1. The decision to establish a Neonatal Task Force is an important development, with the potential to improve the care for vulnerable babies. The Department should set the Task Force clear objectives and associated milestones for improving services, and monitor achievements against these milestones to ensure delivery of the objectives by the end of 2008-09.
2. The reorganisation of neonatal services into clinical networks has had limited impact in reducing geographic variations in mortality rates. Prematurity and illness in newborn babies are associated with a complex range of factors, including social deprivation, ethnicity and maternal age. Primary Care Trusts need to improve their understanding of the changing demographics of their local population and model the impact on demand for neonatal services to target intervention and prevention strategies on key high risk groups.
3. Whilst three-quarters of neonatal units have reviewed the types and intensity of care a unit should be able to provide safely, the resultant re-designation has yet to be implemented in full. All networks should work with their relevant Primary Care Trusts to use the information from local strategic needs assessment to inform the designation of neonatal units, taking into account the standards recommended by the relevant professional groups. Primary Care Trusts should base their commissioning of neonatal services on units being able to demonstrate that they have the right levels of suitably qualified and experienced staff to provide the designated levels of care.
4. There are currently no formal arrangements for performance managing neonatal networks. In return for continued funding of networks, Strategic Health Authorities should agree a set of performance measures and review networks' performance against these objectives. Strategic Health Authorities should also require the two areas without a formal managed network to establish them as a priority.
5. There are wide variations and mismatches in costs and charges between neonatal units for the different levels of care provided, and units' understanding of costs is generally poor. Improving understanding of cost drivers is essential if the Department's plan to introduce a 'Payments by Results' tariff is to be effective. In setting tariffs for neonatal care, the Department should ensure that the full costs, including the costs of meeting professional staffing standards and providing transport services, are taken into account.
6. There are serious shortages in the numbers of neonatal nurses with an average of nearly three vacancies per unit for nurses qualified in neonatal care. Strategic Health Authorities and the new Neonatal Task Force should develop a national action plan to address neonatal nurse shortages, including developing recruitment and retention initiatives based on good practice. In the meantime, Strategic Health Authorities should increase the number of neonatal training courses.
7. Only half of networks provide specialist neonatal transport services 24 hours a day, seven days a week. Some 73% of units experienced delays in transporting babies and 44% believed that care had been compromised as a result. Strategic Health Authorities working with networks need to develop local partnering arrangements so that all neonatal units have 24 hour access to appropriately staffed transport services.
8. On average, in 2006-07, each neonatal unit had to close to new admissions once a week due to a lack of baby cots. A third of neonatal units operated above the recommended occupancy rate of 70% and three of the 178 units operated above 100%. High occupancy rates could have major implications for patient safety due to increased risk of infection or inadequate staffing levels. The functionality of the National Cot Locator needs to be improved so that it identifies occupancy levels in order to meet the needs of networks and units wishing to transfer babies.
