About the review
This review is being conducted independently, but in accordance with the Principles set out by the Scottish Government.
In accordance with those principles it will:
- take a whole systems approach
- make a population-based strategic assessment of current and future needs of the population
- be informed by the experiences of women, birthing people, families and staff throughout
- be forward-looking to make recommendations for sustainable, safe maternity care.
The review will involve detailed analysis of how services are designed and function, at system, board and local levels.
Listening to and engagement with parents, advocacy and community organisations is central and should reflect the diversity of experience including those who have suffered harms and loss and also positive care experience.
It will be inclusive of:
- those from more disadvantaged backgrounds
- different ethnic groups
- urban, rural and island populations
- gender diversity.
Listening to providers at all levels from senior leadership to frontline practitioners across all relevant professional groups is also central.
The principles set out for this review include a forward-looking approach. A forward-looking approach means not only learning from problems and harms but also from positive examples of good practice to inform future improvements.
It aims for understanding of past and current problems to draw lessons for change. Understanding of services that are functioning well is part of the picture to draw lessons for sustainable improvement, quality and safety.
It will require analysis of large-scale and routine data as well as more local and qualitative data to underpin these aims.
Aim of the review
The aim of this review is to examine maternity services, drawing in a range of evidence, perspectives and experience to understand factors that influence quality and safety of care, experiences, outcomes and wellbeing of those who use the service and those who provide it.
The resulting report will present an analysis and recommendations for improvement. Recommendations may highlight key aspects of the maternity system which require change. It will also identify examples of good practice, and what is needed to sustain and adapt or replicate these nationally.
Scope of the review
All levels of service will be in view, from individual experiences to ways in which services are designed, structured and delivered, also taking into account geographical, social and policy context.
The review period is nine months, with submission of the report after a further month. The policy and socio-economic context will continue to change during this period, meaning that any contextual changes should also be taken into consideration.
Improvement workstreams that are already in process or planned, including service action plans following Healthcare Improvement Scotland inspections will not be paused pending the review and will also be taken into consideration in the analysis.
The review scope is maternity services and does not extend to a review of neonatal services, or of other services that intersect with maternity care.
Nonetheless, the intersections with the following are significant and will be taken into full consideration:
- neonatal services
- pre-conception
- miscarriage care
- assisted reproduction
- other areas of women’s and birthing people's health.
All stages of maternity care including postnatal care will be in view.
Key services that also intersect with maternity, such as ambulance services and perinatal mental health services will also be considered, but with a clear maternity services focus.
Longer-term health and wellbeing
Quality, experience and outcomes of maternity care have long-term, even life-long and intergenerational consequences.
The review scope does not include a focus on other services that provide care following discharge from maternity services, such as health visiting, paediatric or other health or care services, but the scope and focus will take into account the central importance of maternity for health and wellbeing in the longer term.
Learning from other countries
The focus is on Scotland’s maternity services, but lessons may be drawn from the other UK nations and from countries with comparable geography, populations and overarching health systems (e.g. Denmark, Sweden, Norway, New Zealand).
Listening and learning
Listening, analysing and understanding the experiences of parents or service providers and other important forms of evidence will be an important part of the scope.
The primary purpose is to draw out recurrent themes and general lessons from their experiences to ensure that the reporting and recommendations inform and contribute to an effective, sustainable and equitable improvement journey.
What the review does not cover
The review scope and purpose differs from an investigation or inquiry in important ways and does not duplicate the work of Healthcare Improvement Scotland inspections.
It does not include:
- investigation of individual cases
- clinical case reviews
- inspection or investigation of specific services.
The ways in which other processes function and the impact of these will, however, be in scope and will be important to inform improvement recommendations. This includes examination of the systems that provide support and redress for those who experience loss or harm, and any factors that may affect the provision of appropriate care and support.
To contact the review team please email ScotlandMaternityReview@citystgeorges.ac.uk.