Welcoming the Scottish Government’s announcement of £12 million investment to implement Best Start

By Mary Ross-Davie on 15 February 2019

Two years on from the publication of Scotland’s Best Start review of maternity & neonatal services I am delighted today to see the official announcement by the Scottish Government that they will be investing £12 million in supporting implementation.

Since its publication, I and the rest of the RCM Scotland team have consistently lobbied for this ring fenced money. The Best Start review recommends a huge shift in how and where maternity and neonatal services are delivered. Such a root and branch change cannot be done on a shoe string. The RCM has argued that in order for the changes to be safe, successful and sustainable, we need to ensure the right conditions are in place (see our position statement from November 2018 here). This money will really support Health Boards to focus on getting those conditions in place.

First and foremost we need enough staff. The new continuity model of care will rely on having enough midwives. We know that many health boards in Scotland have unfilled midwifery vacancies and increasing numbers of midwives retiring. We have significant sickness and maternity leave rates. Where midwives are already struggling to provide high quality care to women in the current model, it will not be easy to implement this significant change safely.

Midwives will need time, training and support to feel confident to work in different ways. That means Health Boards will need, at least temporarily, to increase the number of midwives in the system. We will also need to keep a close eye on what the staffing requirements are in a new continuity based system in the longer term – we know that hospitals will continue to need to have experienced core staffing to be available at all times, in addition to the community based continuity team midwives. It is only if maternity services have enough staff that they will be able to ensure that caseloads for continuity midwives are at a safe and sustainable level.

To have enough staff, Health Boards need to ensure that they keep the committed, skilled and highly experienced midwives that they already have. So, as this change is being rolled out, services must ensure that the voices of all midwives are listened to and that new models provide choices for midwives about how and where they work.

The money invested by the Scottish Government should also be used to ensure that midwives have the clinical equipment and access to cars, IT equipment, mobile telephones, decent office and clinical environments, to provide really excellent care in the communities that we serve. Midwives should feel well prepared, well supported and well resourced.

While we welcome this investment today, we know our work in influencing and shaping this process of implementing the Best Start recommendations is far from over. We will continue to represent the needs and concerns of our members at a national and local level. We will continue to make the case for safe staffing, adequate training, consultation, evaluation and flexibility throughout the next years of implementation.

The RCM Scotland look forward to hearing from as many of our members in Early adopter boards as possible over the next weeks when we come out on listening visits. Look out for the dates and times.