David Davis

NHS England recently completed an update to the Neonatal Critical Care service specification. Service specifications set national standards which all commissioned providers of Neonatal Critical Care services are required to meet. The updated specification for Neonatal Critical Care outlines nurse staffing requirements for the three different levels of neonatal care, including high-risk neonatal intensive care services. The specification requires neonatal units to meet the British Association of Perinatal Medicine’s (BAPM) standards in relation to safe staffing limits for registered nurses with a neonatal Qualification in Specialty. The service specification is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2015/01/Neonatal-critical-care-service-specification-March-2024.pdf

Furthermore, the BAPM standards are available at the following link:

https://www.bapm.org/resources/service-and-quality-standards-for-provision-of-neonatal-care-in-the-uk

Reporting of neonatal mortality in neonatal care units is conducted through audit programmes. Data is published by the National Neonatal Audit Programme (NNAP), with the figures for January 2017 to June 2024 available at the following link:

https://www.rcpch.ac.uk/resources/nnap-data-dashboard#view-the-dashboard

In addition, Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) also report neonatal mortality in neonatal care units, with the figures for 2017 to 2022 available at the following link:

https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/

The NNAP covers England, Wales, and in more recent years, Scotland, and reports the proportion of very preterm babies, those born at 24 to 31 weeks completed gestation, who are admitted to a neonatal unit and die before discharge home, or 44 weeks post-menstrual age, whichever occurs sooner. It does not, therefore, report on babies born before 24 weeks or after 31 weeks, or babies not admitted to a neonatal unit.

The MBRRACE report covers the United Kingdom and captures mortality rates up to 28 days after birth, broken down by the level of neonatal care provided by the trust or health board where the birth occurred.

These data sources only give a partial view of infant mortality in England. All infant deaths, both neonatal and post-neonatal, in England and Wales are reported by the Office for National Statistics, and are available at the following link:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/latest

Department officials meet with Welsh authorities on a regular basis to discuss a range of maternity and neonatal-related issues.

There are currently 43 Neonatal Intensive Care units in England providing care to high-risk babies.

Of the 3,898 registered nursing staff working in Neonatal Intensive Care Units, 2,251 have a qualification in specialty (QIS) for neonatal care. QIS-trained nurses are constantly supporting and directly supervising non-QIS-trained nurses in the day-to-day care of babies within low to high-risk neonatal units.

All neonatal units receive funding depending on the number of days that care is provided, as well as the type of care provided. Specific prices for a ‘cot day’ of neonatal care activity are agreed between local commissioners and National Health Service providers.

From the most recent National Cost Collection for the NHS, in 2022/23, the average national unit cost for neonatal intensive care was £1,879 per bed day. The average national unit cost for neonatal intensive care, special care without an external carer, was £976 per bed day.