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Great Britain

Britain's postcode lottery for newborn deaths: Mortality rates on NHS wards twice as high in some areas, reveals report

Sick newborns in some areas of the UK are dying at twice the rate of seriously ill babies in other areas, a new report has revealed.

The findings raise serious questions about the quality of care in some neonatal units, with experts warning action needs to be taken to tackle the “striking variation”.

Across the country neonatal units are also short of at least 600 nurses with four in five failing to meet required safe staffing levels for specialist nurses.

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The regions with the highest mortality rate at 10 per cent were Staffordshire, Shropshire and the Black Country, where 107 babies died. This compared with a rate of 5 per cent in north central and northeast London.

The Shropshire region includes the Shrewsbury and Telford Hospitals Trust, which is at the centre of the largest maternity scandal in the history of the NHS, with hundreds of alleged cases of poor care now under investigation.

According to the National Neonatal Audit Programme, carried out by the Royal College of Paediatrics and Child Health, for the NHS, only 11 out of 53 neonatal intensive care units had enough specially qualified nurses.

Overall, almost 70 per cent of nursing shifts did not have enough nurses qualified in neonatal care while more than a third of shifts, 36 per cent, lacked enough general nurses to meet NHS England’s guidelines.

Staff shortages also varied regionally with the Staffordshire, Shropshire and Black Country areas again performing worst in the country with 57 per cent of shifts without enough nurses – compared with the Isle of Man which had 81 per cent of its shifts fully staffed.

Dr Sam Oddie, a consultant neonatologist at Bradford Teaching Hospitals Trust and who led the work for the Royal College of Paediatrics and Child Health, said he was “surprised and disappointed” by the differences in death rates between units.

“The mortality differences are very striking, with some units having a mortality rate twice that of the lowest. This variation in mortality is a basis for action by neonatal networks to ensure they are doing everything they can to make sure their mortality is as low as possible,” he said.

Dr Oddie said the figures did not prove poor care was to blame but he suggested the way some networks “were structured, funded or managed could be improved”.

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One in seven babies are born needing neonatal care in the UK every year, the equivalent of 100,000 babies. Across England, Wales, and Scotland there are 181 neonatal services which are organised into regional networks with the sickest babies transferring to neonatal intensive care units.

All neonatal units should meet safe staffing guidelines which require one to one nursing for the sickest babies, but Dr Oddie’s team found many units were running without the required numbers.

In total, the equivalent of more than 79,000 shifts, or 607 nurses were lacking on the wards and Dr Oddie said this was an “extremely conservative estimate”.

“A neonatal ward can never really be closed,” he added, saying the shortages of staff meant “nurses looking after more babies than they should, meaning they won’t be able to give the time and care as they would intend.

“There is evidence where nurse staffing is better, mortality and other outcomes are improved.”

He added there was currently no national consensus on the qualifications nurses needed to work as a specialist in neonatal care.

The report, which had its publication delayed by NHS England until after the election, examined the care of 100,000 babies during 2018 at 181 neonatal units in England, Wales, Scotland and the Isle of Man.

Overall the report revealed improvements in the general care of babies at a national level but there was also variation in the rates of infections and chronic lung disease in children who need help to breathe after being born.

The report said these variations were unlikely to be explained by differences in the patients and it described “widely divergent practices” between some units for specific procedures.

Justin Irwin, chief executive of the premature and sick baby charity Bliss, said: “This report has found that not a single neonatal network in Britain has enough nurses in post to meet the minimum standards for providing safe, high quality care – and that less than half have enough nurses with an appropriate specialist qualification.

“These findings add to the multitude of evidence Bliss has found in recent years which show that neonatal nursing is reaching crisis point.”

An NHS England spokesperson said: “Survival rates for pre-term babies have greatly improved thanks to better NHS care, and the NHS undertook a review of neonatal services to inform how we can make further improvements in care across the country, which national, regional and local teams will put into action.”

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