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Purpose and Scope of the Framework
Improvements have been made to maternity care provision following the 1993 Policy Review, Maternity Services in Scotland. These include a range of choices around childbirth, the provision of high quality local services that are acceptable and accessible to women with speedy and seamless access to specialist services when necessary.
But there is still considerable scope for further change that reflects a modern maternity service appropriate for the 21st Century. The following broad themes are important:
The Framework has been informed by the 1993 Policy Review, the audit report "Maternity Care Matters" (1999) and other relevant documents and available evidence related to maternity care, see Bibliography. All of these, without exception, call for fundamental changes in the structure and culture of maternity services to better reflect the needs of women today, their children and their families.
This Framework has been developed in consultation with women, professionals and consumer organisations involved in providing maternity services.
This Framework has been developed for women, professionals and service planners and providers. It is not a strategy document or a model service specification. It is a philosophical approach that outlines a set of broad principles to inform local maternity services strategies.
It sets out the clear local action required so that NHS Boards, NHS Trusts and other agencies can make sure that maternity services are appropriate to the needs of the people and geography of Scotland. It recognises that there are specific issues that impact on service provision in remote and rural areas.
The Framework will also be a benchmark for the Scottish Executive to assess implementation of local strategies and action plans, and monitor progress.
The Framework recognises that:
This Framework covers the main elements of maternity care: preconception, pregnancy, childbirth and postnatal/parenthood. It:
The Framework sets out principles for service organisation and provision. Service requirements must drive the workforce requirements.
There are real tensions between numbers of available professionals, the current training programmes, the implications of the EC Working Time Directive and the delivery of a safe service. But, as the Scottish Integrated Worforce Planning Group has made clear in its interim report, planning the workforce for the future must take account of models of service delivery, including multi-disciplinary teams, and the model used must be appropriate to the local situation.
Detailed work is needed to set out the workforce implications of the service principles in this Framework. The Scottish Executive Health Department, through the Scottish Integrated Workforce Planning Group, will specify and commission a piece of work with the aim of defining suitable maternity workforce models by the end of 2001. In the meantime, NHS Boards and NHS Trusts should apply the Workforce Planning principles set out in Appendix 6 of this Framework to inform local service organisation. These will also be used to inform the proposed work outlined above.
A large Multi-Professional and Expert Reference Group was set up to inform and develop this Framework.
The Reference Group was chaired by Miss Anne Jarvie, Scotland's Chief Nursing Officer, and included invited representatives from the key professional groups and consumers with an interest in maternity services. It was set up to encourage wide participation and views. Details of the Group's membership and remit are set out in Appendix 1.
The Reference Group set up 5 sub-groups. These were chaired by members of the Reference Group, had Reference Group representation within them as well as other invited professionals and interested parties. The sub-groups were as follows:
The work of the Reference Group and the sub-groups was informed by Scotland-wide consultation with women and health professionals.
The Reference Group identified a number of themes, such as informed choice and homely environment, and models of care that had consistently emerged from the review of available literature. These themes were addressed by the Group and sub-groups, and also by the Scotland-wide Focus Group consultation involving women and professionals.
It was important that the Framework was informed by a clear women's perspective. Scottish Health Feedback, an independent research organisation, was invited, through the Scottish Association of Health Councils, to complete qualitative research that would allow the views of service users across Scotland to be collated through Focus Groups and one-to-one interviews. Health professionals involved in delivering maternity services were also invited to take part in Focus Groups.
The outcome of these consultations reflected the current consensus views of women and health professionals about what the philosophy of a modern maternity service should be. The consultation also put forward suggestions as to how the ultimate goal of a healthy mother, a healthy wanted baby, and a happy and confident start to family life could, and should, be achieved.
Although the women represented in the study reflected a wide range of backgrounds, experiences and needs, a clear and consistent picture of what women actually want from maternity services emerged from the data. These findings are in keeping with other consumer studies. The main findings were:
These themes have been integrated into this Framework. A detailed background to the consultation process is provided in Appendix 2.
Scotland's demography and geography must also be considered in providing maternity services.
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