Neonatal Critical Care Review 25 th February 2020 Daniel Eve - PowerPoint PPT Presentation

Neonatal Critical Care Review 25 th February 2020 Daniel Eve – National Programme of Care Manager – Specialised Commissioning NHS England and NHS Improvement 1

NHS England and NHS Improvement

Neonatal Critical Care Transformation Review - Background • Better Births: Improving outcomes of maternity services in England - February 2016 - highlighted:  Medical and Nursing staffing issues, including Nurse training  Support Staff  Capacity  Safety & Sustainability with reference to remote/rural settings • The NCCT Review commissioned:  In response to the Maternity Review  By NHS England Specialist Commissioning W&C PoC Board  Led by Prof. Neil Marlow and Neonatal Critical Care Clinical Reference Group 3

Neonatal Critical Care Transformation Review - Background National Maternity Review - neonatal care : 4.56………Maternity services cannot be considered in isolation and are inextricably linked to neonatal services, which are key in delivering optimal outcomes for babies. 4.58………In the time frame in which the National Maternity Review was conducted, it was not possible to review neonatal services concurrently. A dedicated review should be taken forward, in light of the findings of this review and its consequences for neonatal services. 4

Neonatal Critical Care Transformation Review - Background The review has been structured over three phases :  Phase one evidence review complete in August 2017 and release of data packs to support local maternity transformation planning covering the following themes: • Integrated Local Maternity System Planning • Neonatal Care Capacity • Neonatal Transport Transfers • Reduction of Term Admissions - ATAIN • Workforce Planning • Mortality 5

Neonatal Critical Care Transformation Review - Background  Phase two structured across the following areas (October 2017 – November 2018): • Models of Care Group Consider Structure of Service, Transport, NICU, LNU and SCU, ODNs • Data Sub Group How to improve accessibility of neonatal data • Workforce and Education Sub Group Consider plan for medical and nursing workforces • Pricing Group Recommendations for resolving inconsistency in pricing and encouraging best practice .  Phase three Implementation (January 2019 - ) 6

Neonatal Critical Care Transformation Review – Key Is Issues  Activity, demand and capacity are key challenges.  Wide variation in mortality and outcomes  Although integral to the provision of safe maternity care, initial MTP planning progressed in a different organisational direction  Neonatal Transport Services under pressure  Variation in pricing by different commissioners 7

Neonatal Critical Care Transformation Review – Key Is Issues 8

Neonatal Critical Care Transformation Review – Key Is Issues  Problems in neonatal nursing  Funding establishment  Recruitment  Securing access to higher training  Problems in medical staffing  Recruitment of trained neonatologists  Entry into paediatrics/neonatology  Staffing particularly at LNU level  Data  Need for nationally collated and reported data 9

Neonatal Critical Care Transformation Review – Key Actions Regional team standards  Women transferred to normal care pathway NICU  <27w/801g and needing NCC  Capacity to deal with this  NICUs – 100 VLBW infants and ~>2000 IC days pa (at HRG2016 definitions)  LNU – Min 500 days combined IC/HD. Work towards ~>1000 pa  Parent supportive environment  Residence  FIC  Bliss Baby Charter/WHO BFI neonatal 10

Neonatal Critical Care Transformation Review – Lo Long Term Pla lan Developing neonatal capacity funding support to deliver capacity for intensive and high dependency care. ODN implementation plans will assist in prioritising support to the correct areas. labour ward capacity and processes and neonatal unit cot locations. ODNs will coordinate work in partnership with LMS Developing the expert neonatal workforce ODN Implementation plans will include targeted recruitment plans, developed with providers that will be phased in as funding is made available. LTP funding is also allocated for the development of expert allied health professional and pharmacist roles to address gaps in services identified by the NCCR. Enhancing parental opportunity Supporting and encouraging parents to be actively involved in delivering care improves babies’ long -term outcomes. The LTP will provide capital funding to develop parental accommodation in prioritised areas. Funding has also be identified for care co-ordinator roles to enhance the delivery of Family Integrated Care linked to accommodation. 11

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Neonatal Critical Care Transformation Review - Resource 13

Neonatal Critical Care Transformation Review - Governance 14

Priorities for the Neonatal Implementation Board Alignment with Support for Assurance of the Maternity implementation Regional Transformation planning Delivery Programme 15 |

Neonatal Critical Care Transformation Review – Publication https://www.england.nhs.uk/publication /implementing-the-recommendations- of-the-neonatal-critical-care- transformation-review/ 16

Neonatal Critical Care Transformation Review – Action Pla lan 1. ODN to lead reviews locally with providers • to develop units to bring them into line with the criteria within five years • Indicative plans for neonatal services will be part of Regional LTP Implementation Plans commencing Autumn 2019 • ODNs will work with LMS supported by Maternity Clinical Networks to develop commissioning implementation Plans by March 2020 2. Transport • LMSs and ODNs should include an evaluation of transport team performance against KPIs (Neonatal Transport Group) and action plans; address gaps in services in implementation plans by the end of March 2020 17

Neonatal Critical Care Transformation Review – Action Pla lan 3. Develop the nursing workforce • Include AHP expertise in planning (Network posts from 2021) • CNST criterion to ensure priority • Funding comes in from 2022 • Education 4. Optimise medical staffing • Gap analysis • CNST criterion to ensure priority • Consider ANNP roles • Monitor via HEE and RCPCH feedback to NIB 18

Neonatal Critical Care Transformation Review – Action Pla lan 5. Develop strategies to ensure AHP input • Funding available 2021 for network based roles to develop expertise across networks • Enhance knowledge and opportunity across network • Plans by March 2020 6. Develop and invest in support for parents • £2.5M available annually to develop these roles • Vision across network • Funds on stream from April 2020 • Encourage Trusts to support BFI neonatal and Bliss Charter • Accommodation fitting out funds available 19

Neonatal Critical Care Transformation Review – Action Pla lan 7. Develop local implemental plans • 5 year commissioning plan for each ODN • Include in LMS submission and describe collaborative working • GIRFT review 8. Ensure integration into Maternity Planning • Nursing plan • Birth in the right setting • Neonatal Safety Champions and CNST criteria 9. National Infrastructure to oversee implementation • NIB, Oversight and Assurance 20

Draft - Proposed Key Lines of Enquiry 2020/21 Metric Measure Lead Frequency (source) A. Are 85% of births at <27weeks in maternity hospitals with a designated NICU? % of births <27 wks in maternity hospitals without a designated NICU Quarterly LMS with ODN (Badgernet) ptshp C. Neonatal services have sufficient nurse staffing in place to meet needs RAG rating – Green would demonstrate: ODN a) Annual strategic multi-professional staffing review. Bi-Annual b) Midpoint review. c) Action plan in place to address any issues C. Is the % of avoidable term admissions to neonatal units <6%? % of term admissions to Neonatal units Quarterly (maintain <6%) LMS / ODN Badgernet D. Are there reviews using the Perinatal Mortality Review Tool of 95% of all deaths of babies suitable for review using the PMRT % neonatal death suitable for PMRT review where this has taken LMS / ODN Annual place E. Are their plans in place to ensure there is sufficient NICU and LNU capacity in the a) Cot occupancy at 80% - Number of occupied cots divided by ODN Quarterly (Badgernet) number of commissioned cots (badgernet) right places? Annual (Badgernet) b) At least 100 VLWB infants looked after per annum. Local Neonatal Units undertake a minimum of 500 days pa of Quarterly combined intensive and high dependency care c) No. of transfers out of normal care pathways (NN transport services) F. Is there sufficient capacity within transport services demonstrated by a) % of time critical IC transport calls where there is a response ODN Quarterly within 60 mins. (NN Transport service) b) % of time critical IC transport calls where team arrive within Quarterly 3.5hrs of telephone call G. There is evidence of improvement in Parental support RAG rating – Green would demonstrate: ODN a) Progress with Baby Bliss charter accreditation Quarterly b) Compliance with National standards for parental Quarterly accommodation (Toolkit for High Quality Neonatal Services) c) Parent co-ordinator in post and development plans agreed Quarterly with each unit