Press Release - Caring for Vulnerable Babies: The
reorganisation of neonatal services in England
19 December 2007
The reorganisation of neonatal services in England has helped
improve care for premature and low birth weight babies with fewer
babies travelling long distances for suitable treatment. But,
according to the National Audit Office, further improvements to the
service are being limited by shortages in nursing staff, a lack of
cots in the right place at the right level of care and a lack of
widespread specialist 24 hour transport.
Every year around 10 per cent, or 60,000, newborn babies require
some form of specialized neonatal care. And these numbers are
increasing, up 5 per cent between 2005 and 2006, due to an increase
in the proportion of women with high risk factors such as high or
low maternal age, obesity, ethnic origin, deprivation and assisted
conception such as IVF. In 2006-07, some £420 million was spent on
running the 180 neonatal units in England, which are organized into
23 managed clinical networks.
Today’s report identified a number of improvements since the
Department announced the reorganization of neonatal services into
networks in 2003. There has been a reduction in long distance
transfers of mothers and babies, with only 3.4 per cent of babies
across England admitted to units outside of their network. Overall,
17 networks are meeting the target to treat babies within their
network and the consistency, communication and co-ordination of
care within and between the networks has improved. The number of
cots has also increased from 3,243 to 3,521. Neonatal units have
made strides in considering the needs of parents and involving them
in their babies care. Parents are mostly very happy with the
specialist care and expertise their babies receive.
In 2005, England’s neonatal mortality rate was 3.5 deaths per
1,000 live births, similar to other developed countries. But the
report found that this figure masks wide variations across the
country. The South West Midlands had the highest mortality rate of
4.8 deaths per 1,000 live births, compared to Surrey and Sussex
with 1.8 deaths per live 1,000 births. More work is required to
determine the contribution that different socio-economic, ethnic,
demographic, cultural and service factors are making to these
variations in mortality rates.
The report also highlighted shortages in the numbers of neonatal
nurses. On average, each unit had nearly three nursing vacancies
for nurses qualified in neonatal care. Only half of units met the
British Association of Perinatal Medicine (BAPM) professionally
developed standard for high dependency care of one nurse to two
babies, and only 24 per cent met the standard for intensive care of
one nurse to one baby. The vast majority of level three (intensive
care) units, which require a 1:1 ratio of nurses to babies for the
whole unit, did not meet the standards for intensive care.
Cots for the right level of care are not always available,
resulting in units having to close and babies being cared for in
the wrong places on occasions. On average, each unit had to close
to new admissions once a week, the most common reasons being a lack
of cots or skilled nursing staff. Nearly a third of units had to
care for a baby who should have been transferred to a higher level
of care and just over half looked after an improving baby who was
ready to be transferred but could not because a receiving cot was
not available. In 2006-07, nearly a third of neonatal units
operated above the BAPM recommended occupancy rate of 70 per cent
and three units operated above 100 per cent. High occupancy rates
could have consequences for patient safety, for example due to
increased risk of infection or inadequate levels of care.
Neonatal transport is an essential element of networked neonatal
care, with all bar one providing some form of specialist transport
during day time working hours, but only half of networks providing
specialist transport services 24 hours a day seven days a week. Few
transport services have separate staffing arrangements from the
clinical inpatient services meaning that staff have to leave the
unit to accompany a baby on a transfer. Three quarters of units
experienced delays in moving babies and 44 per cent believed that
care was compromised as a result.
The report concludes that the cost of neonatal services as a
whole are not fully understood and there is a mismatch between
costs and charges. Also charges per day for an intensive care cot
varied from £173 to £2,384. The reorganization of care into
neonatal networks has improved the co-ordination and consistency of
services pointing to increased effectiveness, however there is
still capacity and staffing problems and a lack of clear data on
outcomes. In addition, the variable financial management
information makes it difficult to judge the economy and efficiency
of the service.
The NAO recommends that NHS and Foundation Trusts need to
improve their financial management information. Commissioners, in
conjunction with networks and Strategic Health Authorities, should
commission all neonatal care services together and in particular
examine the relative cost-effectiveness of the different transport
options currently in place. In addition, NHS and Foundation Trusts
should develop a targeted action plan to address neonatal staffing
shortages.
Sir John Bourn, head of the National Audit Office, said
today:
“Neonatal services are a challenging and necessarily innovative
area of medicine, caring for some of the National Health Service’s
most vulnerable patients who must receive the best care possible.
Efforts made by the Department to improve the service to date are
encouraging, but there is still more to do. Top of the list must be
addressing the staffing and capacity problems. And it is impossible
to say whether the introduction of networks have improved the
overall value for money of the service because of the lack of data
on outcomes and the variable state, and use of, financial
management information.”
Notes for Editors:
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The Department's 2003 report- "Neonatal
Intensive Care Review: Strategy for Improvement” recommended the
BAPM standards but did not mandate them. It believes that decisions
regarding safe nursing ratios are a matter for local networks and
units.
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Press notices and reports are available from
the date of publication on the NAO website, which is at
www.nao.org.uk. Hard copies can be obtained from The Stationery
Office on 0845 702 3474.
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The Comptroller and Auditor General, Sir
John Bourn, is the head of the National Audit Office, which employs
some 850 staff. He and the NAO are totally independent of
Government. He certifies the accounts of all Government departments
and a wide range of other public sector bodies; and he has
statutory authority to report to Parliament on the economy,
efficiency and effectiveness with which departments and other
bodies have used their resources.
Press Notice 65/07
All enquiries to Donna Watson, NAO Press Office: Tel: 020 7798
7038
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