Background
Fortia Insight (formerly part of RSM UK Consulting LLP) was commissioned by the Scottish Government (on behalf of NHS Scotland) to undertake a demand and capacity modelling exercise for neonatal intensive care unit (NICU) services in Scotland.
The work aimed to support the implementation of ‘The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland’, which called for a new model of neonatal care to improve outcomes for pre-term, very-low-birth-weight and critically ill babies by consolidating care into three (rather than the existing eight) designated NICUs across Scotland, leveraging lessons learned from the successful transformation of neonatal services across the rest of the UK.
Our role was to conduct demand and capacity modelling to:
- Inform planning for this new model of neonatal care
- Align with the Best Start recommendations
- Outline considerations to take forward into implementation.
The approach to this work included data collection and modelling alongside engagement with both operational and strategic stakeholders. This involved data collection across eight units, Public Health Scotland (PHS), Scottish Specialist Transport and Retrieval (ScotSTAR) and Scottish Ambulance Service (SAS); developing a demand and capacity model to predict future needs for NICU services; developing change assumptions; and engaging with stakeholders through data-driven workshops with operational and strategic stakeholders at each stage. The report provided detailed findings and considerations for implementation to further support local implementation plans.
Report linkChallenges
- Data variability and extraction limitations: One of the most significant challenges was the variability in data quality and completeness across the eight NICU sites. Compressed time frames meant that some sites required manual collation of data or could not provide the granularity needed for certain clinical indicators. This presented difficulties in creating a uniformly robust baseline and required careful validation and sensitivity analysis to ensure the model outputs were reliable.
- Operational and stakeholder complexity: The engagement process spanned multiple stakeholder groups, operational teams, strategic decision-makers, clinicians, transport services and regional planners, each with distinct priorities. Managing feedback from across these groups, especially within tight timelines, required high levels of coordination and communication to keep momentum and maintain alignment with project objectives.
- Change management sensitivity: Given the scale of transformation, the project required sensitive handling of understandable concerns around service relocation, repatriation logistics and potential impacts on local units and communities. These considerations were acknowledged and carefully discussed in stakeholder workshops to maintain trust and collaboration.
Impacts
- The project provided the Scottish Government, NHS Scotland and health boards with a clearer understanding of neonatal service capacity, future demand and the impact of the new model of neonatal care on future capacity and needs. Our implementation considerations covered workforce planning, NICU flows, repatriation processes and other key areas. The overall impact of the project aims to improve outcomes for neonatal babies, with a focus on family-centred care and keeping mothers and babies together as much as possible.