Reorganisation of neonatal services has improved care for premature and low birth weight babies with fewer babies travelling long distances for suitable treatment. But, according to the National Audit Office, further improvements to the service are being limited by shortages in nursing staff, a lack of cots in the right place at the right level of care and a lack of widespread specialist 24-hour transport.
In 2005, England’s neonatal mortality rate was 3.5 deaths per 1,000 live births, similar to other developed countries. But the report found that this figure masks wide variations across the country. The South West Midlands had the highest mortality rate of 4.8 deaths per 1,000 live births, compared to Surrey and Sussex with 1.8 deaths per live 1,000 births. More work is required to determine the contribution that different socio-economic, ethnic, demographic, cultural and service factors are making to these variations in mortality rates.
The report also highlighted shortages in the numbers of neonatal nurses. On average, each unit had nearly three nursing vacancies for nurses qualified in neonatal care. Only half of units met the British Association of Perinatal Medicine (BAPM) professionally developed standard for high dependency care of one nurse to two babies, and only 24% met the standard for intensive care of one nurse to one baby. The vast majority of level three (intensive care) units, which require a 1:1 ratio of nurses to babies for the whole unit, did not meet the standards for intensive care.
Cots for the right level of care are not always available, resulting in units having to close and babies being cared for in the wrong places on occasions. On average, each unit had to close to new admissions once a week, the most common reasons being a lack of cots or skilled nursing staff. Nearly a third of units had to care for a baby who should have been transferred to a higher level of care and just over half looked after an improving baby who was ready to be transferred but could not because a receiving cot was not available.
In 2006-07, nearly a third of neonatal units operated above the BAPM recommended occupancy rate of 70% and three units operated above 100%. High occupancy rates could have consequences for patient safety, for example due to increased risk of infection or inadequate levels of care, the report warned.
