1.
Summary
In 2019/20 Airedale
Trust made a temporary change to its neonatal service due to
operational pressures linked to Consultant Paediatrician staffing
levels and in consideration of the recommendations of the Neonatal
Critical Care Transformation Review. This meant that the unit
started operating as a Special Care Unit instead of as Local
Neonatal Unit, with approximately 24 families per year being
transferred to a neighbouring unit (mostly Bradford) for delivery
of their premature baby. Airedale NHS Foundation Trust seeks
support to progress with formalising the pathway change for
Airedale neonatal unit, so that it continues to operate as a
special care baby unit, but no longer provides high dependency care
as a local neonatal unit.
2.
Background
Neonatal Units are
the part of hospitals which provide care for babies who are born
prematurely (before 37 weeks gestation), with a medical condition
which needs treatment, or at a low birthweight. Neonatal care
services are provided in a variety of settings dependent upon the
interventions required for the baby and with dedicated transport
services to support babies being transferred to and from neonatal
care units.
In 2019/20 Airedale
NHS Foundation Trust made a temporary change, in agreement with NHS
England and the Yorkshire and Humber Operational Delivery Network,
to its neonatal service due to staffing pressures.
This meant that the
unit at Airedale NHS Foundation Trust started operating as a
Special Care Unit (SCU) instead of as Local Neonatal Unit (LNU),
with approximately 24 families per year being transferred to a
neighbouring unit (mostly Bradford Teaching Hospitals Trust) for
delivery of their premature baby.
The Trust has asked
that NHS England (NHSE) approve the formalisation of this
arrangement, and in 2022/2023 NHS England Specialised Commissioners
notified both North Yorkshire Overview and Scrutiny Committee and
Bradford Overview and Scrutiny Committee of the temporary service
change, as well as the request to formalise the arrangement.
Before NHSE can
approve the formalisation of the change to the neonatal pathway,
the Trust is required to provide further information and assurance
about the impact of the change on babies and their families, and on
the wider population.
The Trust and NHSE
would like to seek the views and support of Overview and Scrutiny
for making this change permanent by presenting:
•
Information about the service change
•
Information about the impact on Babies, Families, and Services
The information set
out in this report is an updated position following our
communication from June 2023.
3. Report
issues
Neonatal Units are
the part of hospitals which provide care for babies who are born
prematurely (before 37 weeks gestation), with a medical condition
which needs treatment, or at a low birthweight. Neonatal care
services are provided in a variety of settings dependent upon the
interventions required for the baby and with dedicated transport
services to support babies being transferred to and from neonatal
care units.
There are three
levels of units:
o Neonatal
Intensive Care Units, for complex care (for example from 22 weeks
gestation)
o Local
Neonatal Units, for high dependency care (for example from 27 weeks
gestation)
o Special
Care Unit, for initial and short term care (for example from 31
weeks gestation)
The table below
sets out the sites where the different levels of neonatal units are
provided in Yorkshire and Humber as part of a networked
arrangement:
|
Neonatal Intensive
Care Units
|
Local Neonatal
Units
|
Special Care Units
|
|
Braford
Hull
Leeds
Sheffield
|
Airedale
Barnsley
Calderdale
Doncaster
Grimsby
Mid Yorks
Scunthorpe
Rotherham
York
|
Bassetlaw
Harrogate
Scarborough
|
Yorkshire and
Humber Neonatal Network help to manage patient flow across the
network, balancing capacity and demand, ensuring services meet
the needs of patients. The network comprises neonatal
services including 4 Neonatal Intensive Care Units (NICU), 9
Local Neonatal Units (LNUs) and 3 Special Care Units (SCUs). There
are also 3 neonatal surgery units and Embrace – the
Yorkshire and Humber Neonatal Critical Care
Transfer service.
These units work
together as a network to deliver local care pathways, with the
capacity and resources to care for the babies of women who
live within the network area. Babies requiring the
highest levels of care are concentrated in relatively few
specialist centres, and it is the networks’ role to
develop coordinated patient pathways across neonatal units and
supporting transport services.
Wherever possible
the network ensures appropriate level of care for babies as close
to home as possible. The network also advises on any
reconfiguration of services across the network area in line with
the recommendations of the Neonatal Critical Care
Review.
The consultant
paediatric team at Airedale covers both the neonatal and paediatric
service. The number of consultants fell during 2019/20 resulting in
significant staffing and recruitment challenges. To mitigate this
staffing risk across both paediatric and neonatal services the
Local Neonatal Unit (LNU) at Airedale temporarily changed to a
Special Care Unit (SCU). This was to ensure that elective and
emergency paediatric services could be fully maintained at
Airedale. The medical staffing challenges within the Airedale
Paediatric team have now significantly improved.
During this time
Airedale neonatal service has worked closely with counterparts at
Bradford Teaching Hospitals NHS Foundation Trust. Babies who are
between 27 and 31 weeks gestation, who may previously have been
delivered at Airedale, have been delivered at an alternative
hospital with an appropriate onsite neonatal unit (in most cases
Bradford).
Airedale is a small
Local Neonatal Unit, with a low volume of high dependency care
activity. If Airedale NHS Foundation Trust were operating as a
Local Neonatal Unit it would not meet the clinical standards on the
volume of activity required for a Local Neonatal Unit to look after
high dependency babies. There is good evidence that units with
higher activity have better outcomes. Ultimately, this change will
ensure the highest quality of care for premature babies across the
region.
Although Airedale
will no longer routinely provide high dependency care of babies
between 26-31 weeks gestation, if required, the unit will still
provide initial and short term care for these babies, in limited
circumstances.
Currently all
premature babies born from 22 to 27 weeks gestation are currently
cared for in Neonatal Intensive Care Units (NICUs) at Bradford,
Hull, Leeds or Sheffield. This means families from across the
region (including Airedale) already travel for this highly
specialist care. In these circumstances facilities are available to
support families eg accommodation, car parking support, food
provisions etc…
After changes to
the 27 week pathway at Airedale babies who are between 27 and 32
weeks gestation would be delivered elsewhere (most likely Bradford)
then, when appropriate to do so, are transferred back to Airedale
for ongoing care. This is likely to impact approximately 24
families per year.
An EQIA was
completed by the Trust. This covers Duty of Quality, Patient
Experience, Patient Safety, Clinical Effectiveness, Prevention,
Productivity and Innovation, Resourcing, Resource Impact, People
Experience, and Equality, Diversity and Inclusion. No significant
risks were identified. This is attached as Appendix A.
A travel impact has
also been considered. As this is a networked service, families
already travel to access specialist care. For the majority of
families, there will be limited impact. Most will now travel
to Bradford to receive high dependency neonatal care. North
Yorkshire / Craven families will experience the most impact in
terms of travelling further to access care (these families account
for an estimated 20 per cent of Airedale activity).
Patient engagement
has seen 34 families who experienced the change in pathway
approached with the opportunity to provide feedback. Only three
responses were returned with positive comments received
regarding care, informed about the care provided, information
provision and discharge planning. Opportunities to learn have been
highlighted from patient experience around providing some
additional support families from admission to discharge from the
service. Further patient focus group activity is planned for
families (to include Craven and North Yorkshire parents) to secure
wider input on the patient experience and any suggestions that can
be taken forward to improve the neonatal pathway.
The change to the
Airedale Neonatal pathway is being progressed in discussion with
system partners including:
•
Bradford Teaching Hospitals Trust
•
Yorkshire and Humber Neonatal Network
•
The Yorkshire and Humber Local Maternity and Neonatal
System
•
NHS England Specialised Commissioners (North East and
Yorkshire)
•
West Yorkshire Integrated Care Board (via the Joint Committee
arrangements with Specialised Commissioning)
4.
Recommendations
Airedale NHS
Foundation Trust seeks support to progress with formalising the
pathway change for Airedale neonatal unit, so that it continues to
operate as a special care unit, but no longer provides high
dependency care as a local neonatal unit.
Further involvement
and engagement with patients will take place to understand if any
further arrangements can be made to strengthen the neonatal pathway
and transition between services.
Although the impact
is small in terms of numbers, the impact of the change and on
patient experience will continue to be monitored closely.
6. Background
documents
The attached EQIA from Airedale Trust (Appendix A) is available as
a background document.
Information about the national NHS England Neonatal Critical Care
Review can be found here:
NHS England » Implementing the Recommendations of the
Neonatal Critical Care Transformation Review
7. Not for
publication documents
Due to the small numbers of patients and area specific information,
the travel impact assessment is not for publication.
