Delay to neonatal reform is putting babies at risk, warn doctors

The lives of some of the smallest and sickest babies in Scotland are being put at risk because of delays in reorganising neonatal care, doctors have warned.

The Scottish government's controversial plan to cut the number of neonatal intensive care units from eight to three was announced in 2017, but has not yet been implemented.

Doctors and charities who support the proposals say they would save lives – but have accused ministers of failing to ensure there are enough cots or staff to safely implement the move.

Health Secretary Angela Constance admitted that the government could not continue to delay the move and promised: "These changes will be made."

Under the plans, neonatal care will be centralised for babies who:

• Are born at less than 27 weeks

• Are lighter than 800g (1lb 12oz)

• Or need specialist complex care

The three national neonatal intensive care units (NICUs) will be based at Aberdeen Maternity Unit, Edinburgh Royal Infirmary and Royal Hospital for Children in Glasgow.

The five other units - in Dundee, Wishaw, Kirkcaldy, Kilmarnock and at the Princess Royal Maternity Hospital in Glasgow - will become local neonatal units (LNUs), providing a limited amount of intensive care to other babies.

A similar move was carried out in England in 2003.

The new model in Scotland was due to be implemented by 2026, but there is still no date for when it will be introduced.

The British Association of Perinatal Medicine (BAPM) said there had been a lack of progress and that Scotland was "lagging behind England".

BAPM president Dr Stephen Wardle said the evidence firmly supported centralisation of services.

He said larger centres improved survival chances for the sickest babies, who would have access to highly trained specialist staff, equipment and surgery.

Wardle said not implementing the new model was putting some lives at risk and that additional resources should be made available as soon as possible.

"Delays in making progress with these proposals will be affecting the outcome for some of these babies", he said.

"Ten years is an awfully long time to wait for these changes".

He said that the delays were related to a lack of capacity of both cots and staff, alongside the extra space required to adapt these larger centres.

BBC Scotland News also spoke to Professor James Boardman, a consultant neonatologist with the NHS and University of Edinburgh.

He said the evidence to support centralisation was "unequivocal" and a "matter of life and death" for the most vulnerable, low-weight babies.

BBC News has learned that the number of cots in the units earmarked for intensive care has not yet increased as planned.

The number of births have been falling in Scotland over the last 20 years, as have the number of babies who need intensive care, according to the available NHS data.

The government says only 50-60 of the most premature and fragile babies will be affected by the reorganisation.

But there has been significant opposition from some parents.

A parliamentary committee is currently considering a petition by campaigners to have the move scrapped entirely.

The scrutiny of the petition has descended into a war of words, with the government accusing campaigners and the media of presenting "repeated misinformation".

Petitioner Lynne McRitchie says there are "outstanding questions" over the published documents and clinical evidence, including conflicting figures about the number of babies affected.

Particular concerns have surfaced around the neonatal unit in Wishaw, with clinicians writing to the committee with their doubts about the new model and its impact on families in Lanarkshire.

Lauren Bruce from Blairgowrie is one of those who fears any reduction in local intensive care provision will be unsafe because of existing capacity issues across Scotland.

Her daughter Grace was born at 37 weeks at Ninewells Hospital in Dundee in March.

Moments after the birth Grace became extremely ill and was admitted to one of four NICU cots at the unit. Under the plans, the number of cots will be reduced to one or two.

Lauren says three other babies needed intensive care on the night Grace was born, but she was told there was no capacity anywhere in Scotland.

"I think that really highlights the pressure that these hospitals are already facing with four intensive care cots there," she said. "What's it going to be like when it's only one?"

Kelly Dalley knew her baby had a heart condition and was expecting to travel from Dundee to Glasgow for surgery after she was born.

However, Annabel was delivered prematurely at 32 weeks. When she was 12 days old she became seriously unwell.

"At that point there was no space in Glasgow, Edinburgh and Aberdeen and staff at Ninewells kept her alive until she was stable," said Kelly.

She is also concerned that any reduction in intensive care cot numbers at Ninewells would be unsafe.

"I dread to think what the outcome would have been if that capacity at Ninewells wasn't there," she added.

BBC Scotland News has also spoken to parents who are in favour of centralisation.

Euan Duff's daughter Nula was born prematurely and stopped breathing shortly after birth.

She spent six weeks in the neonatal unit at Aberdeen Maternity Hospital, which is where one of the proposed neonatal intensive care units would be located.

He said: "Even though it was a really traumatic experience with Nula, I would want my baby taken care of in the best place.

"You can't expect to have all of the most specialised staff in every unit. We would have gone to London if we had to. It is about getting the right care."

And he added: "Parents and babies were getting transferred from our unit to other hospitals on a regular basis for additional treatment, operations… once you see the workings behind it, it doesn't seem as scary."

Bliss, a charity that supports premature babies and their families, is also in favour of the reorganisation. It says there are too few babies to support more than three NICUs in Scotland.

However, chief executive Caroline Lee-Davey said the delays had been "hugely frustrating".

She wants reassurance from the government about staffing levels, the number of cots, transportation, and on-unit accommodation for parents.

Lee-Davey said it was a "travesty" for babies who were not getting the care they should be in larger, fully-equipped, fully-staffed special centres.

Health Secretary Angela Constance said she wanted to reassure women and families that "the changes will be made".

"It's absolutely imperative that we continue to follow the very best clinical evidence," she said.

"What I want to be reassured of is we have the right resources and right organisation in place."

She would not commit to a new timeline, but said: "I don't think we can delay much longer."

Constance added that she had received reassurances from health chiefs that capacity could be expanded, but said it was important to do that in "a phased, planned way".