I expect lots of trainees, clinicians and nurses will have experienced the feeling of being a small cog in the churning wheel of the healthcare system. It can be difficult to stay motivated at times when we do not feel as though our hard work is being recognised or rewarded. It can be helpful therefore to occasionally take a wider view and see where our field of practice sits within the landscape of the NHS. This is a great time to be working in neonatal medicine, during this post I hope to show you why.
I remember my supervisor once telling me that although neonatal medicine is a little fish in a big pond, it creates far-reaching ripples. In this post, I am going to describe an overview and signpost to the interventions currently focussed on improving neonatal care in our network and in the UK.
Here is a chart of infant mortality rates per 1000 live births by country:
In the landscape of medicine, our little corner of neonatology is currently in the spotlight. International benchmarking data shows we have improvements to make in delivering safer care for newobrn infants. Sometimes this can feel threatening, especially for those in leadership roles, with targets to address and data to collect. However, this also represents a once in a generation opportunity to have the attention of the state, the press and the public turned towards us. We can harness this money and momentum to create lasting change in our specialty, to ensure that the next generation of infants requiring neonatal care will have even better outcomes.
This diagram shows the current landscape of neonatal care in Southwest England.
It can be pretty confusing to look at all the different quality improvement drivers and standards and it’s easy to get bamboozled in acronyms and NHS management language so I will try and summarise these now and provide links for further resources.
Maternity Transformation Programme
NHS England programme aiming to deliver safer, more personalised care for pregnant women and babies. The overall aim is to halve the rates of stillbirths, neonatal mortality, maternal mortality and brain injury by 2025.
NCCR= Neonatal Critical Care Review
Review by the Clinical Reference Group (a group of experts in neonatal care) for NHS England which describes the core standards necessary for delivery of a high quality service and describes areas for development. This falls within the wider Maternity Transformation Programme. Specialist Commissioners, who commission services for the NHS use these reference standards to know they are getting a high quality service. You can read more about their recommendations if you are interested here https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-e/e08/
MatNeoSIP = Maternity and Neonatal safety improvement programme
NHS England safety programme aiming to reduce rates of maternal and neonatal deaths, stillbirths, and brain injuries that occur during or soon after birth by 50% by 2025. Here are more details https://www.england.nhs.uk/mat-transformation/maternal-and-neonatal-safety-collaborative/
GIRFT= Getting It Right First Time
NHS improvement programme aiming to reduce variations in the NHS. For example, they have been looking at staffing in neonatal care- you may remember filling out a survey for this about a year ago. They found that 10% of neonatal units had gaps in medical staffing and 15% had gaps in nursing staffing. https://www.gettingitrightfirsttime.co.uk/medical-specialties/neonatal-intensive-care/
NICE= National Institute of Health and Care Excellence
In August 2019, NICE published recommended standards for preterm labour and preterm birth management: https://www.nice.org.uk/guidance/ng25
Saving Babies’ Lives Carebundle 2
NHS England care bundle of evidence-based or best practice interventions. This is specifically aimed at improving the national infant mortality rate and the still birth rate. Despite falling to its lowest rate in 20 years, one in every 200 babies is stillborn in the UK, which is more than double that of some other nations. https://www.england.nhs.uk/mat-transformation/saving-babies/
BAPM Toolkits= British Association of Perinatal Medicine Resources
Toolkits targeting key NNAP (National Neonatal Audit Programme) measures so that departments can access quality improvement tools and methods. https://www.bapm.org/pages/104-qi-toolkits
Periprem- Perinatal Excellence to Reduce Injury in Premature Birth
A WEAHSN (West of England Academic Health Sciences Network) care bundle, currently being implemented in units in the Southwest of England. https://www.weahsn.net/our-work/transforming-services-and-systems/periprem/
PReCePT= Prevention of Cerebral Palsy in Preterm Labour
National quality improvement work to improve uptake of magnesium sulphate in preterm labour.https://www.health.org.uk/improvement-projects/precept2-reducing-brain-injury-through-improving-uptake-of-magnesium-sulphate
Phew!
Well done if you made it to the end of all those acronyms. There may be more which I haven’t included. Hopefully I have shown how much national focus and drive there is to improve outcomes for infants born in the UK at the current time. We may be small cogs, but we all make important contributions which mean that progress and advances in care quality are being made all the time. So stay strong, keep submitting high quality data with your badger entries and get involved with quality improvement work where you can!
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