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Paul Sweeney makes a really good point about how we ensure that good businesses can reach the right standard and undertake the regulatory regime that we are introducing.

As I said in reply to an earlier question—which might have come from the convener—we have been actively looking at support for businesses while we have been drafting the bill. We will continue to do so and will take on board the point about incentives.

They are graphic, yes.

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

Yes.

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.

I will start by quoting from the best start report from 2017. It said:

“It is proposed that three to five neonatal intensive care units should be the immediate model for Scotland, progressing to three units within five years.”

That is the full quote. I am absolutely clear that we need to do this in the safest way possible, given that the intended outcome is to ensure the safety of and the best outcomes for the smallest and sickest babies.

The intention, from 2017, was always to phase the change, and that started in 2019 with two units, Crosshouse hospital in Ayrshire and Arran, and Victoria hospital in Fife. Ayrshire and Arran linked with QEUH, and Victoria in Fife linked with Lothian.

We made that first step and took learnings from that. I do not need to remind anyone in this committee that we then hit Covid, so there was a pause in the services. After Covid, as you have heard in evidence, there was a review to ensure that the circumstances were still the same. Again, that still supported the best start work.

In July 2023, I announced three new neonatal intensive care units. Last week, you heard evidence from Stephen Wardle about the model in England and the fact that, for the population size of Scotland and the number of babies, two units would be the appropriate number. However, because of the geography of Scotland—I think that Andrew Murray and Jim Crombie noted this—it was felt that a unit was needed in the north and Aberdeen was selected. That goes some way to responding to your question about geography.

I live on Islay, which is an island, as everyone knows. If these circumstances arose on Islay, the family would have to be helicoptered off the island. We have the Scottish specialist transport and retrieval service, ScotSTAR, which is both a helicopter and ambulance service, which is currently moving babies around between Wishaw, for example, and QEUH. That service has been set up for about 20 years. It is seen as a world-class service. We have hugely experienced neonatal staff working in that service giving the best support, treatment and care to families that require it. We have looked at the geography. We have looked at the central belt and also further north in Scotland. ScotSTAR and the Scottish Ambulance Service have been very involved in the work as it has progressed. Therefore, we have that support.

On capacity, you are absolutely right. My officials and I have been working hard on this question. We commissioned work to look at the capacity within each unit and the best model to support the move to three units. From my perspective, that is very important. That work spoke to the staff in each unit and took wider information, which was shared with the regional chief executives, who set up a task and finish group to move the work forward. It was never the intention to make an announcement on day 1 and have the change happen on day 2. There has always been an intention of incremental steps as we move towards the more concentrated neonatal intensive care units, which will have a throughput of around 100 babies each year, with the co-located additional services. It is important to recognise that.

I will hand over to Kirstie Campbell to talk about the clinicians’ comments.

You are absolutely right, convener. I cannot imagine what it would be like for any family to be in this situation, which is why I am trying to be completely candid with you. The baby would be transferred by ScotSTAR, and the mother would be too, if she were able. If that was not possible, we have to recognise the pressures that are on the Scottish Ambulance Service just now and the transport would be organised to mitigate any issues on availability of ambulances to support the mother’s transfer.

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 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.

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.