Agenda item

26 week pathway update and regional/national comparators re survival rates and outcomes for babies

Report of Julie Turner, Head of Specialised Commissioning North East and North Cumbria, NHS England, with Dr Sundeep Harigopal and Yasmin Sultana Khan.

The Committee received a presentation from Dr Sundeep Harigopal, Clinical Lead Northern Neonatal Network and Consultant Neonatologist at Newcastle Hospitals, which provided an update on the 26 week pathway and regional and national comparators on survival rates and outcomes for babies.

The Northern Neonatal Network comprises Neonatal Intensive Care Units (NICU), Local Neonatal Units (LNU) and Special Care Baby Units (SCBU).  The update provided information relating to the NICUs at the RVI Newcastle, Sunderland Royal Hospital and James Cook, Middlesborough.

The Committee was informed that in 2015 the Royal College of Paediatrics and Child Health reviewed neonatal services across the region.  This resulted in the following 5 recommendations:

-        Re-designation of the NICU at North Tees to a Special Care Unit (SCU)

-        Increased capacity at South Tees to cater for the re-designation at North Tees

-        Development of a standalone neonatal transport service for the Northen Neonatal Network

-        Expansion of the NICU at RVI

-        Changes to service provision in Neonatal Intensive Care in Sunderland

All 5 of the recommendations were now complete.  The Committee had received an update on neonatal care at its meeting in July 2023.  At that time, the recommendation in relation to the 26 week pathway and access to provision in Sunderland was ready for implementation.  The presentation focussed on the impact of this change.

It was noted that prior to the pathway change, all pre-term babies born from 22 weeks gestation needing intensive care would go to one of the NICUs at RVI, Sunderland Royal or James Cook.  The patient flow after 26 week pathway change set out that babies from 22 weeks will still go to RVI or James Cook.  Pre-term babies from 26 weeks gestation from Durham, Carlisle, Gateshead and Northumbria now go to Sunderland.  It was noted that this would change in the future to babies from 27 weeks.

The change was implemented on 1 August 2023 and it was noted that there had been no ex-utero transfers from Sunderland and 4 in utero transfers from Sunderland to RVI.

The Committee heard that parental feedback from families transferred from Cumbrian units to North East NICU was on the whole positive.  All parents were offered accommodation and financial support for meals and parking.  Families did not feel there could have been anything done to improve their experience but one family did request that there be more communication about what each different hospital is like before transferring.  It was noted that videos providing virtual tours of hospitals had been made available to help families prepare.

The Committee was presented with data in relation to neonatal mortality rates.  The mortality rate for Newcastle (RVI) was 1.65, for Sunderland 1.52 and for Middlesborough (James Cook) 1.35.  The rate was per 1000 live births.  The data captured was from 2021 and was published in the MBRRACE UK 2023 report.  It was explained the data represented deaths up to 28 days from birth and does not take into account the complexity of cases.  It was highlighted that Newcastle is a fetal medicine and surgical centre taking care of sicker babies.

In relation to morbidity, specifically lung disease, it was noted that there is a higher level across the region than at a national level, particularly in Newcastle.  Data in relation to this was measured by infants delivered at less than 32 weeks needing oxygen.  It was explained that there is no clear reason as to why the rates of lung disease in infants are higher but that survival rates are also higher in Newcastle.  It was noted that babies needing oxygen early in life does not translate to future lung diseases.  Whilst Newcastle is an outlier in lung disease, it was explained that it is not an outlier in general morbidity figures and that data on neurodevelopmental outcomes for babies demonstrates that the North East does well in this area.

The Committee discussed the patient flow for those families living towards the west of the region, with intensive care treatment for infants located in the east.  It was also noted that the closure local units like South Tyneside meant more travelling for families to get the required treatment.  It was explained that historically the population has been higher in the east and there has not been enough activity in the west in order to double up provision.  Strong transport links are in place and the North East performs well in transferring mothers before their babies are born and making sure they get the care in the correct place.  Bigger units are better equipped to treat patients than small units dealing with very small numbers per year and therefore provide better outcomes.  Families were receiving support with transport and associated financial costs and whilst patient engagement suggested patient satisfaction was positive, feedback would be continuous to identify potential issues.

Dr Harigopal explained that the next steps for neonatal care in the region are the implementation of the national report published in 2019 called the Neonatal Critical Review.  The report aimed to facilitate the transformation of Neonatal Critical Care further by 2025 through aligning capacity, developing the expert neonatal workforce and enhancing the experience of families.  Work has already taken place around developing the workforce including funding for neonatal nurses, allied health professionals and neonatal quality roles.  In relation to enhancing the experience of families, the Northern Neonatal Network established the first neonatal care coordination team in the UK in April 2021.  Work was currently being undertaken by the network in relation to scoping the aligning capacity theme.

The Chair thanked Dr Harigopal for the presentation.

RESOLVED

i.                 That the presentation be noted

ii.                An update be provided to a future meeting of the Committee