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NHS England and NHS Improvement

Neonatal Critical Care Review

25th February 2020

Daniel Eve – National Programme of Care Manager – Specialised

Commissioning

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NHS England and NHS Improvement

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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

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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.

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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

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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 - )

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Neonatal Critical Care Transformation Review – Key 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

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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

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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

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Neonatal Critical Care Transformation Review – Long Term Plan

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.

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Neonatal Critical Care Transformation Review - Resource

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Neonatal Critical Care Transformation Review - Governance

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Priorities for the Neonatal Implementation Board

Support for implementation

planning

Assurance of Regional Delivery

Alignment with the Maternity

Transformation Programme

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Neonatal Critical Care Transformation Review – Publication

https://www.england.nhs.uk/publication/implementing-the-recommendations-of-the-neonatal-critical-care-transformation-review/





















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Neonatal Critical Care Transformation Review – Action Plan

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

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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

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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

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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

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

LMS with ODN

ptshp

Quarterly

(Badgernet)

C. Neonatal services have sufficient nurse staffing in place to meet needs

RAG rating – Green would demonstrate:

a) Annual strategic multi-professional staffing review. b) Midpoint review. c) Action plan in place to address any issues

ODN

Bi-Annual

C. Is the % of avoidable term admissions to neonatal units <6%?

% of term admissions to Neonatal units

(maintain <6%)

LMS / ODN

Quarterly

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

place

LMS / ODN

Annual

E. Are their plans in place to ensure there is sufficient NICU and LNU capacity in the

right places?

a) Cot occupancy at 80% - Number of occupied cots divided by number of commissioned cots (badgernet)

b) At least 100 VLWB infants looked after per annum. Local Neonatal Units undertake a minimum of 500 days pa of combined intensive and high dependency care

c) No. of transfers out of normal care pathways

ODN Quarterly (Badgernet)

Annual (Badgernet)

Quarterly

(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

within 60 mins.

b) % of time critical IC transport calls where team arrive within

3.5hrs of telephone call

ODN Quarterly

(NN Transport service)

Quarterly

G. There is evidence of improvement in Parental support

RAG rating – Green would demonstrate:

a) Progress with Baby Bliss charter accreditation b) Compliance with National standards for parental

accommodation (Toolkit for High Quality Neonatal Services) c) Parent co-ordinator in post and development plans agreed

with each unit

ODN

Quarterly

Quarterly

Quarterly

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Get It Right First Time

• GIRFT is a national quality improvement programme which identifies unwarranted variation and shares good practice to improve patient outcomes:

https://improvement.nhs.uk/news-alerts/getting-it-right-first-time-recruits-new-clinical-leads/#h2-getting-it-right-first-time-girft-overview

• GIRFT will adapt its approach and focus on reviewing providers against progress made in relation to the NCCR recommendations using data analysis and peer review visits

• The GIRFT review team are planning deep dive visits to all ODNs in spring 2020.

• GIRFT will provide detailed information to ODNs at the time of their deep dive visits to support planning and further develop demand and capacity, workforce and parent accommodation plans.

• GIRFT team will provide data packs to ODNs at the visits.

• Provider visits begin later in 2020, completed in 2021.


































Following publication of NCCR public report Dec 2020: • ODN Implementation plans April 2020

• GIRFT ODN visits – March/April 2020

• Quarterly reporting against KLOE by regions (Maternity/Spec

Comm)

• Incorporation of GIRFT data and information into Implementation Plans

• Reiterated ODN Implementation Plans – September 2020 (TBC)

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Next Steps

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• This is our chance to get it right

• Funding is promised

• Implementation through Regions

• Capital will be challenging

• Develop the full plan over 5 years

• 10 year plan to reduce • Variation

• Show improved outcomes

Neonatal Critical Care Transformation Review – Opportunity

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Thank You

[email protected]

Neonatal Critical Care Transformation Review

powerpoint presentation 16 · title: powerpoint presentation 16.9 author: craig sanderson created...

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