Abstract

Objective: To produce models to estimate the impact of introducing clinical networks and the 2001 BAPM standards to the delivery of neonatal care.

Design: Prospective observational study using a geographically defined population and data collected by questionnaire on staffing levels and cot availability.

Setting: Trent Health Region UK.

Subjects: All infants born to Trent resident mothers at or before 32 weeks gestation between 1 January 1998 and 31 December 1999. Staffing numbers and cot availability for neonatal care in 2001.

Methods: A modelling exercise was carried out using information for all neonatal admissions for Trent resident infants. Three models were investigated: (a) the current care provision; (b) a network where three lead centres provided the intensive care for the region and the remaining units provided either high dependency or special care alone; (c) a network where six lead centres provided the intensive care for the region and the remaining units provided either high dependency or special care alone. Overall costings, staffing levels, and cot requirements were calculated for each model. Data on staffing levels and cot availability were used to calculate current care provision costings.

Results: The current cost of running the service is approximately £33.35 million, although a proportion of nursing posts are currently unfilled. Estimates for the introduction of a three centre model meeting BAPM 2001 standards range from £37.31 to £43.40 million. Equivalent figures for the six centre model were: £36.32 to £42.62 million. Approximately 370 and 230 babies a year would be involved in transfer in the three and six centre models respectively. This is in contrast with 374 and 368 urgent transfers that actually took place in 1998 and 1999 respectively.

Conclusion: The costs associated with the introduction of managed clinical networks and meeting BAPM standards of care are not excessive, especially when considered against the likely implementation timetable of perhaps 7–10 years. Attracting and retaining sufficient staff will pose the major challenge.