Snapshot survey of neonatal services and workforce to help shape future improvements

A comprehensive picture of neonatal services and workforce across the UK is outlined in the findings of a survey published by the Royal College of Paediatrics and Child Health (RCPCH) in collaboration with the Getting It Right First Time (GIRFT) programme.

GIRFT’s neonatology team – led by clinical lead Dr Eleri Adams – worked closely with the RCPCH to develop an ‘on the ground’ snapshot of staffing in more than 150 units caring for ill or premature newborn babies, looking at the day-to-day reality for medical and nursing staff.

The survey was conducted on one weekday and one weekend day in September 2019, with Neonatal Intensive Care Units (NICUs), Local Neonatal Units (LNUs) and Special Care Units (SCUs) asked to submit staffing and activity information for the days in question. In addition, every individual working on medical rosters on those days was asked to complete detailed information about their shift, as well as their views on safety, staff support and wellbeing.

Among the findings outlined in the report, A snapshot of neonatal services and workforce in the UK, are: 

  • 10% of neonatal units had gaps in medical staffing, with 5% of shifts covered by locums.15% of units had gaps in nursing staff;
  • Compliance with national staffing standards was low, particularly at weekends
  • Weekend medical staffing levels are around two-thirds of weekday levels and staff reported higher levels of stress and anxiety at work at the weekend compared with the weekday;
  • Psychology support for families was available during the week in only one-fifth of NICUs and one-tenth of LNUs/SCUs, with no support available at weekends.

Shortages in neonatal medical and nursing staffing have been highlighted in previous national reports including the NHS England and Department of Health and Social Care 2019 report Implementing the recommendations of the Neonatal Critical Care Transformation Review (NCCR) and the 2019 National Neonatal Audit Programme (NNAP) annual report. The NCCR report found that workforce transformation was needed and recommended further analysis of medical and nurse staffing. GIRFT’s neonatology team joined with the RCPCH to develop the snapshot survey as part of its work to support the implementation of the NCCR.

GIRFT neonatology review, supported by NHS Specialised Commissioning, began with the appointment of Dr Adams in early 2019. Dr Adams has been a consultant neonatologist at the Oxford University Hospitals NHS Foundation Trust for 18 years, was clinical director for neonatology for 11 years and clinical lead for Thames Valley Neonatal Network for 16 years. Her appointment as GIRFT clinical lead was endorsed by the British Association of Perinatal Medicine (BAPM).

Dr Adams said: “We have known for a number of years that there are shortages in our workforce, but it was important to have this more comprehensive picture to understand how this is impacting services and to enable us to work towards solutions, not only for the workforce but for the babies we care for and their families.

“I would like to thank all the leads for neonatal services for completing the departmental summaries, as well as the clinical staff for completing individual responses, and all the students, clinicians and administrative staff who collated the returns before sending them to us. We recognise this was a significant additional effort, but we hope you will recognise the importance of carrying out this work.”

A copy of A snapshot of neonatal services and workforce in the UK can be found on the RCPCH website here.

Alongside the neonatology survey, the Royal College of Paediatrics and Child Health (RCPCH) has also published the findings of a survey into general paediatric services and workforce.

General paediatric services were asked to complete information about rotas, staffing, and activity levels. 192 services in the UK were surveyed, and 124 (65%) responded. The findings outlined in the report, A snapshot of general paediatric services and workforce in the UK, include:

  • An average of 10% of staff were missing on the training rotas on weekdays;
  • A quarter of units had at least one locum present (25.3%);
  • Non-medical staff tended to be more available on the weekday compared to the weekend. For example, 84% of units had a play therapist present on a weekday compared to just 31% on the weekend;
  • 6% of acute ward beds were occupied by a child admitted due to a mental health problem.

A copy of A snapshot of general paediatric services and workforce in the UK can be found on the RCPCH website here.

On Monday 5th October, Dr Eleri Adams and Dr Nicola Jay, RCPCH officer for workforce planning and health services, will be co-presenting the findings of the neonatal and general paediatric studies as part of the RCPCH online conference, in a webinar aimed at clinical leaders in paediatrics. You can register for this free online event here.

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