I was very pleased to be asked to by Bliss, the UK charity for sick and premature babies, to read and comment on their latest report prior to its press release on Monday 19.10.2015 The report, titled Bliss Baby Report 2015: hanging in the balance has reviewed the recommendations set out by the Department of Health in 2009 as part of their ‘Toolkit for high-quality neonatal services’. The toolkit was produced six years ago and set out the standards required of neonatal units in order to provide the safest and highest quality care.
The findings of the Bliss report, although not unexpected, are still quite shocking and the overall messages is that units are simply not meeting the standards required of them.
The report emphasises that neonatal staff in the UK are dedicated and hard-working but they are being stretched to breaking point as they continually strive to provide the best care to the sickest and most vulnerable babies. According to the Bliss report 2,140 neonatal nurses are needed in order to provide the safe, high-quality care needed to ensure that all babies admitted to NICU have the best chance of survival and improved long term health. The report also states that:
- 64% of neonatal units do not have enough nurses too meet national standards on safe staffing units.
- 67% of neonatal units do not have enough specialist nurses.
- 72% of neonatal units struggle with nurse training and development.
I am fortunate enough to have worked on two of the largest and most advanced neonatal units in the UK, both with a permanent staff of over 100 nurses. However, despite being expected to care for babies born on the very fringes of life, both units I have worked on struggle with staff shortages. The unit where I currently work has several shifts a week that require agency staff to fill them, even after the regular staff have swapped shifts and worked extra hours on top of their contacted 37.5 hours per week. Nurses are not expected to work additional hours (also known as bank shifts) and only do so if they actually want to, for example to earn some extra money on top of their basic salary.
Although the agency staff we employ are experienced and highly trained they are not permanent staff and so the training opportunities that are available to permanent staff are not usually available to them. Although they have to complete basic mandatory training courses such as fire safety and paediatric life support they do not always have the postgraduate courses that the majority of the permanent nursing staff that I work with do. I completed the neonatal intensive care course within two years of qualifying as a nurse, meaning that I am now classed as specialist staff. The course itself took a year to complete, consisted of three modules taught at the local university and required students to demonstrate a range of skills and advanced knowledge in order to pass.
In addition to staffing shortages, the report found that 70% of neonatal units are consistently caring for many more babies than is considered safe. The recommendations set out by the Neonatal Toolkit state that it is not safe for units to be running at higher than 80% occupancy but I have yet to meet anyone who works on a neonatal unit that, if not completely full, has only one or two cots available for emergency admissions.
Although my current neonatal unit always ensures that we never admit more babies than we have sufficient staff for, this means that we frequently have to transfer babies who are less sick to lower level neonatal units. This means that parents have to deal with the stress of having their baby transferred to a hospital that they are unfamilar with, meaning that they will have to begin forging relationships with entirely new members of staff and adjust to the differing routines and procedures of the new hospital.
The unit where I currently work is able to provide accommodation for parents who live many miles from the neonatal unit or whose babies are critically ill. However, according to the report 34% of neonatal units are unable to provide parent accommodation and so parents must either pay for a hotel to stay close to their baby or spend hours every day travelling to see their baby. When we transfer a baby to a different neonatal unit for capacity reasons we do so knowing that the receiving unit may not be able to provide parents with accommodation.
As well as caring for sick and premature babies, neonatal staff also support and care for the parents and families of the babies. Having a baby on NICU is hugely stressful and traumatic and yet almost as soon as the babies are born we as neonatal staff encourage parents to become and involved as possible in their care by expressing breast milk, comfort holding having skin-to-skin cuddles.
Parents being heavily involved in the care of their babies has been shown to improve the babies development and recovery and also eases pressure on neonatal staff. However, many of the parents are frightened of their fragile babies and so even changing their babies nappy is a task which can leave the parents fraught with worry. On many occasions I have asked parents if they want to change their baby’s nappy and been told that they don’t want to harm their baby and that they would much rather that I did it. Despite this being the parent’s decision they will often say that they feel as though they are not really parents as all they can do is sit and watch their baby.
For parents to have the best chance of being able to bond with the babies, psychological support from properly trained mental health staff. However, the report stated that:
- At 41% of neonatal units parents have no access to a trained mental health worker
- At 30% of neonatal units parents have no access to psychological support at all.
These are statistics that I can relate to, having worked on a unit where no psychological support was available to parents beyond what we as nurses tried to give them, despite having no mental health training ourselves. There is strong evidence that parents who have a baby on NICU are more likely to develop postnatal depression and while the parents are completely focused on their baby, they are unlikely to have much contact with any healthcare professionals other than neonatal staff.
On the unit where I currently work we are lucky enough to have a dedicated unit psychologist who is available to offer support to any parents who wish to engage with him. The referral process is informal and staff can alert him to any parents we feel may benefit from his input or parents themselves can ask to see him. Our psychologist introduces himself to all new parents on the unit and makes sure that he is visible, approachable and that all parents are aware that he is available to support them.
However, lucky as we are to have such dedicated and effective mental health support it should not be down to the ‘luck’ of the unit and I strongly believe that every neonatal unit should have a properly trained member of staff whose sole role is to provide psychological support for parents and families.
To conclude the report Caroline Davey, Chief Executive of Bliss made the following statement.
“The government set out a comprehensive vision for neonatal care in 2009, with the publication of the Toolkit for high quality neonatal services‘. Six years on and we are falling further behind on critical measures of quality and safety, and the shortfall in funding means units are simply unable to meet these standards.”
“This must be a wake-up call for for polict-makes and healthcare commissioners to take action. This unprecedented shortage is putting babies’ safety, survival and long term development at risk. If serious investment is not made, services will be facing a crisis in years to come. It needs to be addressed as a matter of urgency, so that every baby has the best possible chance of survival and of having a full and healthy life.”
I look forward to the government’s response to the findings of this report.
Louise is a full time mum, a part time neonatal nurse and award nominated blogger who has battled depression for many years but was particularly ill during her pregnancy. She lives with her husband (the Northern One) their little boy (Squidge) and their three guinea pigs who live in the kitchen.
Louise blogs at 23weeksocks (http://23weeksocks.com) about lots of different (and seemingly unconnected) topics that she’s passionate about, including mental health, antenatal depression, neonatal care and baby loss. She’s also involved in #MatExp (https://www.facebook.com/groups/MatExp/); an online maternity experience campaign that was formed to help improve maternity services in the UK. As part of this she hosts the #MatExpHour Twitter chat every Friday and would love to see you there.