Neonatal Services Have Improved In England, But Still Overcrowded And Understaffed

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Main Category: Pediatrics / Children's Health
Also Included In: Pregnancy / Obstetrics;  Public Health
Article Date: 19 Dec 2007 - 11:00 PDT

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Neonatal services in England have improved after the reorganization, especially for premature and low weight infants. Now, fewer infants have to travel long distances to get suitable treatment. However, problems still persist, says the National Audit Office. The serious shortage of nursing staff is undermining further improvements, as well as a lack of cots in the right place and a shortage of specialist 24-hour transport.

60,000 babies are born in England each year. About 10% of these babies need some kind of specialized neonatal care. The report explains that the percentage of babies needing specialized neonatal care is rising every year. Several factors are driving this increase, such as either high or low maternal age, obesity, deprivation, and assisted conception (IVF). £420 million ($840m) was spent on running 180 neonatal units in England in 2006/7. They are organized into 23 managed clinical networks.

Today's report identified the following improvements since 2003 -

-- Mothers and babies have had to be transferred shorter distances and less often
-- Just 3.4% of infants in England were admitted to units outside of their network
-- 17 networks are treating babies within their network
-- Consistency, communication and co-ordination of care inside and between networks has got better
-- There are now 3,521 cots, compared to 3,243 in 2003
-- Neonatal units are doing a better job at involving parents in their babies' care
-- Parents are happier now with the specialist care and expertise their infants receive

Although neonatal mortality in England stood at 3.5 deaths per 1,000 live births, on a par with the best in the world, these rates varied widely across the country. While the mortality rate is 4.8 per 1,000 live births in the South West Midlands, it is just 1.8 deaths per 1,000 live births in Surrey. More focus needs to be made on tackling possible factors that impact on the rates, such as socio-economics, ethnicity, demographics, culture and types of service.

Each unit had almost three nursing vacancies for neonatal care nurses. Barely half of all the units met the British Association of Perinatal Medicine (BAPM) standard for high dependency care of one nurse for every two babies, while just 24% met the ratio of one nurse per baby in intensive care. Most of the level three units (intensive care ones) did not meet the 1-to-1 ratio of nurses-to-babies.

As some cots suitable for the right level of care were not always available, a number of units had to close and babies were sometimes being cared for in the wrong places. Most units found themselves having to close admissions about once each week, mainly because of lack of cots and the right kind of nursing staff.

Almost of third of units would regularly find themselves having to care for a baby who should have been transferred to a higher level of care. Half of the units had to care for an improving baby who was ready to be transferred but stayed because there was no cot at the other end.

Almost one third of all neonatal units worked above the 70% occupancy rate, a rate recommended by the BAPM. In fact, three units were operating above 100% occupancy. High occupancy rates can undermine the required levels of care, as well as raising the risk of infection.

"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," said Sir John Bourn, head of the National Audit Office.

-- Full Report (PDF)
-- Executive Summary (PDF)
-- RAND Europe - The provision of neonatal services (PDF)
-- Survey of Neonatal Units in England by the National Audit Office (PDF)

Written by - Christian Nordqvist
Copyright: Medical News Today
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