Neonatal Care

Chris Heaton-Harris Excerpts

Wednesday 6th February 2013 Westminster Hall

[Chris Heaton-Harris (Daventry) (Con)]

It is a pleasure to serve under your chairmanship once again, Mr Streeter. I thank my hon. Friend the Minister, who could have been, but was not, slightly late, which is ironic in a way because the debate is about babies who turn up very early. He was due to be in the Chamber as we speak, but kindly rearranged a whole host of things to be here this afternoon to answer the debate. I thank him very much indeed. He and I have often spoken about neonatal care, and indeed stillbirth, so I know that he will do all he can to answer the debate with deeds as well as words.

Neonatal care is an absolutely vital service that no parent or prospective parent ever wants to have to rely on, but lots do. One in every nine babies in the UK is born either premature or sick—more than 80,000 every year. We therefore need a service that is fit for purpose and provides the best possible care to all premature or sick babies and their families in facilities that can give the best care—sometimes very specialised care—at a harrowing time for the parents concerned.

One of my constituents, a fantastic mum called Catherine Allcott, alas, had to rely on neonatal care a few years ago. Catherine’s twins, Luke and Grace, were born unexpectedly at 26-weeks gestation. At six weeks old, they were separated and sent to neonatal units 40 miles apart due to Luke’s critical condition. Catherine and her husband, Nigel, spent the next three months visiting two hospitals every day until Luke sadly died and Grace was discharged. Grace is now a delightful, happy, healthy six-year-old and Catherine’s experiences during that time have shaped her fundraising and campaigning work for Bliss—a fantastic charity that campaigns for continual improvements to neonatal care and is a strong advocate of care for babies.

When the results of the 2010 general election were announced, Catherine was one of the first people to find my advice centre. Before I knew it, I was being whisked around the Gosset neonatal ward of Northampton general hospital, looking at their facilities and talking to staff and parents. Since then, I have had the pleasure of visiting many other maternity and neonatal wards across the midlands and the south-east.

Catherine is concerned, as Bliss is, about the national shortage of neonatal nurses, particularly those qualified in that specialty. Half of all units do not have enough nurses to meet national standards and one in 10 units is so busy or understaffed that they cannot release nurses for specialist training. According to Bliss’s report on saving our specialist nurses—by specialist, I mean nurses who have a recognised qualification in specialist neonatal care—that figure is pretty solid.

As was shown by a Bliss report in 2010, that boils down to the need for 1,150 extra qualified specialist neonatal nurses—the figure has changed since that date, but that is the latest I have—if we are adequately to provide the service that this country so desperately needs and that babies and their families deserve. Not all nurses working in neonatal care have the specialist qualification, but the “Toolkit for high quality neonatal services” states that 70% of a unit’s nursing work force should hold one.

According to an Oxford university study, an increase in the ratio of qualified and specialist nurses to babies in intensive and high-dependency care might reduce infant mortality rates by 48%, something that is surely worth every penny and for which it is definitely worth fighting. I am told that that works out at about £1,400 of additional investment per baby, which, as the Government have themselves highlighted, would benefit society in the longer term to the tune of approximately £1.4 billion.

As I have said, I have seen my local neonatal care unit in action and know the pressures that Gosset ward is under. The staff at Northampton general hospital do an excellent job, but they face significant pressures, even after an increase in staff equivalent to 4.3 full-time nurses. Despite that increase, the unit has had to close its doors to new admissions more than 20 times in the past year for non-medical reasons, a statistic that is surely not good enough. We should not and cannot restrict access to health care to some of the most vulnerable and innocent in our society—the next generation—on the basis of those lax numbers. Frankly, we must do better and we must do more.

The shortfall nationally shows the extent of the issues that we face. More than half of all units do not have enough specialist nurses to meet the national standard—that 70% of the nursing work force should hold a specialist neonatal care qualification—and the importance of such specialist care is so clearly shown in an area where such tiny and fragile babies can have such complex and often multiple conditions. It is not a hole that can just be plugged in the short term to meet a budget, but something that needs long-term planning and investment in a skilled work force.

If we are to achieve such a national standard and address the recruitment of specialist nurses that neonatal units require, continued investment in education is of paramount importance. I therefore welcome the national changes to the commissioning of specialised services. They promise to ensure that we do not face a postcode lottery, thus improving the consistency of services across the country and spreading best practice.

Locally, my constituents in Daventry and I have other concerns and opportunities. The Minister will know of the “Healthier Together” programme in the south-east midlands, which is looking at the services provided at the five main hospitals in Bedford, Kettering, Luton and Dunstable, Milton Keynes and Northampton. There are options or plans to reduce the number of maternity units that are consultant-led from five to three, an action that would have a clear impact on neonatal services, because it is most likely to result in the closure of neonatal units at the hospitals that have midwife-led units.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing this important debate. I have a very successful midwife-led maternity unit at Hexham general hospital. Does he agree that such units can provide a fantastic ongoing service, but that it is very important that parent and larger hospitals in the region provide them with neonatal transfers and ongoing support?

--- Later in debate ---

[Chris Heaton-Harris]

I am happy to agree with my hon. Friend, and I will speak about that in more detail later.

I am not particularly against the mooted changes in the south-east midlands if they provide a higher quality of specialist care at nearby centres of excellence. However, the changes raise several important questions that I hope the Minister will answer either now or later by letter. Will he ensure that the “Healthier Together” proposals and similar ones up and down the country are driven by a genuine programme to improve outcomes and quality, and not just to save costs or money?

As my hon. Friend the Member for Hexham (Guy Opperman) said, it is absolutely vital that the needs of families of premature and sick babies are factored into any changes and are not inadvertently overlooked when mainstream maternity and children’s services are redesigned. Will the Minister say something about transport to neonatal centres, both now and in the future? Many parents find themselves quickly transported from knowing what is happening and where they expect a birth to take place, to not knowing what is going on and intense worry.

When parents have to travel further afield to centres of excellence, they have plenty of increased costs in the travel, parking charges and time considerations that come from such changes. Those responsible for planning services must take that into account. I hope that the Minister will respond on that point, and assure me that those planning services take costs into account so that not only do babies receive the highest quality care, but services and support are in place to meet families’ needs.

The parent is intrinsic to the care of the child, which I believe sets neonatal care apart from almost every other branch of medicine. We must therefore consider the needs of the parent alongside those of the child. It makes good economic sense: babies whose parents are included in their care grow faster, have less illness, go home sooner and do not come back; and their parents have less stress and fewer mental problems later. There is a huge benefit from getting neonatal care right, and if we can get it right at an early stage of planning service changes, that is all to the good.

Has the Minister heard of the children’s air ambulance service that is currently being set up by the East Midlands air ambulance, which will help to cut transfer times? It will go operational on 13 March, but has already done the odd transfer here and there. On Monday 10 December, a baby who was a few days old was flown from Glenfield hospital to Sheffield children’s hospital for potentially life-saving treatment. The total transfer time was only 34 minutes, but it would have taken one hour and 23 minutes for the team to have gone by road, which is a huge time saving for a baby suffering from a serious illness. Obviously, being operated by the air ambulance service, such transfers are at little, if any, cost to the taxpayer.

As I said, when I visited neonatal wards—especially at my local hospital, Northampton general, and the John Radcliffe in Oxford—I was really taken by the kind and understanding manner with which the staff dealt with parents. From stories related to me from across the country, I am absolutely sure that best practice can be better spread. I hope that the Minister might comment on how he will continue to ensure that the needs of such families are taken into account and that best practice is spread.

In any Westminster Hall debate on health, we get to talk about money. Although cost should not act as a disincentive to provide quality and specialised care, it is obviously a factor that cannot be overlooked. Payment by results, which has been introduced in this area, works for many other areas of policy where there is a national currency but a local tariff. However, payment by results takes into account only the current levels of service provision, rather than the services required to meet national standards; currently, those standards are not quite being met. Thus, the current shortfalls that I have outlined will only be reinforced, rather than addressed, by the payment system. A set national price would ensure that commissioners can focus on quality and outcomes of service. However, neonatal care faces a local tariff, where price invariably is a larger factor, and that equates to variable outcomes across the country.

In other types of care, significant service levels remain available under the system, but the statistics show that the disparity between one unit and another is growing in neonatal care, which suggests that the system is not working in this particular case. What steps is the Department taking to ensure that the current shortfalls are addressed and how can we ensure that this Government’s legacy sets a precedent for future neonatal care?

On a day when a disaster in Staffordshire will dominate the news on the national health service, I want to acknowledge that, all across the country, there are some amazingly wonderful NHS staff delivering the best care that they can and helping mums, such as my constituent, Catherine, and their premature babies get through some of the toughest times any of us can possibly imagine. However, with the help and advice of charities such as Bliss, the spreading of best practice and the sensible allocation of resources, I believe that neonatal care—this fantastic service that we already offer—could, and should, be delivered in a better and more consistent way.