Overstretched neonatal services put babies' lives at risk, research says

'Grim' report reveals that almost two-thirds of units in England do not have enough nurses

The report says that this is largely due to “a severe lack of funding" some units do not have enough doctors (Rex)

Sick babies’ lives are being put at risk in England because neonatal services are overstretched and under intense pressure, according to new research.

A severe shortage of neonatal nurses and doctors was identified by the charity Bliss, which said that units were not meeting national standards on safe staffing levels for premature and ill babies – in a study the health watchdog, the Care Quality Commission, said reflected its own concerns.

The report's recommendations

• Recruit 2,140 more nurses to give babies the best chance of survival
• Invest in neonatal care so hospitals can recruit the professionals required
• Address skills shortages to ensure babies consistenly receive the best care

Almost two-thirds (64 per cent) of units were found to not have enough nurses – a finding that the Royal College of Nursing (RCN) described as “stark” – and two-thirds do not have enough doctors to meet national standards.

The report says that this is largely due to “a severe lack of funding, which accounts for three-fifths of those units falling short of nurses and half of those units not having enough doctors”.

The Royal College of Paediatrics and Child Health (RCPCH) said it made for “grim reading”.

The Government’s national standards recommend that it is not safe for units to be running at higher than 80 per cent occupancy. Yet while the NHS insists that its level of care is on a par with other European nations, the Bliss report has found that more than two-thirds of neonatal intensive care units are consistently caring for more babies than the national guidelines allow.

In its Toolkit for High Quality Neonatal Services published in 2009, the Department of Health said intensive care units should have a ratio of one nurse to one baby.

Saying that nurses caring for the most vulnerable babies do incredible work but are being “stretched to breaking point”, Bliss is calling for 2,140 more nurses to give babies the best chance of survival and improved long-term health.

Other recommendations include further investment in neonatal care so that hospitals are able to recruit the nurses, medical staff, mental health workers and other allied health professionals to meet appropriate safety levels.

Plans must also be put in place to address skills shortages so that babies are consistently receiving the best care, the report says. The charity also found that many neonatal units are still failing to meet the standards of good practice that were set by the Department of Health and the NHS in 2009.

Professor Edward Baker, deputy chief inspector of hospitals at the Care Quality Commission, said the report “echoes what we found on some of our inspections”.

He said: “Where we have found concerns we have told trusts to make improvements. We expect trusts to look at staffing in a sophisticated way focused on the quality of care, patient safety and efficiency, rather than just crude ratios of one group of staff.

“We are currently looking at the quality of neonatal care as part of a national review to see how trusts care for newborn infants with deteriorating health; particularly how successful services are at working together. We expect to publish our findings next spring.”

Fiona Smith, the RCN’s professional lead for children and young people’s nursing, said: “Major progress has been made in recent years in the treatment of very premature babies, and many people are alive today who would simply not have survived in previous decades. This makes it especially stark that these advances could be put at risk by a shortage of expert staff.

“It takes a great deal of expertise, experience and training to care for premature babies, so a shortage of the right staff can have a profound effect. The care of premature babies and their families also requires great concentration, emotional support and a calm environment – all things that are difficult to achieve without the right resources.

“That the care of very tiny, vulnerable babies could be jeopardised by hard-pressed staff being pushed beyond their limits should be a matter of great concern.”

Professor Neena Modi, president of the RCPCH and a consultant neonatologist, said: “Today’s report describes a service that is overstretched and inadequately funded. Two-thirds of neonatal intensive care units are regularly caring for more babies than is safe, staff training is severely compromised and national standards are not being met.

This must be a wake-up call for policymakers and healthcare commissioners

&#13; <p>Caroline Davey, the chief executive of Bliss</p>&#13;

“The Bliss report makes for grim reading and echoes much of what the RCPCH found in our own workforce survey published just three months ago – there is an unacceptable shortage of healthcare professionals to care for sick babies and support their families.

“When the care of babies is compromised, so too are their chances of life-long health. This will increase their future requirements for healthcare. On moral and economic grounds inadequate funding for newborn care does not make sense. That’s why we support Bliss’s call for more investment in newborn care and a national strategy to address skills shortages.”

Caroline Davey, the chief executive of Bliss, said: “Six years on [from publication of the guidelines] we are falling further behind on critical measures of quality and safety, and the shortfall in funding means units are simply unable to meet these standards.

“This must be a wake-up call for policymakers and healthcare commissioners. This unprecedented shortage is putting babies’ safety, survival and long-term development at risk. If serious investment is not made, services will be facing a crisis in years to come.”

An NHS spokesperson said: “Despite increasing demand, studies consistently show standards of neonatal care are on a par with other European countries. We will consider the recommendations and continue to work closely with Bliss and others to improve neonatal services, ensuring every premature or sick baby receives the best possible care.”