Feedback from Stakeholder Engagement Event 6 th July 2016 Neonatal Service Review

Achieve: Right Baby, Right Place Improve cot utilisation/occupancy rates Improve workforce capability, capacity and planning 2 Aims of the Neonatal Review

Baseline assessment of Activity, Workforce, Quality, Safety and Patient experience across Maternity and Neonatal Services Objectives and Actions Plans set for three work streams of the Review – Clinical, Contracting and Patient Options and Recommendations based on Findings from the Review process Implement recommendations Evaluate benefits 3 Review Process

Review Structure NHS England, Midlands and East Senior Management Team Executive Service Review Group Clinical SCN West Midlands Maternity and Newborn Steering Group Contracting Patient NHS England Co-Commissioning Board NHS England West Midlands Maternity Board

Contracting Desktop data collection ODN Badger Visits Clinical Desktop data collection Unit Visits Stakeholder Event – 18 th March 2016 Patient Unit Visits Patient and Clinical Survey Patient Focus Groups Stakeholder Event – 6 July Work stream Progress Output Retrospective Demand Data Report Contract Products for 2016/17 Output Co-Commissioning Contract Products Recommendations Output Reports and Recommendations Findings Report from the three workstreams informed the themes for the Stakeholder Event on 6 th July 2016

Baseline assessment of Activity, Workforce, Quality, Safety and Patient experience across Maternity and Neonatal Services Objectives and Actions Plans set for three work streams of the Review – Clinical, Contracting and Patient Options and Recommendations based on Findings from the Review process Publish report - Autumn Deliver agreed actions 6 Review Process

Four broad themes 7 The type and location of neonatal cots we have do not meet the demand we have for the service. That arrangements for transferring and discharging patients are inconsistent. That the interface between maternity and neonatal care can be improved. That emotional and practical support for parents is highly variable.

Capacity – overall picture 8

9 North Network

Capacity - underutilisation 10 South Network

11 Central Network

Why is neonatal activity going up? 12

Average number transfers out of region per month: 5.5 Average number of transfers in (from out of region):

Average number transfers out of region per month: 5.5 Average number of transfers in (from out of region):

Average number transfers out of region per month: 5.5 Average number of transfers in (from out of region):

16 SCBU, TC and Normal Care (Maternity) Shared Workforce and Interventions

17 Mortality Rates and SIs

18 Mortality Rates and SIs

Criteria for discharge from the neonatal unit to Postnatal Ward / Transitional Care Criteria for discharge home Transition into Primary and Community Care Follow Up Variation in Transfer and Discharge

Funding – variable and split between CCGs and NHS England Location – NNU, TC area in NNU, Postnatal Ward (Maternity) Interventions Staffing Model No Service Specification Much of SCBU activity can be delivered in TC Variation in Transitional Care

21 Variation in Community Outreach

There are higher numbers of ex utero and in utero transfers between hospitals than necessary – this creates risk and poor experience. 22

Similar themes to Maternity Review Feedback from Stakeholder Day

Capacity: How do we arrange the service to ensure the right baby is in the right cot? Transfers and Discharges: How do we improve consistency around discharges and transfers? Links with Maternity Services: What actions do we need to take to improve collaboration between maternity and neonatal services to reduce demand on neonatal cots? Emotional and Practical Support: What are the top 3 priorities to improve emotional and practical support for patients and parents? 24

Networks: 25 Commissioning boundaries not aligned to networks. Inconsistent protocols, behaviours and priorities. Consensus from networks to merge. Need to retain operational capacity

Transport: 26 Time is being wasted in ringing around and clinical staff are giving time to feed in information System needs to include maternity bed availability Transport system prioritises NICU babies and may not have capacity for lower level transfers

Tariff and Pricing : 27 Maternity Tariff doesn’t always support complex care Inconsistent arrangements for TC and Outreach HRG 4+ impact could be material Patient choice challenging re right mother right place

Joint Working : 28 High volume of term admissions Inconsistent links between maternity and neonates re expected admissions Willingness from units to consider a shared workforce – could be an opportunity Little concept of shared capacity

Standardise Clinical Practice 29 Varying access and egress criteria Varying processes and protocols for transfers More explanation to mothers regarding pros and cons of C section Assess Term admissions and C section rates (Every Baby Counts national scheme) to establish any link

Next Steps: th July 2016: Commissioner Meeting 29 th July: Engagement on this phase closes Autumn: Report published Co-Commissioning Intentions

SCT Recommendations

We will create a single Maternity and Neonatal network board to oversee 2 operational teams (down from 3) to deliver a work programme jointly agreed by NHSE and CCGs. 32

We will move cots around the system with the ambition to level out occupancy to under 85% 33

We will undertake a joint mortality review (alongside CCGs), factoring in the level of care a unit is designated for. 34

We will work jointly with CCGs to consistently commission Transitional Care and Outreach to reduce demand on NHSE and CCG commissioned services. 35

We will encourage networks and transport teams to develop real or near-time information sharing around cot and maternity bed availability. 36

We will establish a clinical workstream to develop aspirational protocols for the following: 1. Transfers and repatriation 2. Discharge criteria 3. Transitional Care 4. Outreach Services 5. Others as identified by CQUINs etc 6. Standardised communications 37

We will work with HEE to ensure that we have a joined up approach to planning workforce as new models of care develop 38

We will, alongside CCGs, agree 5 high impact changes to improve the interface between maternity and neonatal services 39

Consider, with STPs/CCGs and providers, identifying a pilot footprint to trial an ACO approach to neonatal and maternity services. 40

Q: What is the scope of opportunity and vehicle for progressing collaborative commissioning for maternity and neonatal services? 41

Review Structure NHS England, Midlands and East Senior Management Team Executive Service Review Group Clinical SCN West Midlands Maternity and Newborn Steering Group Contracting Patient NHS England Co-Commissioning Board NHS England West Midlands Maternity Board STPs

Thanks 43