Agenda item

The Head of Stakeholder Engagement and Consultant Neonatologist, NHS England spoke to the report (in the published pack).

Also introduced were the NICU Lead Commissioner and Neonatal Services Project Manager.

Head of Stakeholder Engagement provided a statement for clarity, that there was no planned closure for Southmead hospital or the neonatal unit at Southmead.  The Committee was advised that the proposal as presented was to strengthen relationships that exist between the two neonatal units and reduce the amount of babies that needed to be transferred from Southmead to St Michaels for services not available at Southmead.  The proposal would result in all Level 3 Neonatal Intensive Care services being at St. Michael’s (UHB) with a supporting Local Neonatal and Special Care unit at Southmead (NBT).

There was a discussion about plans to create 10 extra cots at St Michaels, including timescale and costs, and the Committee was advised that Southmead specialised in pre term very small babies, at risk of having complications that may need surgical expertise; so on occasions unwell babies needed to be transported to St Michaels in specialised ambulance and have surgery. It was known that 30-40% of those babies (10-14 babies per year) ended up having to be transported so there was a need to design a system where they got all things in one go.

The Committee was advised that the suggestion was to bring expertise of 2 groups of clinicians together, involving good collaboration, which enabled safer care, so more babies survived. There were proposals to transfer the 8 intensive care cots from Southmead to St Michaels, and then funding had been agreed to open an extra 2 intensive care cots also at St. Michael’s.  This would create 41 intensive care cots in Bristol, for babies delivered in the Bristol, North Somerset and South Gloucestershire area and wider neonatal network region.

The Committee asked how the additional 30 women giving birth at St Michaels rather than Southmead would be identified; would the need for transport to St Michaels be identified early in the pregnancy.   The Committee was told that there were different choices where to give birth, but women don’t have a choice about going into labour pre-term, which would remove the choice for homebirth.  That group of women would still need to seek help at their local hospital, as some would go on to deliver early – although most would not.  The proposal would minimise the number of babies that need to be transferred after delivery.  If a woman was considered too high risk to transfer she would deliver and then move.  Staff would rotate around service - this was about creating a unified tertiary care system.

The Committee was advised that there was no reduction in cot numbers; and they were expanding; this was not about cost saving, but doing what it was felt as clinically correct.

The Chair referred to difficulties in recruiting staff, and asked if there was confidence about recruitment, and the Committee was advised that there were increasing numbers of staff that wanted to come through and do neonatal work; that Southmead provides good training, but as soon as a baby developed a surgical issue or heart problem, the baby was moved to St Michaels so staff at Southmead did not all have experience of this type of care.  The Committee was told that the ability to provide academic output was important. The team at Southmead have worked hard to produce published research.  Amalgamating services meant the ability to do research has increased.  A bigger service, bringing units together, would be positive for the city and attractive for recruitment.

The Committee asked about technological advances, and whether, with the current technology, a plateau had been reached in terms of saving very small babies, and was. advised that there were continuing debates through neonatal colleges. Technological issues included that there could be more difficulties the smaller that items were manufactured.  It was explained that we used to be pushing boundaries at 28 weeks – now those babies would be expected to be fine. There was now a focus at 24/5 weeks.

The Committee was advised that more public engagement was needed; the feedback was ongoing and interesting.  The main concerns included ‘where will we park’, ‘where will we be accommodated’, ‘what is the bereavement support at St Michaels?’  There was a need to ensure the right bereavement support would be in place. 

BCC Cabinet Member for Adult Care asked if the diversity of Bristol’s communities and their different needs around birth and neonatal services had been taken into account.  The Committee was advised that this had been discussed via Maternity Voices Partnership, although the majority of women who attended have had babies at term and not so many on neonatal units; there was a will to take views from as wide a group as possible.  This was about a tiny proportion of women having babies - Southmead admitted 770 women in total in 2016, of which 54 delivered babies at less than 28 weeks. 

Head of Stakeholder Engagement stated that there would be further engagement with staff and public; there was an intention to write to the Joint Health Scrutiny Committee to invite it to monitor and scrutinise further development and engage in the process.

RESOLVED;

·         That Committee Members could submit further questions in writing to scrutiny@bristol.gov.uk.

·         That the Joint Health Scrutiny Committee endorse the proposal to centralise level 3 NICU at St Michael’s, with families still able to access level 2 neonatal services at Southmead, and the direction of travel, subject to any changes and developments be brought to the Committee for further updates and scrutiny, and is able to be fully engaged in the process.