Written evidence from Bliss (COM 94)
1. INTRODUCTION
1.1 Bliss is the UK charity that cares for
premature and sick babies. For thirty years Bliss has been dedicated
to ensuring that these babies survive and go on to have the best
possible quality of life. We provide practical and emotional support
to families during an extremely difficult time, so they can give
the best care to their babies. Our specialist study days and training
supports doctors and nurses to develop their skills and we fund
research to improve the care of all sick and premature babies.
We also raise awareness of the issues affecting special care babies
and campaign for essential change within government and the NHS.
We welcome the opportunity to respond to this call for evidence.
2. SUMMARY
2.1 Bliss welcomes this call for evidence
as it comes at a time when huge changes are being made to commissioning
that could either address or aggravate the current weaknesses
in the system. This submission will focus on the proposed changes
in commissioning of specialist services, and the opportunity this
presents to integrate commissioning across the whole pathway of
care.
2.2 Bliss is urging the following:
— Neonatal services should be commissioned
along the whole pathway of care through a single body, such as
the NHS Commissioning Board, to ensure a fully joined up approach
to services at all levels, and in particular, with maternity services.
— Bliss welcomes the development of a national
currency for neonatal services. Yet we still have a number of
concerns that could mean neonatal services are not providing the
care premature and sick babies deserve.
3. COMMISSIONING
NEONATAL SERVICES
3.1 The White Paper offers some important
opportunities to address current weaknesses in commissioning of
maternity and neonatal care.
3.2 Currently neonatal care is provided
in three levels of care (Special Care, High Dependency and Intensive
Care) that are coordinated by managed clinical networks. These
levels of care are not been commissioned by the same bodies. Intensive
Care and High Dependency Care are generally commissioned by Specialist
Commissioning Groups whereas Special Care is generally commissioned
by Primary Care Trusts.
3.3 The condition of a baby in neonatal
care will often change frequently, meaning that the level of care
they require also alters. For example, a baby admitted to a neonatal
unit immediately after birth requiring high dependency care, may
experience problems requiring several spells intensive care, before
being moved back down to high dependency and then special care
as the baby gets better and stronger. The baby may receive all
of these differing levels of care in the same unit, while being
cared for by the same team of health professionals. However, in
many part of the country the care this baby receives is being
commissioned by different bodies. Maternity services, of which
neonatal care is an integral part, are also commissioned separately.
3.4 These separate commissioning arrangements
complicate what is already a highly specialised area of care.
The National Audit Office report, Caring for vulnerable babies,[153]
and the Toolkit for High Quality Neonatal
Services[154]
both identified problems with the fragmentation of commissioning
in neonatal care. The Toolkit included a comprehensive framework
for commissioners, detailing how there should be a "whole-systems"
approach to commissioning neonatal services.
3.5 Bliss therefore recommends that services,
such as maternity, newborn and neonatal care, including neonatal
surgery and transportation, are commissioned in a coordinated
manner under a single body, such as the NHS Commissioning Board.
Commissioning services in this way will ensure full integration
of services from special care to neonatal intensive care and high-risk
obstetric services for mother and babies.
3.6 We feel strongly that special care should
be commissioned together with specialised neonatal services and
maternity care for the following reasons:
— Special Care is a vital part of the maternity
and newborn pathway and it is highly important that it is all
commissioned together for the above reasons. The Coalition Government
has the opportunity to put right the weaknesses in previous commissioning
structures and it is vital for high quality neonatal care that
they do so.
— Neonatal care is effectively an emergency
service and babies admitted do not enter the service through their
GP but through the maternity ward. It is therefore logical for
Special Care to be commissioned alongside maternity services under
the NHS Commissioning Board.
4. PAYMENT BY
RESULTS
4.1 Payment by Results (PbR) is being introduced
for neonatal care in the near future, with a national currency
but a local tariff. A significant problem with developing these
tariffs is that current services are under-resourced and underfunded.
The pressures facing neonatal services are detailed in the National
Audit Office report and the Department of Health's Impact assessment
of principles for quality neonatal services.[155]
If the tariffs are based on current levels of service provision,
this will only serve to reinforce the current problems.
4.2 We believe PbR can work well to stimulate
improvements in neonatal care. However Bliss recommends that a
national price is established as soon as possible to replace the
variable local price. A national price would ensure that commissioners
focus on the quality and outcomes of the service; a local price
would lead to inevitable variation in standards. Neonatal services
often work in a national or at least supra-regional basis, and
without national strategic overview of this service delivery there
will be more fragmentation and a less equitable service quality
and provision, to the detriment of babies and their families.
5. CONCLUSION
5.1 Overall we recommend the following:
— Neonatal services should be commissioned
along the whole pathway of care through a single body, such as
the NHS Commissioning Board, to ensure a fully joined up approach
to services at all levels, and in particular, with maternity services.
— Tariffs for neonatal care should be mandated
on a national level, not set locally or by network. In addition
it would be highly detrimental to the service if tariffs are based
on current levels of service provision.
October 2010
153 National Audit Office, Caring for Vulnerable
Babies, London: The Stationery Office, 2007. Back
154
Department of Health, Toolkit for High Quality Neonatal Services,
2009. Back
155
Department of Health, Impact assessment of principles for quality
neonatal services, 2009. Back
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