N

a. There should be greater communication and co-operation between NHST and NHS Grampian (“NHSG”) in relation to the care of patients who are resident in the geographical area of one authority and subject to treatment in a facility run by the other.

b. NHSG should make greater efforts to co-operate in Significant Clinical Event Analysis (“SCEA”) inquiries in NHST where there has been involvement of NHSG staff and facilities in the care of a patient affected by the significant clinical event under consideration.

c. NHST should take steps that the information provided in its “My Birthplace” App is fully available to those prospective parents who do not have or do not make use of online resources of this kind.

d. The following information ought to be provided to prospective parents considering water birth: i. there is no good scientific evidence based on clinical trials comparing outcomes for people giving birth in water and those not giving birth in water to say that giving birth in water is as safe as giving birth out of water; ii. in the experience of midwives as a collective body (both nationally and internationally) it is practised commonly and, based on anecdotal evidence of midwives, it would appear to be safe; iii. if their choice is to opt for water birth at a remote CMU the mother and baby will receive midwife led care; iv. the facilities available at a midwife led remote CMU like Montrose for a baby born unexpectedly unwell at term are limited in nature as there is no specialist obstetric or paediatric care available on site; v. a seriously unwell baby would have to be taken to the specialist obstetric or paediatric care units at Ninewells; vi. there is no specialist recovery service that could be deployed at short notice to take a seriously unwell baby to specialist obstetric or paediatric care; and vii. the period of delay that may occur in taking a seriously unwell baby to specialist care or in specialist assistance arriving at Montrose CMU could extend to several hours.

I recommend that the 999 ambulance option should not only be available in such restricted circumstances but accorded far greater prominence in the guidelines.