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The development of the networks has made a difference. The match between supply and demand is getting better, and there is the full range of special care, high dependency and intensive care in most localities. The networks are only beginning to get to grips with case load and case mix, and with securing the right level of care in that context. Their objective is to provide over 90 per cent. of neonatal care locally. However, in some situations that might not be possible or desirable.
The Department has also funded the development of the neonatal intensive care unit capacity planning tool to assist in making decisions about the configuration of neonatal intensive care units within a region. Those decisions include the location of neonatal intensive care units, the number of cots, staffing levels, and the levels of intensive care each unit provides. The tool also allows consideration of different hospitals operating together in networks, thus sharing the workloads between hospitals.
Mr. Khan: Can my hon. Friend explain the inconsistency between a tool giving guidance on staff numbers and the fact that the BAPM guideline on, for example, one nurse per high dependency cot is not met if PCTs do not fund the staff?
Mr. Lewis: My hon. Friend makes a reasonable point, but it is difficult to say, “We issue guidance and we identify priorities,” but then add, “We instruct PCTs to deliver in every area in a particular way.” That would take away the capacity to make flexible innovative local decisions.
One of the difficulties in this respect is that the definition of one-to-one support is not always clear. There can be ambiguity about what that might mean in any given set of circumstances. Does it mean support 24 hours a day? Does it mean having one named person who is clearly responsible for care and is available all the time, but who may not be physically present all the time?
So there are different definitions, but we also have to be honest and point out that PCTs are constantly making choices about priorities in the light of finite resources. In some areas that will be reflected in staffing levels that BLISS would regard as acceptable and desirable, but in others, although I believe that staffing levels always meet minimum safety standards, they do not necessarily meet the high standards that appear in the guidance. So on these occasions, it is important that we be frank about the consequences of finite resources and local management decisions, because we cannot avoid them. At the same time, it is also right that we constantly try to stretch the system to do better, and to ensure that such families are properly supported, not just through health interventions but from an emotional point of view as well. We all accept that that is very important.
It is worth focusing for a moment on a linked issue—the availability of nurses. As at September 2005, 19,178 paediatric nurses were employed in the NHS in total. That figure includes neonatal nurses and other nurses involved in the care of children, and represents an increase of 25 per cent. since 1997—to pick a random date. The annual number of students entering training to be children’s nurses increased by 59 per cent.
between 1996-97 and 2004-05. The national vacancy rate for paediatric nurses has fallen from 4.4 per cent. in 2000 to 1.7 per cent. in 2005. Interestingly, that compares with a vacancy rate of 1.9 per cent. for all qualified nurses. So the message is that there has been a lot of progress, and a lot of positive developments and steps forward, but there is still a long way to go. We should be honest about that, and be clear about the challenges ahead.
Another challenge, to which my hon. Friend referred, is commissioning. Specialised services—defined as services with a planning population of more than 1 million—are those with low patient numbers, which need a critical mass of patients to make treatment centres clinically safe and cost-effective. Under this definition, level 2 and level 3 care are defined as specialised services. Level 1 care is not a specialised service and is generally provided as part of each maternity service. At the moment there are no plans to redefine level 1 as a specialised service—an issue to which my hon. Friend referred.
There are currently no tariffs for neonatal intensive care. Critical care is outside the scope of payment by results, and funding for the service continues to be locally negotiated between commissioners and providers. Health care resource groups, which are the underlying currency for tariffs, are being developed for neonatal critical care by the NHS information centre.
Given the sensitivity of this issue, it is very important that in developing services we also consider how we relate to parents as user representatives; it is important that they have a strong voice in such development. A review group has recommended that in future, each network should have a supervisory structure that includes key stakeholders in the provision of care.
Those stakeholders should include representatives of parents, providers and commissioners. So we do envisage governance arrangements that will ensure that the voice of users is extremely strong as we re-engineer and reshape services.
For maternity services more generally, a comprehensive service review is scheduled to take place next year, partly as a result of four recent investigation reports. My hon. Friend is correct to say that the Healthcare Commission has recently contracted the Royal College of Paediatrics and Child Health to run a general clinical audit of neonatal care. I congratulate my hon. Friend again on raising these important issues in the House today.
Mr. Khan: Before my hon. Friend finishes speaking, may I point out that the one question that he has not dealt with is his special relationship with the Treasury, and how much more money he will be able to lever into this important area?
Mr. Lewis: If I want to continue to enjoy a special relationship with the Chancellor and the Treasury, I should not refer to any financial decisions. I shall simply say that this is a matter for the comprehensive spending review. That is a very boring answer, but it is very wise one from a career point of view.
We have made a great deal of progress, and parents can feel reassured. However, there are many challenges ahead, and we need to work with organisations such as BLISS and the representatives of other stakeholders to ensure that we get our interventions right. In the way in which we treat parents and babies in those incredibly challenging circumstances, there is nothing more important than that.
Adjourned accordingly at half-past Six o’clock.
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