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Vulnerable babies need more cots

19/12/2007

Improvements that could be made to neonatal care are being limited by a number of problems including a lack of cots, a report concludes today.

The National Audit Office (NAO) said services for vulnerable babies will not improve further unless there are more nurses and cots in the right place at the right level of care.

A lack of widespread specialist 24-hour transport is also hampering progress, according to the NAO.

At present each neonatal unit closes to new admissions about once a week, with the most common reason being a lack of cots or skilled nursing staff.

The highlights of its report include care of premature and low birth weight babies improving since the reorganisation of neonatal services in England, with fewer babies travelling long distances for suitable treatment.

A total of 17 health networks out of 23 are meeting the target to treat babies within their remit and the consistency, communication and co-ordination of care within and between networks has improved.

Every year about 60,000 newborn babies require some form of specialised neonatal care. This number is increasing due to an increase in the proportion of women with high risk factors such as high maternal age, obesity and assisted conception.

Although the NAO said most parents seem happy with the care their babies received, the neonatal mortality rate varies widely across the country; the south-west Midlands had the highest mortality rate of 4.8 deaths per 1,000 live births, compared to Surrey and Sussex with 1.8 deaths per live 1,000 births.

The NAO says more work needs to be done to determine the contribution different socioeconomic, ethnic, demographic, cultural and service factors are making to the variation in mortality rates.

It also calls for an increase in the number of neonatal nurses and more cots in appropriate care settings.

NHS and foundation trusts need to improve their financial management information, including cost-effectiveness of the different transport options currently in place, the NAO concludes.

It also states that these trusts need to develop a targeted action plan to address neonatal staffing shortages.

NAO head Sir John Bourn described neonatal services as a "challenging and necessarily innovative area of medicine".

"Efforts made by the Department [of Health] to improve the service to date are encouraging, but there is still more to do," he added.

"Top of the list must be addressing the staffing and capacity problems. And it is impossible to say whether the introduction of networks have improved the overall value for money of the service because of the lack of data on outcomes and the variable state, and use of, financial management information."