1. Christine Duncan Change Manager, Maternity Services Child and Maternal Health Division Christine.duncan@scotland.gsi.gov.uk 0131 244 4634

2. Maternity Services Action Group What is it? –Convened by the Scottish Government –Overarching strategic group for maternity services in Scotland Role? –provision of leadership, guidance and advice regarding the implementation of SG policy Who? –Royal Colleges, Service Managers, Planners, Special Health Boards, NSD, Scottish Health Council, Scottish Government

3. Overview of specific actions in MSAG’s Workplan –Refreshment of the framework for maternity services –Neonatal Services –Reducing inequalities in access, care and experience –Harnessing patient experience-to drive service improvement –Improving health-prioritising and identifying gaps- e.g. parenting, maternal and infant mental health –Caesarean section rates –Workforce development and planning

4. Why refresh the framework for maternity services? –Policy, evidence and knowledge has moved on since 2001- particularly in relation to the impact of maternal health and social circumstances on health outcomes for children –Original framework weak on performance measures –There are significant inequalities in outcomes

5. Maternal and Infant mortality Inequalities Maternal and perinatal mortality both show a strong association with area deprivation and social class Women from the poorest areas are twice as likely to have babies who are small for their gestational age Babies born to women under 20 are more likely to have poorer outcomes across a range of domains, including low birth weight, higher mortality and morbidity rates Women from asylum seeking groups and BME communities are 3 times more likely to die in childbirth (UK data- poor data collection in Scotland) Women living in the poorest areas ( tends to include majority of teenage births) are known to access antenatal care later and engage less with maternity services Women’s experience of maternity services care is socially patterned CMACE recommendations Language and communication and access to clinical care –need to be addressed to improve safety and effectiveness

6. The Big Cultural Challenge Shift in perspectives needed? Health inequalities are avoidable and can be reduced NHS services do have a critical role to play in addressing health inequalities- maternity services are a critical universal NHS service to women and children

7. The Cultural Challenge Shift in perspectives needed? Health inequalities are a clinical issue Maternity services are the only universal public service to women- 2 key 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 7c’s of clinical quality

8. Equity in Quality C aring and c ompassionate staff and services Clear c ommunication and explanation about conditions and treatment options Effective c ollaboration between clinicians, patients (and others involved in providing care and supporting the patient) A c lean and safe care environment C ontinuity of care and good access to care C linical excellence

9. System Challenges? Data collection and information Planning structures and mechanisms (planning needs to extend beyond the Acute Sector world- shifting the balance of care) Resources

10. Refreshment Approach Synthesising 2001 framework/EGAMS/New policy/New evidence Nothing taken out but some merging Language updated- but needs more work Key additions- –addressing inequalities in access, care and experience –Identifying performance measures Caution: work in progress-needs further development!

11. Feedback so far Right direction 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

12. Next Steps Writing group meeting on 15 th June Further feedback gathered over the summer Consensus day in October Circulated with ministerial approval- November/December

13. Primary care services GP’s Health Visitors Specialist services CAMHS LAAC Psychiatric services Community Addiction teams Third sector Women’s Aid Community development projects Local Authority services Social services Education Housing Pregnancy and postnatal care pathway Access-Assessment-liaison/referral-care-discharge-outcomes Woman and infant Maternity services

14. Question Thinking about inequalities and the need for collaboration within the NHS-what do you think should happen to strengthen links between maternity services and children’s services such as Health Visiting, CAMHS,LAAC, Specialist Paediatrics etc –can we strengthen service planning, core workforce skills or is there something else?