CARING FOR VULNERABLE BABIES: THE REORGANISATION OF NEONATAL SERVICES IN ENGLAND
Publication of the Committee's 26th Report, Session 2007-08
Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:
"There was widespread support for the reorganisation of neonatal services five years ago, resulting in the creation of 23 clinical networks. However, this change has had limited effect in reducing regional variations in mortality rates of babies born prematurely or suffering an illness needing specialist care. There are complex combinations of factors at work here, and Primary Care Trusts need to improve their understanding of the high risk groups in their local populations.
"Constraints in capacity mean that the Department of Health is still struggling to meet the demand for neonatal services which has risen year on year. The serious shortages of neonatal nurses must be addressed. Only half of the networks provide round the clock transport services to transfer babies to other units for the right levels of specialist care. And high occupancy rates in a third of units could have major implications for patient safety, owing to increased risk of infection or inadequate staffing levels.
"The decision to establish a Neonatal Task Force is an important development. It should be set clear objectives and associated milestones for improving services to those who can really be described as the most vulnerable members of society."
Mr Leigh was speaking as the Committee published its 26th Report of this Session which, on the basis of evidence from the Department of Health and the NHS, examined the quality and effectiveness of neonatal services in caring for these most vulnerable members of our society. The report looked at the ability of the system to meet increased demand for neonatal services, the benefits of networking neonatal units, recruitment and training of staff and the impact on health inequalities.
Neonatal services provide care to babies born prematurely or with an illness or condition which requires specialist care. Over the last 20 years, neonatal services have undergone substantial organisational and technological changes whilst remaining a challenging and innovative area of medicine. Following a 2003 review of neonatal services, the 180 neonatal units based in the English National Health Service and Foundation Trusts were organised into 23 geographical, managed clinical networks. Demand for neonatal care has risen year on year. In 200-07, around 60,000 babies (roughly one in ten births) were admitted to neonatal units, at a cost to the NHS of some £420 million.
Whilst there was widespread support for neonatal services to be delivered through clinical networks, these networks have developed at different rates and two areas have yet to establish a formal managed network. Networks have helped improve communication and co-ordination between units and have made progress in reducing the number of times babies have to be transferred long distance to obtain the necessary level of care, but there has been less progress on a key review recommendation for networks to re-designate units to ensure that the supply of intensive, intermediate and special care matches demand.
The NHS still has limited data on patient outcomes, other than mortality rates which show unexplained variations between networks. While these variations may be due to the demographics of the population covered by the network, such as high and low maternal age, obesity and smoking, other factors, such as access to care during pregnancy and speed of access to the right level of neonatal care, may also have an influence.
Constraints in capacity mean that the Department of Health is still struggling to meet the demand for neonatal services, and problems over recruiting, retaining and training the staff required to deliver the service remain a major challenge. Financial management at the unit level needs to be improved. Neonatal units have a poor understanding of the costs of running their unit and there are differences in how units determine their charge for a cot day with wide variations in charges between similar types of unit.