University of Exeter Medical School

Academic Institute

Martin Pitt

NIHR

nnrd44

When organising neonatal care in England, there is a tension between the centralisation and localisation of services. These services are currently provided at different levels, ranging from neonatal intensive care units (NICUs) to special care units. For the most-ill infants, intensive specialised care delivered in high-volume NICUs (i.e. those that see more ill infants) has been shown to deliver improved health outcomes; however, smaller local units provide easier access and reduce travel times for parents. Geographic analysis and computer models were used to investigate a range of alternative scenarios for neonatal care, looking at the impact of greater and lower levels of centralisation. The models suggest that having fewer units, especially for intensive care, could potentially improve infant survival rates. Costs and resource implications (e.g. the number of nurses required), as well as the impact on parental travel time, were also investigated using these models. The results demonstrate the advantages of different service configurations and provide a framework to assist policy-makers in planning neonatal services. We also looked at the most effective way to present these results using a range of graphical and visualisation tools. When parents were interviewed, it was found that the health of the mother and the baby dominated their concerns. Parental overheads associated with entitlement to unpaid leave, food, travel, accommodation, baby care and parking were also revealed to be important concerns. Further work is needed to investigate the relationship between maternity and neonatal services and to understand the impact of alternative configurations of care on infant health and well-being.

There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Pimary objective is to develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measure is the ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.

The aim of this study was to develop an analytical framework to address key issues in the configuration of neonatal services in England. The primary component objectives were to: Analyse neonatal service organisation and explore the trade-offs that are inherent in reconfiguration. Understand the benefits and costs, both to the NHS and to parents, of service centralisation and model the impact of different configurations. To use simulation, modelling and location analyses to understand the behaviour of this complex system and investigate trade-offs at the national level. Model costs and outcome changes associated with service reconfiguration. To explore the impact of service reconfiguration on clinical outcomes (e.g. mortality) and costs [e.g. neonatal bed-days, length of stay (LOS) and parent costs] and to undertake qualitative research on factors that families and policy-makers see as important in determining service configuration. Investigate the use of visualisation tools to communicate research findings. To understand the informational requirements of the key stakeholder groups and to research and develop effective communication tools to convey the research findings. Consult with the parents of neonatal infants. To ensure that the needs and concerns of parents and families are taken into account, to explore the best ways to communicate findings to parents and the public, and to involve them in decision-making in neonatal service configuration.

REC reference: 15/NW/0503

Release