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There are three levels under the BAPM structure. The national intensive care units are the ones that we are talking about for the three areas: Glasgow, Edinburgh and Aberdeen. They will care for the smallest and sickest babies—those who are those born under 27 weeks and with a body weight of less than 800g. Those are the babies we are talking about—babies who need additional care, sitting beside co-located surgery and other neonatal support.

I should say that decisions to move babies are very much taken from a clinical perspective. Clinicians would decide whether a baby should move.

There are then local neonatal units, which support babies of up to 1,500g. Those units provide all levels of care for singletons greater than 27 weeks and multiple births greater than 28 weeks, and for babies requiring perhaps a short period of intubated ventilator support—a level of intensive care that was highlighted last week by both Andrew Murray and Jim Crombie.

The special care units provide care for babies of 32 weeks’ gestation and upwards, and some may care for babies of greater than 30 weeks of gestation. Again, that depends on local geography—as we know from Mr Ewing’s questions last week, that is a key thing within Scotland. Those units will also provide care for babies with additional care needs who do not meet either the intensive care or the high-dependency care criteria.

Those are well-known categories in neonatal practice, and Scotland is following the BAPM guidelines in moving in this direction.

I cannot comment on mortality, but perhaps Kirstie Campbell can give more information.

Yes, I have read that as well.

Bliss is an advocacy group to represent generally people who have experienced this type of care. To help progress the move to three neonatal intensive care units, I asked for—and in June last year we ran through Citizen Space—a survey of patients and parents who had experienced neonatal intensive care to ensure that their voices were heard. We also ran a number of focus groups. As I indicated in my introductory remarks, I have also met with parents and with patients and their parents in neonatal units in Scotland to hear about the care that they are getting.

I am confident that that voice is listened to. I have also been very clear in the task and finish group that the importance of listening to the patient’s voice is recognised to ensure that it is heard clearly.

Yes.

I would like to reiterate my thanks for the work that the committee has done in this area. Clearly, it is a very emotional area of healthcare and one that we really want to get right, so the questions that you have prompted in your evidence gathering have ensured that we have that covered in the work that we have been doing with the task and finish group and we are very appreciative of that.

Thank you for inviting me to provide evidence today. Addressing concerns about the new model of neonatal care is very important to me, so I am pleased to be here to talk about the petition. First, I will address a point made at the previous committee meeting and make it absolutely clear that no units are closing as part of the new model of neonatal care.

In 2023-24, around 4,500 babies were cared for in neonatal units. Just over 800 were admitted to intensive care. The majority of those babies need intensive care for only a short period—less than 48 hours. A small number need longer, highly specialised intensive care. For those babies, the complexity of that neonatal intensive care has increased, particularly for babies born at extremes of prematurity or with extremely low birth weights.

As the committee heard from Stephen Wardle of the British Association of Perinatal Medicine and Andrew Murray and Jim Crombie, the chairs of the best start perinatal sub-group, the clinical evidence shows that outcomes for the smallest and sickest babies are improved when they are born and cared for in a unit with a high throughput of cases, defined as at least 100 new, very low birth weight admissions per year and where support services are co-located.

That evidence underpinned the best start recommendation and also the professional guidance published by the British Association of Perinatal Medicine. As defined in the guidance and as highlighted by Stephen Wardle to the committee, local neonatal units will continue to provide a level of intensive care and be able to care for singleton births over 27 weeks’ gestation, with babies receiving care in one of the three intensive care units being transferred back to their local neonatal unit for on-going care as soon as possible. The best start report—“The Best Start: A Five-year Forward Plan”—was based on evidence and a range of expert clinical opinion. The options appraisal that followed, as you heard from Jim Crombie and Andrew Murray, was objective, followed evidence-based criteria and was undertaken by an expert group comprising clinicians with service users represented by Bliss Scotland.

I was disappointed to hear at the last committee meeting that colleagues raised again that NHS Lanarkshire was not present within the process. I have corrected that point many times previously, and I am grateful to Jim Crombie for further clarifying to the committee NHS Lanarkshire’s involvement in both the best start perinatal sub-group and the best start programme board. The members were appointed based on national roles that they represented, to provide an objective view to an evidence-based clinical approach. As the committee previously heard, having the right infrastructure in place is essential to support implementation of the new model and to optimise the parents’ experience.

When I announced those changes in 2023, I asked the regional chief executives to lead on detailed implementation plans that described how they would build capacity in the three units before commencing any changes. The Scottish Government also commissioned detailed capacity modelling to inform those plans. In addition, work is under way with the regional chief executives’ task and finish group to look at maternity capacity, financial modelling and cot capacity management. The best start report had family-centred care as one of its core principles. Among the earliest best start recommendations were the establishment of the neonatal expenses fund in 2018, now the young patients family fund, and the provision of accommodation on or near all neonatal units for the parents of the sickest babies. Other improvements include accessible psychological support services for parents, offered throughout their neonatal journey.

Since my appointment, I have been committed to listening to both families and clinicians from across Scotland, and I have seen at first hand the passion and commitment of the neonatal staff by visiting University hospital Wishaw, the Queen Elizabeth university hospital in Glasgow, and the new Royal infirmary of Edinburgh. I have also met with Wishaw neonatal campaigners and elected representatives on several occasions. I had the pleasure of presenting both Ninewells and Forth Valley neonatal units with their Bliss baby charter gold awards, recognising the care that those units provide and will continue to provide.

I also want to thank staff at Ninewells for their efforts in reassuring the local people that the new model is the right model. I want to put on record my thanks to all the neonatal nurses and consultants who do such a fantastic job in caring for babies and supporting families, and to thank Bliss for all its work for families at a time when they need that support the most, and their work to advocate for those families in national policy. I recognise that families will be concerned about the change, but I want to provide reassurance that this decision has been made in the best interests of the very smallest and sickest babies.

I thank the committee for listening carefully to the evidence of those involved in the process, and for taking time to visit Wishaw university hospital.

ScotSTAR provides a separate ambulance; it is not a general ambulance. ScotSTAR ambulances are key ambulances designed specifically for neonatal baby transfer.

I have been very clear that ScotSTAR will transfer the babies. The decision about whether the mother can travel with the baby depends on the health of the mother. My understanding of the layout of a ScotSTAR ambulance is that the mother would have to sit for the duration of the journey, which might not be appropriate for her own health, so separate transportation decisions as to the safest and the right way for a mother to be transferred would be needed. It may be by ambulance, but it may also be by private car.

You are absolutely right that ScotSTAR is key to ensuring the right support. As I highlighted earlier, ScotSTAR has been operating for 20 years. It is a well-recognised model of providing transfer between hospitals for the smallest and sickest babies. As I said earlier, ScotSTAR and the Scottish Ambulance Service, which operates ScotSTAR, have been involved in the best start work right from the start, and that is very important.

Any modelling that is required will be done. As Kirstie Campbell noted, the work is happening on a financial basis. One of the directors of finance, who is part of the task and finish group, is looking at the work from a once-for-Scotland approach. If the capacity of ScotSTAR needs to increase, that will certainly be built into our approach to ensure that babies are transported in the safest, most careful way, to ensure the best outcomes for them.

I refer to Bliss’s involvement in the best start programme. Right at the start, they made the point very clearly that if you have a baby who is in intensive care for some time, it can be financially draining on the family. Accordingly, one of the requirements of best start was to set up the neonatal family fund, which provided money for families in this situation, whether for food, accommodation or travel. That was covered. We have since extended that to the young patients family fund, which ensures that support is available for families in those circumstances.

I visited the people who organise the YPFF in QEUH, and for people who deal with expenses and finance, they were some of the most caring people that I have met, because they recognise the impact—the pressures and the stresses—that such circumstances can have on families. They ensure that all the staff in neonatal wards are aware of the YPFF, but also make visits themselves, and will support families in completing the application forms for the funds. That can be done on a weekly basis or at the end of a stay. The regularity with which the funds arrive is entirely up to the family. The fund is most important and I commend Bliss for its work to ensure that it was included in our recommendations.

Bliss was very positive on not only the finance side but around psychological support for families in this situation. Psychological support can be provided either on the wards or by the third sector, including by Bliss.