BAPM Responds to Single Delivery Plan

On 30th March 2023 NHS England published the Three year delivery plan for maternity and neonatal services. The plan sets out how the NHS will make maternity and neonatal care safer, more personalised, and more equitable for women, babies, and families.

BAPM has produced a formal response to the plan which can be read here.

British Association of Perinatal Medicine's Response to the Single Delivery Plan - April 2023

Key Points:

BAPM fully supports the aims of the report which are to make maternity and neonatal services safer, more personalised and more equitable. However, without significant investment, the objectives outlined in this report will not be realised.
The focus on safety in this report is commended and we fully support the national safety champions for maternity and obstetrics but are very disappointed that there is still no national neonatal safety champion to work alongside the existing NHS England maternity and obstetric safety champions. BAPM will continue to work with Bliss and RCPCH to achieve ministerial approval for the creation of this important safety role.
BAPM agrees with the Family integrated care (FiCare) approach to support full parent partnership in care, as well as individualised care for babies and families in neonatal services. BAPM calls for all neonatal units to have funded protected time, when staff do not have a clinical caseload, for lead roles and training for FiCare and Unicef UK Neonatal BFI accreditation.
Funding from the NHS LTP and Ockenden over the last few years has helped to support improvements in cot capacity and neonatal workforce. However, to achieve the ambitions in this report there will need to be significant further investment
- to fully align cot capacity with network needs to provide equitable and timely access to neonatal care
- in parental accommodation and bereavement facilities within neonatal services to achieve parent partnership and personalised care for families within the FiCare model
- in the neonatal workforce, including medical, nursing, allied health professionals, pharmacy and psychology, to achieve the required national standards needed to improve safety, and to train and develop the workforce to retain our valued staff
BAPM fully support the measures outlined to improve perinatal safety culture and strongly recommend use of the BAPM document 'Building Successful Perinatal Optimisation Teams' to support this.
BAPM agrees that accurate, complete data and review of care are required to inform learning and it is imperative that
- there is specific funded SPA time in consultant job plans and funded roles for other health care professionals (HCP) for PMRT/governance activities
- all neonatal units should have sufficient funded and appropriately skilled clinical and administrative support to ensure accurate, complete data for national benchmarking.
The lack of focus on digital transformation within neonatology is a huge omission within this report. BAPM recommends that
- Trusts ensure that maternity and neonatal electronic patient record systems are fully linked to facilitate improved clinical care and avoid duplication of data entry.
- Neonatal services are given focussed support from Trust EPR teams, to understand the needs of the service and the dataflows required.
- Trusts use the “Service Specification for Neonatal Data Requirements” to ensure their neonatal EPR system is fit for purpose. This is currently being developed by BAPM Data and Informatics Group and publication is expected before the end of 2023.
- Funding is required to support equity of data analytics across all ODNs.

Introduction

This report sets out the key priorities for maternity and neonatal care for 2023-2027, consolidating recommendations from recent high profile national reviews [Refs 1,2] and responding to feedback from stakeholders, to refocus on key areas for improvement within the Maternity Transformation Programme in England [3].

BAPM fully supports the aims of the report which are to make maternity and neonatal services safer, more personalised and more equitable. However, without significant investment, the objectives outlined in this report will not be realised. We remain very disappointed that despite the focus on safety and working together, there is still no National Neonatal Safety Champion to work alongside the NHS England Obstetrics and Midwifery Safety Champions. BAPM will continue to press for ministerial approval for this important National Safety Lead, in partnership with Bliss and RCPCH.

In the report, key objectives and responsibilities are outlined separately for trusts, integrated care boards (ICBs) and NHS England and are divided into four overarching themes:

Listening to and working with women and families with compassion
Supporting the workforce
Developing and sustaining a culture of safety
Meeting and improving standards and structures.

BAPM broadly welcomes the greater inclusion of neonatal care within the report and the focus on a smaller number of key priorities. However, we note that some objectives in this report will be unachievable without further resource, and it is unclear where the funding for these will come from.

Listening and Supporting Families

Supporting parents as partners in care. We welcome the emphasis on listening and supporting women and families and concur with the suggested family integrated care (FiCare) approach in neonatal units, which supports full parent partnership in care as well as individualised care for babies and families in neonatal services. We would strongly advocate for

funded protected time to perform the FiCare role for all neonatal units and
for all units to use an audit tool, such as Bliss baby charter audit tool [6], to support improvements in FiCare.

Unicef UK Baby Friendly Initiative Accreditation for Neonatal Units (Unicef UK Neonatal BFI). We support the stated objective that all neonatal units should achieve UNICEF UK Neonatal BFI [7] but would strongly advocate for

funded protected time, when staff do not have a clinical case-load, to support optimal breast milk expression and breastfeeding and leading Unicef UK Neonatal BFI accreditation for all neonatal units
funding to support training of staff for Unicef UK Neonatal BFI. BAPM notes that funding to support neonatal units to achieve Unicef UK Neonatal BFI is not specified in this document, whereas commitment to fund maternity services to meet Unicef UK BFI is included.

Funding and infrastructure for local maternity and neonatal voice partnerships (MNVPs) is strongly supported by BAPM, but we ask for clarity around the source of funding for neonatal parent advisory groups representing service user experience within Neonatal ODNs and the source of financial support for parent representation in Neonatal ODN governance.

Increasing access to perinatal mental health services is strongly supported by BAPM. However, ICBs should ensure this includes appropriate access to mental health support services for those families who are resident in neonatal units for prolonged periods of time as part of FiCare.

Expanding access to bereavement services is also warmly welcomed by BAPM and ICBs should ensure that all families who sadly experience loss have 7 day access to these services, no matter where the baby’s death occurred.

Capital funding challenges include:

Insufficient funding to fully align neonatal cot capacity with network needs to improve equitable access to care. Whilst the existing funding which was agreed as part of the Implementation of the Neonatal Critical Care transformation review (NCCR) [4] is improving the situation in some areas, this will not resolve the significant cot capacity deficit across the country [5], and the remaining gap and resource required to resolve this needs to be identified to reduce morbidity and mortality in the most high-risk infants. The report suggests that this gap analysis will be completed over the next 3 years.
No identified central funding to provide appropriate accommodation for parents including for bereaved families. There are significant shortfalls in parental accommodation and bereavement support in many units [5] e.g. 45% NICUs have inadequate bereavement facilities, which will require capital funding to resolve. This remains challenging as the commitment to new investment for improved parental accommodation in the NHS Long Term Plan [4] has not materialised.

Supporting our Workforce

Having the right workforce, with appropriate skills and training, is essential to support a safe culture, and high-quality services which will improve outcome for babies and their families. BAPM welcomes the allocated workforce funding

from the NHS LTP and Ockenden over the last few years which has helped to support significant improvements in the neonatal nursing, education, AHP and psychology workforce.
to establish neonatal nurse quality and governance roles in this financial year.
to strengthen neonatal clinical leadership with a national clinical director for neonatology and a national neonatal nurse lead.

Workforce challenges

Despite recent investment, there remain significant gaps in neonatal staffing across all areas (medical, nursing, AHPs, pharmacy and psychology) when compared to the staffing requirements to achieve national standards [5] and more clarity is needed on how this gap will be filled. In particular, there needs to be

specific funded SPA time in consultant job plans and funded roles for other Health Care Professionals (HCPs) for PMRT/governance activities.
neonatal ODN pharmacists to match the existing AHP and Psychology network roles.

Assurances regarding staff training and development time will be needed as many services are stretched and loss of training time is often used as a short-term fix.

Developing and sustaining a culture of safety

BAPM fully supports the measures outlined to improve perinatal safety culture which should be the bedrock of safe, kind and compassionate care for both staff and families. We are pleased to note that neonatal leaders and neonatal services are included in the perinatal culture and leadership programme planned to take place this year. BAPM also strongly recommend use of the BAPM document “Building Successful Perinatal Optimisation Teams” [8].

Meeting and improving standards and structures

BAPM welcomes initiatives to improve care and make it safer including:

Saving Babies Lives Care Bundle version 3 to support reductions in still birth, neonatal brain injury and death. BAPM quality toolkits [9] are available to support this.
NEWTT2 – the updated newborn early warning trigger and track tools developed by BAPM [10].
Use of accurate data to highlight safety issues promptly. The National Neonatal Audit Project (NNAP) is an important tool already available to support this within neonatology. The newly formed Maternity and Neonatal Outcomes Group will play an important role in developing this further.

BAPM agrees that accurate, complete data and review of care are required to inform learning and it is imperative that

there is specific funded SPA time in consultant job plans and funded roles for other HCP for PMRT/governance activities
all trusts should have sufficient funded and appropriately skilled clinical and administrative support to ensure accurate, complete data for national benchmarking.

Making better use of technology

BAPM strongly supports making better use of digital technology. However, we are concerned that there is a lack of focus on digital transformation within neonatology which is a huge omission in this report. Whilst most neonatal units still use a single neonatal data system for some data collection, there is often no data linkage between this system and evolving local trust EPR systems. In addition, sometimes neonatal units are required to use a different internal system to their trust maternity EPR with poor system linkage. The lack of understanding regarding neonatal data flows is beginning to cause fractures to the previously high-quality data collection in UK Neonatal units.

In addition, at neonatal ODN level, there is significant inequality in access to data analysis support and a commitment to support equity of data analytics across all ODNs would allow greater alignment of national data, supporting improved benchmarking and quality improvement work.

BAPM recommends that:

Trusts ensure that maternity and neonatal electronic patient record systems are fully linked to facilitate improved clinical care and avoid duplication of data entry.
Neonatal services are given focussed support from Trust EPR teams, to understand the needs of the service and the dataflows required.
Trusts use the “Service Specification for Neonatal Data Requirements” to ensure their neonatal EPR system is fit for purpose. This is currently being developed by BAPM Data and Informatics Group and publication is expected before the end of 2023
Funding is required to support equity of data analytics across all ODNs

BAPM remains committed to the goal of single data entry with seamless data transfer between maternal and neonatal records, and to national systems used for monitoring patient pathways, activity & acuity, national benchmarking, audit and research.