North of Scotland Planning Group - Horizon Scanning Project Gathering evidence / stakeholder views to inform the NoSPG Horizon Scanning work NoSPG work programme: Neonatal Managed Clinical Network Name (of person completing): Nikolaus Kau Title: Dr Telephone: 01224-552637, mobile 0753-6628032 Email address: n.kau@nhs.net mariegardiner@nhs.net Others consulted / completing form (eg Network meeting, if appropriate): Marie Gardiner Neonatal MCN clinical facilitator The project working definition of horizon scanning (based on Defra 1 ): Horizon scanning is the act of gathering published insights and predictions (threats, opportunities and likely future developments) that may point us towards affirming or amending existing trends and developments as well as identifying new and emerging trends and developments (including those which are novel and unexpected) which are on the margins of our current thinking, but which will impact on our services and plans in the future and enable us to identify further information / research requirements. Essentially the focus is on how will the future be different? Responses requested by the 5 th August 2011 please to: NoSPHN Coordinator - Pip Farman, C/o Public Health, Assynt House, Beechwood Park, Inverness, IV2 3BW pip.farman@nhs.net 1
Evidence? Published evidence available (please give details/ references) Other information/ additional knowledge (please detail) eg expert opinion 1. Trends please describe the current trends (over next 2-3 years) with regard to your NoSPG area of work (ie burden of disease increasing / decreasing, service demand, service capacity, workforce etc) and with reference where known to the: National position North of Scotland position (is this position consistent across the NoS Boards?) Position in local Boards? Neonatal trends Demography The population projections available from GROS, as summarised by NoSPHN 2, identifies that the population in the North of Scotland is projected to increase by 2033. In an earlier population projection, prepared by the NoSPG team, those aged 15 and under would account for 16.2% of the population which was higher than previously thought. This latter projection was linked to a growth in the birth rate. 3 Projected birth rates by Gro-Scotland based on 2008 figures shows a variable change across the Region. 2
Table 1. below highlights the differences for each Health Board area. 2008 figures 2016 % change 2021 2026 2033 Grampian 6,037 births -1% 0% -2% -4% Highland 3,197 births -1% +2% +1% -3% Orkney 200 births -6% -5% -5% -9% Shetland 254 births -17% -25% -49% -41% Table 1. These figures indentify a relatively steady birth rate for the mainland boards but show a dramatic decrease in birth rate for the islands, in particular Shetland. This will magnify the current issues affecting the islands in terms of sustaining a safe service and maintaining skill and expertise. Research by BLISS in 2007 showed a trend of increasing very low birth weights across Scotland. Admissions to Scottish units of babies weighing less than 1500g increased by 10 babies per unit in Scotland while non-scottish units had less of an increase with 3 babies per unit in 2007. References: ) GROS Population Projections NoSPHN, June 2011. Population Profile www.nospg.nhsscotland.com/?page_id=844/populationprofile Projected Births (2008 based), by NHS board areas http://www.gro-scotland.gov.uk/files2/stats/time-series/births-by-sex-year-and-nhs-board-area-91-09.xls BLISS, June 2007,Handle with care- A Review of neonatal Services in Scotland. Commission on the Future of Public Services June 2011. www.publicservicescommission.org APS Group Scotland DPPAS 11647 (06/11) 3
MSAG, Neonatal sub-group, 2008, Review of neonatal services in Scotland November 2008. MSAG, Neonatal services sub-group, 2009, Review of scottish Neonatal Services in Scotland, April 2009. 2. What are the key factors / drivers that may change this position over the next 3-5 years plus? For example demography, epidemiological needs, interventions (primary and secondary prevention initiatives, diagnostics, treatments, post treatment), technology change or policy change? Please give specific details. Review of Neonatal Services in Scotland 2008 Maternity Services Action Group Neonatal subgroup. The Neonatal Review recommends the development of Managed Clinical Net works (MCNs) across Scotland to support the delivery of a safe and effective Neonatal service. The North of Scotland MCN is the final link in the development of these MCNs. The North along with South East And Tayside and West of Scotland now work collaboratively to develop Regional Work plans to support and monitor the service. The NoS Network aims to show progress on improvement in the quality of service, reducing inequalities where reasonably possible, reducing duplication and waste and ensuring the transport of babies either inutero or exutero is maintained at a minimum level. This however will not be achievable if the principles of Regional working are not maintained. The increasing demands of such a highly technological and specialist service require the flexibility of service delivery without the constraints of financial and beaurocratic barriers preventing the movement of service across the region. The work of the NoS Neonatal Network is driven and affected by the following health policy frameworks: The NHS Scotland Healthcare Quality Strategy- http:// www.scotland.gov.uk/topics/health/nhs-scotland/nhsquality builds on the work of The better Health Better Care Action Plan (2008) to strengthen the role of NHS Healthcare in giving all children the best start in life. The work plan of the Neonatal MCN aligns itself with Quality strategy to ensure the service delivery is person centred, clinically effective and safe for every baby every time. A New Look at Hall 4-the early Years- Good Health for every Childwww.maternityservices.scot.nhs.uk This highlights the importance of early assessment and planned support for the baby and family. This may mean agreeing the baby s health plan indicator with the family before the baby is born. Effective communication, referral and liaison is essential between Neonatal, Obstetric, Paediatric and Primary Care services to ensure appropriate care pathways are in place around the child and family. Getting It Right For every Child (GIRFEC) http:/scotland.gov.uk/topics/people/youngpeople/childrensservices/girfec/programme-overview is a central part of the Scottish Government s commitment to improving outcomes for all children. Girfec promotes multiprofessional and interagency working to provide a service around the child and family. Early assessment and intervention along with appropriate follow-on treatment and support are essential to ensure the children of Scotland have the best possible start in life. 4
The NoS Neonatal MCN will work to contribute to the National Performance framework- Scotland Performs http://www.scotland.gov.uk/about/scotperforms by working to support the delivery of at least 4 of the Scottish Governments 15 National Outcomes by ensuring : Our children have the best possible start in life. We have improved the life chances for children at risk. We have tackled the significant inequalities where possible We live longer healthier live A Refreshed Framework for Maternity Care in Scotland - The Maternity Services Action group. This report highlights the need to identify appropriate care pathways to ensure early and timely intervention as required for mother and baby. The Neonatal MCN will support collaborative working with appropriate services to ensure the baby and family is receiving the care required. Future planning of neonatal and child health services must work collaboratively at a strategic level to ensure the ethos of joint working and planning is supported effectively. 3. What is the likely impact of these changes and the magnitude of any change (eg on epidemiology, burden of disease, service demand / capacity)? The delivery of the Neonatal service will be challenged by all of the above issues and policy influences. NoS future planning must recognise the need to maintain highly specialist skill within the service. Training and education will require the resource to ensure staff is released and backfill is available to maintain the level of skill and competence required for each area. The internal knowledge transfer must be supported to ensure the regional skill level is maintained and the barriers to supporting this financially and managerially must be broken down through modernised ways of working and HR support. Recruitment and retention of skilled nurses must be addressed through collaboration with HEIs to ensure the most appropriate and cost effective training is available for staff in the NoS region. Midwives who have qualified with a midwifery qualification only can no longer take on the neonatal role and still maintain their midwifery registration. Improved education and exposure to neonatology at a student level must be explored in the child health nursing course. Other solutions to filling the potential gap with in the middle grade rota must be explored. The development of senior AHPs to take on new roles within the service must also be considered. The high level of assessment skill and diagnostic ability must be utilised to ensure we are maximising the potential of every 5
member of staff to maintain service delivery across the region. The delivery of on-going developmental intervention for every baby that requires it must be achieved through effective communication and the establishment of an efficient care pathway involving all members of the multidisciplinary team. Modernising ways of working in this area and reducing duplication of assessment and clinical appointment time for baby and parent must be a priority. This will only be achieved through open and flexible working of services and agencies to provide the best care for the patient without territorialism or ownership becoming the main drivers for service delivery. The delivery of a safe and effective neonatal service to the remote and rural areas must be addressed. The potential decrease in birth rate for the islands will lead to a further reduction in exposure to neonates for the staff in these areas. Ways must be identified to sustain the service for the safety of babies born in these areas. An agreement must be made on which level of care the NoS neonatal units will deliver and be able to sustain. The ability to cross charge boards must be possible to ensure babies are cared for in the most appropriate level of unit. The Highland/Grampian border must become more flexible to sustain the service in the future. Modernised ways of working will not only apply to the clinical setting but also HR and Finance. 4. Are you aware of issues other than health that may directly impact on your area of work in the next 3-5 years plus eg economic, social, environmental or political (if not already stated above)? The current economic climate will have an ultimate effect on those people in more disadvantaged areas. This will have an impact on the general health of the population and therefore potentially on the unborn child. There is the potential for an increase in the number of preterm babies if the economy does not improve. 5. In your view are there likely other things we do not know about that will have an impact over the next 3-5 years plus (ie the unknown unknowns)? E-health and telehealth are areas of development which offer huge potential for the delivery of services to remote and rural areas. The acceptance and efficacy of their use is not fully understood but further research and outcome measures would help to overcome these issues. 6. Please make any further comments below. 6
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