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Maternity Services Review:
Option Appraisal

Option Appraisal

At its December 2010 meeting, NHS Grampian Board approved plans to conduct an option appraisal during 2011. 

Why carry out an Option Appraisal?

The aim of the option appraisal is to come up with recommendations about how services should be set up i.e. what they should provide, who will provide them and where they should be located.

What is an Option Appraisal?

An Option Appraisal is a process that is often used when considering a new way to provide services. Option Appraisals allow a wide number of views to be considered and as robust an assessment of options as possible to be created. Option Appraisals look at all the ways in which a service could be provided and the most promising options are then assessed by comparing their benefits, risks and costs. The aim is to develop the best possible model for the maternity service in NHS Grampian within the resources available.

Who took part in the Option Appraisal?

Six workshops were held during February, March and April 2011 and participants included a range of clinicians (doctors and midwives), managers and public representatives from across Grampian. An average of 30 people attended the workshops and the contribution of the public representatives was significant. Staff from the Scottish Health Council, whose role is to ensure NHS Boards meet their public involvement responsibilities, also attended.

What did the group do?

Participants were given information and the opportunity to ask questions about the current service and the difficulties staff and women and families experience because of the way the service is set up. 
Participants then developed a list of detailed benefits which they would like to see any option (service model) deliver. The 9 benefits were then put in order of importance and given a weighting as to how important they were.
The benefits are:
  • Safe
  • Sustainable
  • Reduce health inequalities
  • Improve health outcomes for women and babies
  • Accessible
  • Improve normality
  • Women and family centred
  • Manage interdependencies (with other NHS services and with partner organisations)
  • Improved (physical) environment
Participants then developed and debated a wide range of options for the way the service could be set up. The different models covered pre/early pregnancy care, pregnancy, labour, birth and after pregnancy.
Participants then scored 11 options (10 potentially new service models as well as the current service - the status quo) against how well they met the 9 benefits e.g. how safe they were likely to be. All the individual scores were added together resulting in a list of scored models. At the same time, work was done to cost the 10 potentially new models. 
At the final workshop, it was agreed that the models that scored the highest would be written up in more detail and the costs further refined. This work was completed during Summer 2011.  
There are many parts of the different models that are similar for the way care is provided during pregnancy and after delivery and which participants agreed will improve the experiences of women and families. The main differences between the models is in relation to the number and type of maternity units for labour and birth across Grampian.

What happened next?

The option appraisal group's preferred option was presented to the NHS Grampian Board at its meeting on 6 December 2011. At the meeting, the NHS Grampian Board agreed to launch a formal consultation on the proposals.  Information about the consultation is available at this link.