Sick and premature baby charity Bliss says shortage of staff affects two thirds of units, and most work beyond safe capacity

Two thirds of NHS neonatal intensive care units do not have enough nurses and doctors, and a similar number are consistently working at higher than safe capacity, a charity has warned.

A growing shortage of specialist nurses and doctors has left neonatal services “stretched to breaking point”, putting the safety of vulnerable babies at risk according to the report from the sick and premature baby charity Bliss.



It argues that without urgent action from the government and NHS England, the gap between the standards expected and the care provided will widen.

“The government set out a comprehensive vision for neonatal care in 2009, with the publication of the toolkit for high quality neonatal services,” said Caroline Davey, chief executive of Bliss.



“Six years on and we are falling further behind on critical measures of quality and safety, and the shortfall in funding means units are simply unable to meet these standards.”

The government’s national standards say it is not safe for units to be running at higher than 80% occupancy on average, but more than two thirds of neonatal intensive care units are consistently caring for more babies than this.



In order to meet national standards, 2,140 more nurses are needed, said Bliss, which found 64% of units (52 out of 81) did not have enough nurses, and two thirds did not have enough doctors. The charity said the overall shortfall in nurses has grown more acute, rising from an estimated 1,150 five years ago to the present gap.

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“It is clear that not enough funding is reaching neonatal services, despite the government’s welcome commitment to provide funding for the NHS. This leaves units unable to recruit the staff they need to meet the government and NHS’s own standards on minimum safe staffing levels,” said Bliss.



There are also limited training and development opportunities, with 72% of units saying they struggle with nurse training and development.

“There were never enough nurses working in the neonatal unit,” a mother is quoted as saying in the report. “We were often just left to sit by our baby’s incubator. We were rarely given the chance to hold our daughter and when we did we were left to our own devices.”

Neonatal units found it difficult to release nurses from their frontline duties due to an inability to fill these posts while they were away. Bliss said this suggests a catch-22 situation in some units where there is insufficient staff to cover for nurses to spend time training, but a lack of training is contributing to the shortage of qualified nurses.

Many units also had difficulty in taking on enough junior and middle-grade medical staff even with funding for the posts. The result is that neonatal units are often reliant on locum doctors to fill the gaps.



The report also found that 855 babies were transferred between hospitals last year due to a shortage of staffed cots rather than medical need, putting babies at risk and adding to their families’ stress and worry.

And at 41% of units, parents do not have access to a trained mental health worker, despite parents of premature and sick babies being at a far greater risk of postnatal depression. One third of units were not able to provide overnight accommodation for parents of critically ill babies or those living many miles from the hospital.



Increasing demand for neonatal care is being driven by a number of factors, including: an increase in age of women having babies; a general upward trend in fertility rates since 2000; and medical advances. One in nine babies is born needing neonatal care in England – 77,000 annually.

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“The findings of the Bliss report are extremely concerning and provide further evidence that, similar to maternity services, pressure on neonatal services is also growing,” said a spokeswoman from the Royal College of Obstericians and Gynaecologists.

Fiona Smith from the Royal College of Nursing said: “Major progress has been made in recent years in the treatment of very premature babies, and many people are alive today who would simply not have survived in previous decades. This makes it especially stark that these advances could be put at risk by a shortage of expert staff.

“The NHS, government and local managers must work together to find an urgent solution, ensuring that we are training and employing enough skilled staff to do this vital work.”



An NHS spokesman said: “Despite increasing demand, studies consistently show standards of NHS neonatal care are on a par with other European countries.



“We will consider the recommendations of the report and continue to work closely with Bliss and others to improve neonatal services, ensuring every premature or sick baby receives the best possible care … NHS England’s quality surveillance team is developing specific plans to undertake a comprehensive round of peer-review visits of all neonatal services.”

