Chamber and committees

The Best Start emphasises parents as key partners in caring for their baby and aims to keep mothers and babies, and families together as much as possible in the crucial early weeks, with services designed around them.

The new model of care aims to minimise the separation of families, and to support parents with babies in neonatal care. We have a number of measures already in place to support families:

• Providing accommodation for parents to stay on or near neonatal units;
• Roll out of the Young Patients Family Fund (formerly the Neonatal Expenses Fund) to support families with the costs of travel, accommodation and food whilst their baby is in neonatal care;
• and
• Repatriating babies to their local neonatal units as soon as clinically possible.

Under the new model of care mothers in suspected extreme pre-term labour are transferred before they give birth (in-utero) to maternity units in the hospitals that have neonatal intensive care units. Experience from the Early Implementer Boards indicates that this will happen in the vast majority of cases. On occasion when it is not possible to transfer mothers before they give birth, the baby will be stabilised and transferred to a NICU by the specialist neonatal transport service ScotSTAR, and the mother will be transferred to the maternity unit in the same hospital as her baby.

The membership of the Best Start Review Group and the Best Start Sub-Groups is published in Appendix E and Appendix F of the Best Start Report .

Dr Ian Wallace, at the time Medical Director at NHS Lanarkshire, was a member of the Best Start Review Group and the Neonatal Models of Care sub group.

The Best Start Report, published in 2017 followed a review of maternity and neonatal services in Scotland, and was based on research evidence, the views of clinicians and the views of service users. Based on data on birth data, the report recommended that we move to a model of three intensive care units in Scotland.

The process of determining which units should provide Neonatal Intensive Care followed an Options Appraisal process undertaken by an expert group, including clinical leads and service user representatives. The Royal Hospital for Children in Glasgow, Edinburgh Royal Infirmary and Aberdeen Maternity Hospital scored highest based on an agreed short list criteria, definitions and weighting. The group were asked to recommend three units and there was no consideration given to including a fourth unit.

The three NICU units; Royal Hospital for Children in Glasgow, the Aberdeen Maternity Hospital and the Edinburgh Royal Infirmary will serve the West, North and East regions of Scotland. Data on births in Scotland is published on the National Records of Scotland website for every year since 1991, broken down by NHS Board or council area of birth.

The locations of the three Neonatal Intensive Care Units was based on clinical evidence that the very smallest and sickest babies, including those born extremely premature (below 27 weeks), do best when they are cared for in larger specialist neonatal units which look after a lot of these babies, and have the right staff and services available on site to give them the very best care. The Best Start report recommended that we move to three of these units in Scotland, to meet the needs of our population.

The Options Appraisal Report , published on 25 July 2023 describes the process undertaken to determine the three final Neonatal Intensive Care Units, and the feasibility analysis and testing that followed the conclusion of that process. Annex A of the Report includes the criteria and weighting used for the Options Appraisal Process. Based on the evidence, the criteria focused on collocated clinical specialist services.

To support all parents who have babies admitted to neonatal care the Young Patients Family Fund provides funds to cover the cost of travel, subsistence and any accommodation required.

It is not within Healthcare Improvement Scotland’s legal remit to assess decisions made nationally. Healthcare Improvement Scotland’s Community Engagement arm supports, ensures and monitors NHS Boards and Integration Authorities activity in relation to patient focus and public involvement in health services.

When decisions are made by the Scottish Government on NHS services, they are scrutinised through the Parliamentary process, the Health and Social Care Committee and Audit Scotland.

The Scottish Government’s Participation Framework provides information / guidance on relevant commitments to public participation that Scottish Government must adhere to. The Participation Framework supports Scottish Government to take decisions about how to open up opportunities for participation in ways that best suit the needs policy areas, the types of contribution being sought, and the characteristics and needs of the people being engaged with.

The Scottish Government is committed to an infrastructure solution to address landslip risks at the A83 Rest and Be Thankful and shares the urgency communities and businesses place on maintaining and improving connectivity of this vital route.

The medium term solution consists of improvements to the existing Old Military Road through the Glen Croe corridor to make it a more resilient diversion route until the long term solution is in place. These improvements will improve the resilience of the diversion route, reduce journey times, and are the quickest to implement, of relatively lower cost and would have the least impacts overall across the range of criteria assessed of the medium term options considered.

A detailed programme for the proposed improvements is being developed. These include debris catch fences, temporary bunds, drainage improvements and widening and discrete realignment to improve bends and avoid flooding. It is expected that these works will be carried out on a phased basis starting later this year with Phase 1 which is realignment of the southern end of the route. It is anticipated that Phases 2 and 3 will commence in financial year 2024-25, subject to obtaining any necessary statutory authorisation consents. Construction of these phases is expected to take approximately 12 months subject to weather conditions.

The Scottish Government remains committed to medium and long term solutions to address the landslip risks at the A83 Rest and Be Thankful. This scheme is a priority for the Scottish Government, it is a key recommendation in STPR2, it is included in the Programme for Government 2023 to 2024 as well as the First Minister’s Policy Prospectus.

The recent exceptional rainfall on the A83 at the start of October resulted in seven landslides reaching the A83 trunk road, encompassing two very significant landslides at the A83/A815 junction, four landslides at Glen Kinglas and one small landslide at the Rest and be Thankful. Four further landslides were captured by hillside mitigation above the trunk road that includes pits, bunds and catch-fences, with two slips occurring at Glen Kinglas and two at the Rest and be Thankful.

The recent storm events in the areas have not impacted the development of the scheme, and we are still very much focussed on progressing this scheme as quickly as we are able to bring the benefits to those who use the A83.

The figure of 10-15% reflects data taken from the 2022 Care Home Census. The latest census will be published in due course and may reflect different data.

Reasons behind this figure include: the fact that registered beds do not necessarily equate to available beds for a wide range of reasons; a UK-wide staff shortage in the social care sector which has an impact on bed availability; different care home providers using different business models which can affect the number of people that can be admitted at any one time.

The statutory responsibility for delivering and commissioning services at a local level lies with local authorities, NHS boards and integrated health and social care partnerships. Publicly funded places in care homes are covered by the National Care Home Contract, which is negotiated annually between COSLA and Scottish Care. The information requested on the number of NHS funded beds that are currently empty is not held by the Scottish Government.