a review of Wigtownshire maternity services, which reported in July this year. The initial findings of the independent review of maternity services in Wigtownshire have been published, and the review has the support of the community maternity hub at Galloway community hospital. The review wants to see the community midwifery maternity hub return to the hospital.
The hub would provide an on-call, intrapartum midwifery unit. A lot of constituents have long campaigned for the return of a local midwifery-led service unit in Wigtownshire. That includes the Galloway community hospital action group, with which I have worked closely. The previous Minister for Public Health, Women’s Health and Sport, along with colleagues, met with members of the action group in Stranraer.
I understand that if the service is to be resumed, changes will be required in the current Clenoch birthing centre, including an upgrade in the facilities and equipment, with projected costs of £103,000. The report says that staff will also require updated education on obstetric emergencies before maternity services can properly resume. Those recommendations are a step forward, and I thank everyone who has been involved in carrying out the review.
I acknowledge, however, that the safety of mothers and babies is of paramount importance. Expert clinicians, doctors, midwives and anaesthetists must be involved, not only for their clinical input; they must be able to be recruited and retained in order for service delivery to be achieved safely and returned to Wigtownshire.17:43
I congratulate my colleague Meghan Gallacher on bringing this important debate to the chamber. I also welcome the campaigners from Wishaw general hospital who are in the public gallery for the two important debates today. They continue to fight for what they and I—and, I think, most members in the chamber—believe is the right outcome for them and for the local area.
However, I will focus my remarks on Dr Gray’s hospital and the maternity services there. During today’s earlier debate, I was astonished to hear the minister basically patting herself on the back by saying how good things are in Moray now because there is a pledge to reinstate consultant-led maternity services by 2026. We should remember that those services were first temporarily downgraded in 2018, and now the Government wants thanked for the fact that they may get back up and running by 2026.
The minister visited Elgin back in August, just a few weeks ago. After that meeting, Kirsty Watson—with whom I have been in contact last night and today, ahead of the debate—and others in the Keep MUM campaign group were frustrated by the lack of progress. We are getting no answers from NHS Grampian or NHS Highland about how this consultant-led unit will be introduced. The responses from the minister on 24 August and in subsequent letters have been to say, “Everything is fine. Don’t worry. This service will be back up and running.” Minister, we are worried. We are desperately worried in Moray that no real progress is being made and that that is having an impact.
I want to use my time today to articulate a very difficult birthing story. It is really important that the minister hears this, because this is happening to Moray mums right now, and it has been happening since 2018. I have explained in the past in this chamber my own family’s story, but this is one that should shock the minister and, I hope, the Government into action.
This mum spoke about her first baby being born at Dr Gray’s hospital in 2020. The downgrade made the family worry about having another child, but they did, and things were going well. However, there were last-minute complications. I am going to read exactly what the mum put in the public domain.
“I was told I had to give birth in Aberdeen. On the morning that my contractions started, I phoned Dr Gray’s and was advised to make my way through to Aberdeen ASAP as it was a second pregnancy and, because of this, they wouldn’t turn me away. We drove through and I was contracting the whole way, which was horrible. When I arrived in Aberdeen and was examined and triaged, I was told I was only 2cms so would need to go home as women labour best at home.”
The mum explained that she was from Elgin, that it was a four-hour round trip and that it was not possible to just nip back home for the labour to continue. She went on:
“They then advised that we would need to book a hotel as we couldn’t stay at the hospital as they didn’t have space, so we frantically tried to find a room to book and managed to get one just down the road from the hospital, but check-in wasn’t until 3pm. By this point, it was only 12pm. We asked if we could stay at the hospital for a few more hours and we were told no.”
“I was then contracting heavily in the hotel car park. My waters had gone and were leaking everywhere, and I was crying my eyes out, feeling so scared and uncomfortable. I phoned the hospital back around 2pm and explained that the contractions were a lot stronger and closer together and asked if I could come back in, but they said they didn’t have space for me and I could only come back in at 3pm. So, I waited another hour, and by the time I got into triage and was examined, I was 7 to 8 centimetres and my baby was born 30 minutes later.”
She finishes by saying:
“The whole experience was awful and felt inhumane. I had several panic attacks throughout and afterwards, and I still feel panicked when I think about it now.”
Minister, this is happening right now in Moray, in Scotland, and it is unacceptable. It is inhumane. We must ensure that consultant-led services are reinstated to Dr Gray’s hospital as quickly as possible so that no more mothers and no more families have to suffer in that way.17:48
I remind members of my membership of the GMB trade union, which organises NHS workers, and I suppose that, in the idiom of Douglas Ross, I ought to record that my wife is a serving trade union organiser for NHS workers.
I thank Meghan Gallacher for bringing this important motion to Parliament. In so doing, she has shone a bright national parliamentary spotlight on a dark plan to centralise and downgrade nationally critical, locally based neonatal services. Like her, I am especially concerned about the threat that is hanging over the neonatal intensive care unit at University hospital Wishaw, which is proposed to be downgraded from level 3 to level 2.
One experienced midwife, Elsie Sneddon—minister, these people are the clinical experts as well—told me that
“this would not just be a disaster for Lanarkshire, but a disaster for Scotland.”
She went on:
“Greater Glasgow and Lothian patients are often transferred into Wishaw so why take it away?”
Four weeks ago, I wrote to the cabinet secretary setting out some of those concerns. At the time, there were 10,000 signatures on a public petition; there are now more than 12,000 signatures on that petition. At that time, there had been no consultation with the public, no consultation with the trade unions, no consultation with anyone based in Lanarkshire and, shockingly, no consultation with families who have direct experience of the neonatal intensive care services at Wishaw.
All these weeks later, I have to report that there has still been no consultation, even though the proposed downgrade could have profound implications for patient safety, and even though every staff member who delivers those services tells me of their anxiety and concerns about infection control and risk, about neurodevelopmental care and outcomes, about family-centred care, about staff retention and staff transfers and about ambulance demand and capacity. There appears to have been no assessment of any of that—no equality impact assessment; no risk assessment; no assessment, let alone an independent validation, of the data sets that are used; no assessment of the co-location of specialist paediatric services on site at Wishaw; no assessment of the skills, training and irreplaceable institutional knowledge that are now at risk; no assessment of the impact that that is now having on staff morale; and no assessment of the human cost. No assessment.
We are told to follow the evidence, but the whole exercise has lacked transparency. There is no breakdown of the weighting of the scores in the options appraisal report. There is widespread concern, too, that the statistics being used are way out of date. It is the Government’s job to consider the best available evidence. I say to the minister tonight: do not rely on the tables in the report. Listen to the human stories of the lives that have been saved, the futures that have been won and the hope that has been given. Do not extinguish that hope.
Finally, there are risks in service redesign, risks in the so-called new model, risks in overcentralisation, risks in cutting the number of beds—that is what this means—and risks in the downgrading of our local NHS services. If we have not learned that over the past few years, we have learned nothing. It is time that the minister stepped in, stopped the plan and finally listened to the voices, including those of the people who are here tonight, who need to be heard. That is the right thing to do; it is the only thing to do; and it is what we are calling on you to do tonight.17:52
I have listened to the previous debate and this debate with interest. The minister was not prepared to take any of my interventions earlier. I will take any of hers, if she is prepared to make them, because her earlier contribution was, in my view, tin eared. She was not listening. I say to the minister that, even now, she has an opportunity to say that she will reconsider and pause the plan. She won the vote earlier, but it is not binding—she can change her mind. As she closes the debate for the Government, she could say that she will reconsider and go back to the drawing board. That is exactly what she should do.
I congratulate Meghan Gallacher on securing this members’ business debate. However, it should not have been necessary. The plan to downgrade the neonatal intensive care unit in Wishaw has managed to provoke the ire of patients and staff. As we heard earlier, it has attracted 12,000 signatures on a petition that the Government is apparently ignoring. It would see babies who require specialist care being taken to Glasgow, Edinburgh or Aberdeen from Scotland’s third-largest health board area.
The staff at Wishaw are not just among the best—they are the best in the United Kingdom. Here is what one of them told me:
“Wishaw Neonatal unit are currently a level 3 unit, successfully managing care for the babies of Lanarkshire effectively, confidently and to a high standard. Our multi-disciplinary team won UK neonatal team of the year in 2023 & our care and success was evidenced on the Tiny Lives documentary.
We successfully manage our workload with a highly competent and skilled team of staff. It is a concern that downgrading will mean that we should stabilise babies that we are skilled at caring for, and transfer them to another hospital, to the detriment of staff, babies and families. I query how this is child or family-centred care and propose that it is financially or politically motivated and based on inaccurate data.”
Presiding Officer, this has been a deeply flawed process. The Scottish Government consultation fell short of being fair and inclusive, and it was in no way transparent. Decisions were made by the Scottish Government without representation from Lanarkshire on the board. No one from Lanarkshire was there, but other boards were fully represented. Why was that? Perhaps the minister could tell us. She could intervene on me now and explain that, but she does not want to. NHS Lanarkshire representation on the perinatal subgroup was only there until 2019, before the options appraisal process started. There was no local representation after that.
Data in the document is no longer relevant—it was, in fact, relevant only in 2015. The scoring system used has been called into question. It was weighted heavily on the ability to provide interventional care for rare congenital anomalies, most of which are picked up during pregnancy anyway and plans then put in place for delivery. Wishaw has specialist fetal medicine expertise for just that purpose.
The planned move could—and will—have a detrimental effect on NHS Lanarkshire, which could lose skilled staff to other areas. That is happening already, as we heard in the previous debate. It could also see mums being moved to other hospitals. Having a sick baby is a hugely traumatic situation for any parent. Earlier, we heard Mark Griffin speak movingly about that. It is completely senseless to move mums from their local area, including their support network of friends and family, and ask them to leave their other children, if they have them, when local care would be more appropriate, which it is.
This is not a plea or a campaign that is based on wanting to keep something local just for the sake of it. We say that the decision should be revisited, not because it sounds good but because it is the right thing to do for staff and, crucially, for mums, dads and their babies. The Government must think again and must not palm us off, as the minister tried to do earlier, with focus groups. That does not cut it.17:57
I, too, thank Meghan Gallacher for securing the debate and for bringing everyone together. I join her in paying tribute to all the campaigners and families in Caithness, in Moray and, indeed, in Lanarkshire, on whom I will focus in my remarks.
I know that Meghan Gallacher feels this personally, as a mum who gave birth to her baby girl in Wishaw just last year. My daughter was born in the same hospital—not last year, but 17 years ago. A few years ago, Richard Leonard and I had a lovely special visit to the hospital so that we could go and meet staff and listen to those who work in maternity and neonatal care. To my surprise, I was reunited with my midwife, who gave me the biggest hug. I was humbled that she remembered me, and we had a lovely chat.
In my earlier speech, I mentioned that, to families who have had experience of being in the neonatal department, the staff there feel like family. They feel that genuine love, compassion and care. Continuity of care is really important.
Earlier today, I made the mistake of sitting behind Mark Griffin while he made his speech. I agree with Graham Simpson that it was very moving. The fact that Mark and his family have been so open about their struggles has helped other families, particularly in relation to the financial support that Mark’s campaigning has helped to secure. In the debate, we have heard a lot about mitigation and the support that people might be able to get if the plan goes ahead, but the whole point is that we can prevent such trauma from happening.
I should also say that Mark Griffin has had to leave the chamber because Rosa needs to be picked up from Rainbows tonight, but I am sure that we would all welcome that—we would not begrudge Rosa her Rainbows experience.
As the minister knows, I chair the cross-party group on women’s health. I am very passionate about women’s health, and I make no apology for that, but I have to say that on the point about the impact on women—the birth trauma that Douglas Ross has addressed—so many issues that affect women also affect dads, partners and family units, and they can have lifelong impacts. It does not need to be like that.
I am quite jealous of Jenni Minto, as she probably has one of the best jobs in Government as Minister for Public Health and Women’s Health. She is sitting here as a lonely figure tonight, but we do not want her to be alone in this—we do not want her to be burdened with this terrible dilemma. People want to help: the people in the gallery want to help. Our communities know what they are talking about and they want to help, too.
I would actually quite like Richard Leonard to be the minister who is looking at this, because he went through the issues forensically. He asked the questions that ministers need to be asking civil servants and clinicians. We must be forensic, and we must get to the bottom of this. Carol Mochan was very clear about that earlier, and she hit the nail on the head when she asked: where is the transparency? Where are all the documents? NHS Lanarkshire was not even properly at the table, a point that the Royal College of Midwives has made in its briefings.
There is not a lot of time left. I hope that Collette Stevenson asks her business manager to secure a proper debate in the Parliament, because parents who are sitting in the gallery tonight have messaged me to ask, “What does this actually mean? What did that vote actually do?” The vote endorsed the downgrading of the neonatal unit, and that is not what people want. We are going to live to regret that, minister.
As we have heard from some of the families that have been mentioned this afternoon, significant long-term complications can be linked to premature birth and the need for neonatal care. The ability to go back to our local hospital and see those familiar faces—to have that institutional knowledge that Richard Leonard talked about—is something that money cannot buy.
So, yes, this is a dark plan. This downgrading will be dangerous. However, it is not too late, minister—we can stop it.
The question that I wanted to ask the minister earlier, when she did not take an intervention, was this: when did she last go to University hospital Wishaw? When did she last visit the neonatal unit, speak to the staff and try to walk in their shoes to understand the situation? We cannot sit behind a desk or in this Parliament and just write them off. Please listen—these people are award winning for a reason.18:02
I thank my colleague Meghan Gallacher for bringing this debate to the chamber. As we have heard, the Scottish Government appears to be determined to downgrade, or even to remove altogether, vital maternity services across the whole of Scotland. Its actions are, in some cases, putting expectant mothers at unnecessary risk, especially those who live in rural communities, such as mine of Galloway and West Dumfries, and who often face lengthy journeys because there are no neonatal services close by.
“Born on the A75” might sound like a dodgy rip-off of Bruce Springsteen’s classic hit, but sadly it is no laughing matter, because that has become the reality, with women having to give birth in lay-bys along that road. Indeed, I know of one child whose birth certificate lists her place of arrival as “Drumflower road end, Dunragit”. That is simply unacceptable.
I do not want to focus on the risk that is associated with the A75, because I know that the paramedics and midwives who accompany the mothers are left with no option but to make the 70-mile journey, and they provide the highest level of care, no matter where they are. However, the situation simply cannot continue: one new mum said that she had had to travel 7,500 miles during her pregnancy to get maternity care. Some mothers have told me that they would not have any more children because they could not face the uncertainty of not knowing whether they might have to make those kinds of journeys, including the sort of journey that Douglas Ross described.
The fact is that, increasingly, mothers-to-be are denied a choice in where they give birth. A normal and natural physiological birth, in their community and with their support network around them, should not be denied to any woman. Whether they are in Dumfries, Stranraer or at home, women have the right to make that decision and not to have that dictated to them because of a flawed management decision related to workforce decisions or the downgrading of maternity or neonatal services.
The minister will be aware of the campaign to reinstate the midwife-led Clenoch birthing centre in Stranraer. The campaign, which is led by mothers, elected members and the Galloway community hospital action group, resulted in an independent review of maternity services in the west of Dumfries and Galloway. The review was led by NHS Ayrshire and Arran’s Crawford McGuffie and Jennifer Wilson, with the support of midwifery expert Angela Cunningham.
Two proposals were drawn up: the existing model of a community maternity hub with home births, and a second option, which also included planned on-call birthing for low-risk births at the Galloway community hospital’s birth centre. The recommendation from that independent group was for option 2 but, bizarrely and frustratingly, the integration joint board has not as a matter of urgency put in place the plans to deliver what that independent inquiry recommended. I call on all the IJB members to do the right thing.
The Scottish Government must support local NHS boards to improve workforce planning, retention and recruitment, especially given the huge demands on our much-valued midwives, who now have increased responsibilities and require an increased set of skills, particularly in rural areas.
Everyone wants the best care for mothers and babies, and the move to ensure that the smallest babies are looked after in centres that will have the right level of care is not disputed. However, the Royal College of Midwives has voiced concerns surrounding the testing of the Government’s model, following publication of “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland”.
We are in a very different world demographically and financially from that of 2017, when “The Best Start” was published. The ethos of the report is that we should provide care close to home, keep mums and babies together and individualise care around the needs of women, their individual circumstances and their family circumstances. That is certainly not what is being offered in the west of my constituency.
I stress again that fathers and mothers-to-be must be given a choice when it comes to giving birth. After all, it should be one of the most precious moments, if not the most precious, in our lives.18:06
I thank all the members who have taken part in the debate.
The new model of neonatal intensive care recommended by “The Best Start” outlined that Scotland should move from the current model of eight neonatal intensive care units to a model of three units supported by the continuation of current NICUs redesignated as local neonatal units. The evidence is clear that the highest-risk babies are more likely to survive when they are cared for in units by clinicians who see more such babies and with access to specialist support services.
“The Best Start” report was underpinned by evidence. Eight evidence reviews are detailed in the report, which was led by Professor Mary Renfrew of the University of Dundee. The evidence is clear and is set out in the report.
The minister has heard repeatedly that the staff at Wishaw are performing at the highest level: they are the best in United Kingdom. Her argument does not stack up. Even at this late stage, is she prepared to say that she will pause the decision and have a rethink?
I have made it clear that the decision was based on clinical evidence from clinical experts. We need to take account of that evidence.
Babies who are born at highest risk are defined as those who are born at fewer than 27 weeks’ gestation, weigh less than 800g or need multiple complex intensive care interventions or surgery. It should be understood that no neonatal units will close, and that local neonatal units will continue to provide a level of neonatal intensive care for sick babies in their areas. However, the most preterm and sickest babies will receive their specialist complex care in one of our specialist NICUs and will—which is important—return to their local area as soon as is clinically appropriate.
The process of determining which units should provide neonatal intensive care followed an options appraisal that was undertaken by an expert group, including clinical leads and service-user representatives. That model is supported by a range of stakeholders and clinicians, including Bliss, which is the leading charity for babies who are born premature or sick. It recognises that the new model of care is based on strong evidence and will improve the safety of services for the smallest and sickest babies.
I appreciate that a lot of the work started before the minister was in post. Now that the matter is on her desk, what steps has she taken to go back to check that everything is in line, as it should be? She has talked about the importance of clinicians, but what has she done to make sure that there was no one missing from the discussion? The information in my folder suggests that the process is flawed.
When I came into post, I had a number of meetings with officials to talk through the matter, and there was a review in 2022 of the decision that was made in 2019 and the outcomes.
As members will be aware, we currently have 15 incredible neonatal units in Scotland, each of which is providing invaluable care for babies in their area. That will continue under the new model of care. “Best Start” recommended that the new model of neonatal care should be based on the British Association of Perinatal Medicine’s definitions of levels of care. Neonatal units in Ninewells hospital and medical school in Dundee, the Princess royal maternity hospital in Glasgow, University hospital Wishaw, the Victoria hospital in Kirkcaldy and University hospital Crosshouse in Kilmarnock will continue to function as local neonatal units.
As I said in the previous debate, the scope of practice of a local neonatal unit is wider than that of a level 2 neonatal unit. I reassure members that, under the new model, the scope of practice that a local neonatal unit can undertake means that the vast majority of babies who need neonatal care will still receive it locally. Local units will continue to provide a level of intensive care and will be able to care for all local babies who are born at greater than 27 weeks’ gestation. As members have highlighted today, the work that those units provide, and will continue to provide, is incredible. Hearing the words of parents whom I have met and who have written to me detailing their experience has only reassured me that the care that we are providing to the most vulnerable babies is inspirational.
I take this—[Interruption.] I will not take an intervention; I would like to make some progress.
I take this second opportunity to congratulate Wishaw hospital’s neonatal multidisciplinary team on being named the UK neonatal team of the year in 2023. I have also heard reference to Dr Gray’s hospital, so I will touch on that. Douglas Ross is correct—I visited Dr Gray’s in Elgin in August. I was disappointed that Mr Ross was unable to join me at the meeting, because it was, from my perspective, very helpful. I heard from Keep MUM, which was very clear about its concerns. As I said in that meeting, I am very clear that five years was too long, which is why I am pleased that the plan between NHS Highland and NHS Grampian was agreed in March. When I met the boards, we discussed what progress was being made and, as Mr Ross will know, a project manager has been appointed.
I also point out that the Scottish Government has put £5 million into refurbishment at Raigmore hospital and £5 million into Dr Gray’s. I have written to both health boards, requesting that they improve the timelines that they have set and that they continue to give the Scottish Government more information.
I, too, was disappointed that I could not meet the minister. I appreciated her officials contacting me and apologising for the late notice of the minister’s visit to Elgin. However, we cannot just keep going round in circles, having more letters go from the Government to the health board. The Government can instruct NHS Highland and NHS Grampian to ramp up their efforts. There is real frustration that we are seeing little or no progress. Simply writing to them and urging them to do a bit more is not cutting the mustard. Indeed, Keep MUM has said that, at the moment, it has
“little faith that our voices ... will be heard”.
Its members’ voices are not being heard by the Government, NHS Grampian or NHS Highland. If they were, we would see far more action on the ground right now to reinstate full consultant-led maternity services at Dr Gray’s.
As I understand it, Mr Ross was given enough time to know that the meeting was happening—we had given him that notice.
I have been listening to Keep MUM, and I have been direct with the health boards as to what I expect them to be doing.
We are seeing no progress.
I would like to make some progress, thank you.
Stranraer was mentioned by Finlay Carson and Emma Harper. The midwife service there was temporarily withdrawn because of staffing. As has been pointed out, there has been a review by NHS Ayrshire and Arran, and the IJB will be considering the issue, I believe, at the meeting at the end of September.
Will the minister take an intervention?
I will not take an intervention; I would like to make some progress, thank you.
In reference to the petition that has been highlighted today, I appreciate that local people will have concerns about the announced changes. I would like to clarify that those changes will affect a small number of families in Lanarkshire. I appreciate that, for any family affected, that is probably difficult to cope with.
I will also highlight a range of other features of the new model of neonatal care that was outlined in “Best Start”. The new model of care positions parents firmly as partners in their baby’s care. It includes expansion of transitional care, which will allow for mothers and babies who need some additional neonatal support to stay together in a postnatal ward, improved facilities and support for parents, and expanded neonatal community care, which will allow babies to get home sooner.
Members will be aware that we have begun to address the financial concerns of parents with babies who are in neonatal care through expansion of the neonatal expenses fund, which is now known as the young patients family fund. The fund continues to support many parents with the cost of travel, meals and accommodation while they are partners in the care of their babies. I say to Meghan Gallacher that £8.50 is for meals—all travel is compensated in full.
We are rolling out transitional care across Scotland, with all units being on track to have that in place next year. In addition, all our units are working towards implementation of the Bliss baby charter, with almost all units at silver or bronze level, two units having achieved gold standard and four more golds expected this year.
Minister, could you please bring your remarks to a close?
We will now work with all health boards that are affected to plan for and implement the service change over the course of the next year, informed by the testing that has been under way over the past few years.
I thank everyone who has taken time to speak with us to inform our picture of what more needs to be done to reassure both the parents and the staff in our neonatal community. I thank all those who have worked with us to look at how best we can deliver the changes that were recommended by the “Best Start” report. Their experience is invaluable in informing our approach to date, and it will continue to be invaluable as we take forward our work, thereby ensuring that the Government does as much as we can do to support those who require neonatal care in Scotland.
Thank you, minister. That concludes the debate.Meeting closed at 18:17.
Air aisDecision Time