Adverse birth events – admission to neonatal care

Jane Abbott Head of Programmes

Bliss is the UK charity working to provide the best possible care and support for all premature and sick babies and their families.

– Supporting families with practical and emotional support.

– Working with health professionals to improve the care delivered to babies and their families – Campaigning to ensure neonatal services have the resources they need

Overview

•1 in 9 babies each year in England (70,000) require hospitalisation immediately after birth •Most (54,000) due to preterm birth •Preterm births increasing •Overall birth rate inc •Inc maternal age •Inc in multiple births

What’s it like for parents who expect a normal birth but have unexpected neonatal admission?

Parents are expecting this……..

40% of premature births are unexplained and spontaneous – What do parents experience : • Shock, confusion, fear ‘The nurses do the same thing everyday, day in day out, but when you walk into that unit it is like – you could have walked onto the moon’ [Bliss/Picker focus group, 2010]

What do they need?

•Information •about their baby •about the unit •Support • practical and emotional •Facilities •to stay close to their baby •to cope with day to day life on unit

And parents for whom preterm birth is predicted or who have term but sick baby?

• Antenatal unit visit (Picker survey 41% given chance to visit) • Need for info, support and facilities is same • Term sick babies – may or may not have had antenatal diagnosis (group often given less focus)

Parents’ experiences

• 85% able to touch their baby before admission • Only 46% given photo of their baby • 59% mothers cared for on same ward as mothers who had their baby with them • 27% didn’t get any written info about baby’s condition and treatment • 45% not included in discussions about their baby’s care as much as they wanted

Family Centred Care

• Putting parents at heart of their baby’s care • Recognising the needs and role of parents • Parents and HPs working in partnership • Evidence of benefit (short and long term) for babies, families and service.

[POPPY report 2009]

Challenges to service

• Toolkit min nurse staffing levels (1:1, 1:2, 1:4) • Bliss report 2010 –less than third units meeting min stds – less than quarter of intensive care units –Approx 1,150 extra nurses needed.

Bliss SOS report 2011

• 1 in 3 units had made/were planning to make further cuts – 140 posts already lost – Further 32 units with planned cuts • Cuts to nurses qualified in specialty – More than half units not meeting Toolkit standards of 70% nursing workforce qualified in specialised neonatal care

Implications of cuts

Strong evidence to support Toolkit standards - Inc ratio of specialist nurses in ITU & HDU associated with decrease is risk-adjusted mortality (Hamilton et al 2007) - Nurses in intensive care units spend average of 56 mins in every hour giving direct care to babies ( Milligan D et al 2008 ) - Understaffing leads to problems inc delays to essential treatment and reduced clinical care (Pilllay T et al 2011)

What is Bliss doing? What are we asking for?

• Increase quality and consistency of FCC across all units/networks – Toolkit principle 3 – Bliss Baby Charter Standards – Bliss audit tool and accreditation scheme

Bliss SOS report recommendations : – Trusts to review programme of cuts to frontline services; use Toolkit to find ways to make services run more efficiently – Trusts & commissioners to work together to show how they will meet Toolkit standards by 2020 (prioritising increasing specialist and non-specialist nursing posts) – Clear mandate from Govt to NHS Commissioning Board to prioritise implementation of Toolkit & NICE standards – Retain networks and their role (with authority to hold trusts to account)

Thank you

Jane Abbott Head of Programmes [email protected]

020 7378 1122