Y&H Neonatal ODN
Annual Report 13/14
Annual Report 2013/2014
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Foreword – Simon Morritt (Alison Hollett) CE, SCH as Network hosts.
Sheffield Children’s NHS Foundation Trust is delighted to be the host of the Yorkshire
and Humber Neonatal ODN which is focused on ensuring that the care for newborn
infants across the region meets nationally recognised standards. The neonatal ODN
sits alongside the Paediatric Critical Care ODN, the only ODN of its kind in the UK
ensuring a seamless and consistent approach to the standards of care expected for
children within the region from birth through to adulthood.
Sheffield Children’s NHS Foundation Trust is one of only 4 independent children’s
Trusts in the UK. As a specialist Trust it has a focus on patients both locally and
regionally and has an ability to ‘make things happen’. The Trust has experience of
establishing and running other Yorkshire and Humber based services, as it also hosts
Embrace, the Yorkshire & Humber Infant and Children’s Transport Service, again the
only one of its kind in the UK.
The Yorkshire and Humber Neonatal ODN is part of the Surgery & Critical Care
Division at Sheffield Children's NHS Foundation Trust which includes as well as the
Paediatric Critical Care ODN, Embrace, Paediatric Intensive Care, High Dependency
Care, Paediatric Anaesthesia, Theatres, Pain Service the Surgical Specialities and the
surgical wards, including Neurosciences and Burns. Working within a Division that
focuses on the delivery of care to patients at a critical time and which already has
experience of ensuring that a region wide service is allowed to develop has been
critical for the ODN at it’s launch. The Neonatal ODN has to hold Sheffield Children’s
NHS Foundation Trust to account for the quality of care it provides, and the Division
welcomes this role and ensures that the ODN has the same expectations of
compliance to standards as elsewhere within the region.
The Trust is excited to be working as part of the Neonatal ODN as well as hosting this
service, as it develops to be at the forefront of the delivery of high quality
Neonatal Surgical Care.
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Y&H Neonatal ODN Executive Group Chair – Chris Edwards, Chief Officer,
Rotherham CCG.
In Yorkshire and Humber, we have a long and successful history of working together
to ensure that high quality neonatal care is provided through the region. The
restructuring of the NHS in 2013 and the subsequent formation of Operational
Delivery Networks, allowed us to build on the success of existing Clinical Networks in
the north and south of the patch and for the first time bring together clinicians from
across the whole of Yorkshire and Humber into a single network.
During 2013/14 the North Trent Neonatal Network successfully merged with the
Yorkshire Neonatal Network to form the Yorkshire and Humber Neonatal
Operational Delivery Network (ODN). The new network is hosted by Sheffield
Children's Hospital and is required to perform against the NHS England Neonatal
ODN Service Specification. This work is overseen and managed by the Yorkshire and
Humber Neonatal ODN Executive Group which I am honoured to have been asked to
Chair.
The Neonatal ODN works closely with the Paediatric Critical Care Operational
Delivery Network, also hosted by SCH, to ensure we have efficient administration
systems in place.
This report details the progress that has been made during the transition, and as
Chair, I would like to thank the provider organisations and the network team for
their dedication and hard work over the year.
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ODN Manager – Helen Brown
I joined the newly formed Yorkshire and Humber Neonatal ODN team in October
2013 having previously managed the Jessop Wing in Sheffield.
I first came to work in the NHS in the early 1990s as a Data Analyst working in Clinical
Research, later becoming a Researcher in my own right and working alongside
eminent Professors in the field of Cancer, contributing to many published studies.
With the publication of the ‘Improving Outcomes Guidance’ in 2000 I stepped into
the world of NHS Management and Managed Clinical Networks helping to shape
Surgical Cancer Services across what was formerly known as the North Trent Cancer
Network. Waiting Times compliance formed a large part of this role resulting in the
redesigning of how services were delivered in order to meet the challenge.
It was these acquired skills I took with me to Jessop Wing helping to establish
maternity and neonatal services as the Tertiary Referral Centre for South Yorkshire
and beyond.
With the arrival of the Health and Social Care Act in April 2013 the NHS was once
again dramatically changed and the concept of Clinical Networks revisited. Whilst
the benefits of wide clinical engagement and delivered sustained improvements
were recognised any previous variation that existed in form and function was now to
be addressed.
Now known as Operational Delivery Networks (ODNs); they have specified roles and
remits with their focus being one of an operational supporting role. To ensure
quality standards and networked patient pathways are in place and to support
provider Trusts in meeting their new challenges.
ODNs operate on a membership model across a wide geographical area; bringing
together clinical opinion, sharing good practice; influencing policy/commissioner
decisions and supporting provider units to operationalise strategy.
Whilst it is mandatory for provider units to be a member and participate in the ODN
it is not a statutory body with the authority to impose change, to police provider
units or to provide a source of funding.
The former North Trent and Yorkshire Neonatal Networks that successfully existed
before were very different from each other as well as very different from the
expectations as an ODN. In addition, and understandably, concerns existed, and to
some extent, still do, about the future of networks and their survival.
Many staff previously involved took opportunities to either leave the NHS or move to
new roles so one of my first challenges as ODN Manager was to provide reassurance
and minimise further loss of knowledge, skills and capacity. My focus was to build a
cohesive team, working together. This was in part achieved by maintaining the focus
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on continuation of existing valid outputs such as provision of training and education
and robust clinical information. But building on previous successes has in itself
proved challenging as starting points varied both across specialities and across
geographical areas. Clinicians, themselves, requiring support to aid their own
understanding of the changes and reassurance that good practice will continue albeit
under a different umbrella.
Having said all that, the achievements within the first year, of the Yorkshire and
Humber Neonatal ODN’s existence have been significant and commendable as this
report will show. On a personal note I feel privileged to work with such personable
and committed teams with the ability to show a genuine sense that babies and their
families remain firmly and squarely at the centre of clinical care whilst still meeting
new challenges head on.
Administrator – Laura Murphy
I started working for the network in August just as the ODN was being developed
from the former Yorkshire Neonatal Network, North Trent Neonatal Network and
the Paediatric Critical Care Network. It has been a learning curve for all involved as
people’s roles have changed to accommodate the new structure and new avenues of
work are being looked at.
My main role is to support Helen Brown the Network Manager and the Lead Nurses
and Lead Clinicians in their projects and meetings as well as undertaking the general
administration work for the networks. I hope to get more involved with the network
data in the near future.
Previously I have worked at Mid Yorkshire Hospital Trust, YHIP hosted by Bradford
Teaching Hospitals Foundation Trust and West Hull Primary Care Trust so bring NHS
experience as well as a variety of administrative and project work experience gained
from other organisations to the role.
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Y&H Neonatal ODN Clinical Lead (North) – Chris Day
Before settling into a consultant post in Bradford and later becoming Clinical Lead for
the old Yorkshire Neonatal Network I had worked in quite a lot of the units of the
Y&H Neonatal Network – Airedale, Leeds, Bradford, Sheffield and Rotherham as well
as a stint in Newcastle so I have a reasonable feel for our huge geographical region.
When I took over the clinical lead of the Yorkshire Neonatal Network (YNN) from
Bryan Gill it was already well established and the most pressing challenge was
resolving the movement of babies between multiple units with hard pressed
capacity. Together with our network manager Michelle Milner the network team
played a significant role in modelling various options which ultimately led to the
funding of the joint paediatric and neonatal transport service. While the start of the
Embrace service hosted by SCH ended the networks direct responsibility for
transport I have remained committed to this service with involvement in the
Embrace Reference Group and in picking up issues on network site visits. During our
rounds of NICE quality standard visits the new Embrace service was the most
frequently brought up area of region wide success - highlighted by almost all units in
the north – and the units of the YNN were not well known for agreeing about
anything!
Site visits have been a significant feature in the relationship between YNN and all the
units – we found them a good way of helping unit’s clinical and management teams
focus on challenges and present successes – it would be only fair to flag up that
every unit had some of each!
The YNN has been involved in organisational convergence – what we would now call
LNUs closed in Huddersfield and Pontefract, Dewsbury became a SCBU and is now
moving towards becoming a midwifery led unit (MLU). This has been associated
with trusts combining so that we have gone from having 13 providers down to only 8
organisations though still 10 sites with neonatal care. After a long period when the
number of small delivery units fell we now have the rise of the MLUs in our area and
possible challenges managing babies needing neonatal care will continue to be
monitored.
The neonatal clinical forum has been an important part of the success of the
network – it existed before the network and has continued as an important
independent voice with its own chair and secretary. While working very closely
together this with the network it has been invaluable to have this clear independent
clinical voice and friendly critique of the networks activities! The neonatal
community have been very keen to embrace the plurality of practice that exists in
areas where there isn’t a clear evidence base as to what represents best practice –
the nurses and doctors across units large and small have had no difficulty expressing
friendly disagreement but have also embraced common practice e.g. around cooling
when it was clear it would be vital to have a common approach to this new therapy.
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We have already identified areas where the NTNN had made more progress and we
are now looking at developing a mortality review process across the north.
On a personal level I’ve been closely involved in the regional developments in NLS
and other educational activity. I’ve had a role in supporting individuals and units
after clinical incidents helping to ensure organisational support is available and that
training for all the key staff could be provided with the then larger network team
playing key roles in e.g. arranging specific on site simulation training after difficulties.
I worked with Alan Gibson in Sheffield what now seems like a long time ago, well it
was in a previous millennium! I hope that we will be able to complement each other
in our roles in the north and south of the network – compliments might be less
likely!
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Y&H Neonatal ODN Clinical Lead (South) – Alan Gibson
I have been clinical lead for the North Trent Neonatal Network (NTNN) since the
inception of networks more than 10 years ago. The evolution and coordination of
neonatal care across the region and now extending to integration with the Yorkshire
network has been a process which although at times difficult has been immensely
rewarding. In the early years of the NTNN work was concentrated on the
assessment of individual units against the standards prevalent at the time and
redirecting the limited funding that was available in an attempt to support units to
achieve comparable standards in different domains. An early target was to move
towards centralisation of the most immature and vulnerable babies and although
this did not initially meet with universal support continued dialogue eventually lead
to agreement. As a consequence the NTNN developed regional capacity so that
centralisation could be achieved and attained this target quite early in comparison to
some other regions. It is rare for a baby to be moved out of region for intensive care
other than for supra-regional specialised services and the interaction between the
different units that made up the NTNN has continued to mature into a very cohesive
co-ordinated system.
One of the priorities for the NTNN at the beginning was to develop an independent
transport system for moving babies requiring intensive care across the network.
There was agreement that this was a necessary service and a team that was
primarily run by advanced neonatal nurse practitioners with additional support from
medical staff when required and continued for several years. Funding was not
sufficient to provide a 24 hour service but it was interesting that this rarely led to
significant clinical problems. Very understandably there has been increased
emphasis on the importance of transport for both neonatal and paediatric intensive
care services and the NTNN transport team was duly replaced by the regional
neonatal and paediatric transport team, Embrace. Our old NTNN transport team
pales into insignificance when compared with the new highly efficient and seamless
Embrace service but at the time was a major development in network wide care.
Collection and analysis of high quality data has always been regarded as an issue of
primary importance within this region. It is difficult to make constructive and logical
plans without the information to justify the need. The NTNN was extremely
fortunate to have recruited Charlotte Bradford at an early stage in development and
we are lucky to still have her services. In the national data collections it is becoming
apparent that in many areas the quality of data being produced is highly
questionable but it is definitely not the case within our region.
As part of the data collection that the NTNN performed an annual report was
compiled that included information on mortality. On a regular basis this raised
concerns about higher than expected death rates and repeated reviews, including an
expensive external review, concluded that although occasional deficits in care could
be identified most variation in mortality against "expected" levels was largely
accounted for by failure to recognise that populations differed widely and also that
very important confounding variables were not being taken into account. Although
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we were confident in these conclusions we also recognised that others might
conclude that this was an easy and simplistic conclusion. To make sure that
mortality within region was subjected to careful scrutiny we set up a network
mortality panel which reviews all deaths of babies within the network units. To
avoid any local bias the panel has representatives from different hospitals and
different specialties and annualised data are produced for network wide
dissemination. We believe that this is a very important quality control mechanism.
The ability to now combine accurate data from both the South and North parts of
the Yorkshire region is providing a robust data set on a very substantial portion of
the UK population which will continue to be extremely important in contributing to
local and national discussions on major issues of service development. Feedback
from accurate locally collected data to national data collection systems has allowed
substantial modifications of the national systems to help improve standards. The
fact that a Bradford-based neonatologist is now leading part of the national data
collection system is a further development that should continue to help enhance
these standards.
After service configuration was addressed a second priority that was identified was
development of network wide clinical protocols. With significant and very important
contributions from Elizabeth Pilling in Sheffield, Aiwyne Foo at Chesterfield and
Catherine Smith from Embrace a concerted period of guideline development led to a
substantial number of agreed network wide guidelines which have now been in
operation for several years and many are due for revision in the near future.
Acknowledging the fact that the evidence for strict guidelines is not always present
and that some individual variation was not necessarily a bad thing led to
development of guidelines which were agreed as safe but within which some
individual interpretation was still possible. This continues to be an important area
and one that we are intending to further develop as the network continues. Another
allied development has been production of a network wide drug formulary where
information on all the commonly used neonatal medications is available and which is
evidence based wherever possible. Again it is acknowledged that there are
individual variations in practice and there are hopes that in collaboration with the
Northern part of the ODN this service may continue to develop in such a way that
individual units can subscribe to the areas where they are comfortable with the
recommendations and dialogue will continue between units to try and further
standardise information. The fact that the units across Yorkshire often transfer
babies within the region both for clinical need and because of capacity issues and
that an independent transport team facilitates these transfers does mean that
greater use of standardised treatment protocols and drug regimes can only enhance
care and improve safety.
Once the guideline team had produced a core set of guidelines their attention then
changed to developing an education and training package. Across the region for
several years there have been four educational meetings a year which have taken a
number of different formats but most recently have been concentrating on
enhancement and maintenance of practical clinical skills. These have been very
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popular and have always evaluated very positively. It is our intention to continue
this programme as soon as a new education and guideline lead has been appointed.
One of the most important elements of network development has been the
improved harmonious interaction between the different units that make up the
Neonatal Network. In early years when redefining roles and moves towards
centralisation dominated discussions there were times when interactions were
strained. It is a credit to all those involved in these discussions - and many of the
current network members have contributed from the beginning - that relationships
have continued to mature in ways that can only be to the benefit of the babies in the
population that we serve.
The combination of the Yorkshire and North Trent networks into one common
operational delivery network could be seen as a challenge but in reality seems to
offer further opportunities to enhance the service. For several years before it
became apparent that a merger would be mandated there was already an
agreement that a core group should regularly meet to make sure that the two
networks were working along common trajectories. Although there have been
different priorities for the different networks this has provided opportunities for
developments to be adopted that have already been tried and tested elsewhere.
We have a very good understanding of patient flows and population needs and we
recognise that working together closely is essential to maximise our potential to
improve services further. I think it is true to say that all the personnel involved in the
Yorkshire and Humber Neonatal ODN work very well together and are agreed in their
common goals. The recent past has been challenging but endlessly interesting and
major improvements in the care of newborn babies have resulted. The future will
bring new challenges and further rewards and integrated working practices will be
central to this progress.
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Y&H Neonatal ODN Lead Nurse (North) - Denise Evans
I have worked within the discipline of neonates for 40 years. My first experience in
neonatal care was in 1974 when as a Nursery Nurse I undertook the one year Special
Care Baby Course at Lincoln County Hospital. Once I realised this was my vocation I
went on to train as a registered nurse at York County Hospital immediately followed
by my midwifery training at St James Teaching Hospital.
I quickly returned to neonatal practice where I consolidated my training. I was
accepted on to the Neonatal JBC 400 at the UCH in London. I have worked overseas
in Saudi Arabia as part of a commissioning team and more recently regular visits to
Uganda to co-develop and lead a teaching package in Neonatal and Child Health and
also develop and project manage the creation of a new neonatal unit that was fit for
purpose.
I worked at Leeds General Infirmary neonatal unit for 21 years as the Education
Sister developing induction programs and in service training. I have worked on the
neonatal unit as a Professional Development Sister and senior sister in the surgical
newborn area prior to taking up my Network role as a Regional Network Educator in
2004, followed by the Lead Nurse role in 2008.
Other Neonatal qualifications include the ENB 904 which I undertook at Liverpool,
the ENB R23 Enhancing Neonatal Practice which I undertook at Manchester and a
nursing degree at Leeds. This has given me valuable insight when supporting
continuing education for staff in the region.
I continue to lead and organise collaboration throughout the Network. My belief is
that to facilitate high quality care and excellent practice it is not just about
introducing new knowledge or practice but more importantly is about sharing
evidenced based knowledge. It is about what is out there in our Network and how
we impart knowledge and experience while meeting local needs with a strong multidisciplinary team ethic.
As Chair of the Neonatal Nurses Association I represent neonatal nursing on the
Neonatal CRG. A member of the UK committee for Children and Young People and
regularly undertake case reviews and give advice for the Parliamentary Health
Ombudsman all of which enables me to inform the region of the National agenda to
help facilitate and adapt our vision and service.
The last twelve months have been about the transition of the Neonatal Network
from a Managed Clinical Network to an Operational Delivery Network. Influencing
how people see and understand this change through the transition has sometimes
been difficult.
However, joint team working with my counterpart in the South, Kathy Parke, has
resulted in some very well received, early wins for the network, in terms of
educational events and nurses forums. With the help of BLISS and the exceptionally
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successful parent advisory groups established in the North, PAGs are now being
positively encouraged and forming in the South.
Y&H Neonatal ODN Lead Nurse (South) - Kathryn Parke
I began my neonatal career in 1983 as a paediatric nurse working in a neonatal
surgical unit. This experience confirmed my belief that I wished to pursue a career
as a neonatal nurse, therefore I completed my ENB 405 course in Sheffield in 1986. I
returned to neonatal surgery for a short time before taking my first Sister's post in
SCBU in Rotherham. This was followed by my second post as Sister in Doncaster with
a return to Rotherham in 1993 as Clinical Manager. Since then I have held a variety
of positions as Matron/ Lead Nurse, but have always maintained responsibility for
the neonatal unit largely from choice.
In 2004 I was appointed as Lead Nurse for the North Trent Neonatal Network as a
seconded position 1 day per week. I was very honoured to be offered this
opportunity and the experience broadened my insight into the national neonatal
agenda and the dilemmas facing our local units.
In April 2013 I became Lead Nurse for the Y&H ODN south as part of the transition
from a managed clinical network to ODN. As Lead Nurse I represent the interests of
nursing staff and advise on the neonatal agenda and it's application to nursing
services. I represent the network from a nursing perspective at National events and
meetings. I am particularly interested in patient experience and the challenges faced
by both units and the network in engaging with service users in a meaningful way. I
am also interested in the clinical governance of neonatal care and have been very
involved in the network mortality reviews, in particular in ensuring that we share
good practice and learn from these reviews.
The ODN South has been able to learn from the successful implementation of user
involvement achieved in the ODN north. In the latter part of the year I have stared
to take a lead on patient experience issues for the whole network, but mainly
concentrating on increasing parent engagement in the South using a similar model to
that deployed in the North.
I have continued to support the Nurse Leads professionally and continued to
represent the interests of the Network locally and nationally.
A joined up approach…
The transition from managed clinical networks to ODN's in 2013/14 has posed some
interesting challenges for the Lead Nurses, particularly as the two roles had evolved
differently due to the differing structures in the Yorkshire Network and the North
Trent Network. We have worked increasingly more closely together to integrate the
nursing teams across both networks using the strengths of the two lead nurses to
lead on key developments. The greatest challenge has been maintaining our core
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responsibilities and identity as leads for the North and South and ensuring that the
interests of nursing staff in each of our units continue to be represented.
The integration of the two networks has provided opportunities to use the strengths
of the two lead nurses to best effect with consideration for the differences in
allocated hours.
2013/14 also saw the launch of the second Picker survey. We have campaigned hard
to ensure maximum participation in this survey to ensure that we reap the benefits
of benchmarking on a large scale. Funding for a non mandated survey proved a
challenge for most units but negotiations with Picker in conjunction with Bliss,
Picker, Nurse Leads and Network Managers nationally resulted in a reduction in the
overall costs to units. We look forward to the results as a combined network in
2015.
2013 saw the launch of an ANNP course at Sheffield University. Therefore as Lead
Nurses we have worked very closely with the university in the development of this
course to ensure that it prepares practitioners for their role as advanced practitioner
and is of value to the clinical environment. The initial evaluations of this course have
been very positive from both the students and the provider units. In the latter half
of the year we have stared to work with the universities to evaluate all the neonatal
courses to ensure that they meet the training requirement for Neonatal Nurses as
defined in the NICE standards.
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Y&H Neonatal ODN Information Manager – Charlotte Bradford
My name is Charlotte Bradford and I am the Information Manager for the Neonatal
ODN. I started working with the North Trent Neonatal Network back in January 2005
and then following the changes to network structures in April 2013 I became the
Information Manager for Yorkshire and Humber Neonatal ODN; incorporating both
the North (the former Yorkshire Neonatal Network) and the South (the former North
Trent Neonatal Network) of the patch .
The role has changed significantly since I commenced back in 2005 but some of the
biggest changes came about last year. The area and number of units covered has
significantly increased and as such practical hands-on support, which all units were
used to having, has been reduced.
During 13/14 considerable effort was put in to ensure that units were provided with
the data required for their CQUIN submission as well as the quarterly National
Quality Dashboard data. The completion of the monthly staffing tool has continued
and all units continue to make use of it and a monthly summary of gestation
compliance is also compiled.
There has been a great deal of work put in to migrating the units in the south of the
patch from Badger3 over to the BadgerNet version of the Clevermed software used
by all neonatal units in England. Whilst proving to be a time consuming exercise, it
will benefit all users and allow units to have access to a much broader range of
reporting functionality. Having all 20 neonatal units within the ODN all operating the
same version of the system will also make day-to-day tasks for me much simpler.
As well as trying to support units on a practical level the role also requires me to
work closely with the Network Manager and our colleagues within the SCN to
support national projects, initiatives and quality improvement drives by analysing
and providing data as appropriate.
I would like to thank all staff members across the network who have been actively
involved in Badger data entry and the administrators who ensure data quality. Once
again, without your help we would not be able to produce such robust activity data
for this and other projects and reports.
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Y&H Maternity and Children’s SCN Manager - Clare Hillitt
I am delighted to contribute to the Annual Report 2013/14 for the Y&H Neonatal
Operational Delivery Network.
2013/14 marked the first year of operation of Strategic Clinical Networks and
Operational Delivery Networks - new organisations amongst many other new
organisations in a very new NHS landscape. For both the challenge has been
establishing and developing new organisations with committed commissioners,
providers, clinicians and patients, retaining the best of the work and success that had
been undertaken before whilst developing new ways of working.
During 2013/14 the Y&H Children’s and Maternity Strategic Clinical Network and the
Y&H Neonatal and Paediatric Critical Care Operational Delivery Networks have
started collaborating and working together with the objective of improving
outcomes and experience for babies, children and their families across Y&H.
This work commenced in September 2013, when Clinicians and Managers from the
Y&H ODN were amongst over 100 stakeholders from across Yorkshire and the
Humber who attended a Children’s and Maternity Strategic Clinical Network
engagement event. This event helped the SCN to shape its work programme and
governance arrangements and ensured that the views of the Neonatal and PCC
ODNs were reflected in both the outcome of the event and the SCNs plans to
improve services and outcomes for children and their families.
In October 2013, Mr Jim Dwyer, SCN Clinical Lead for Maternity and I were pleased
to be asked to present the keynote speech at the launch of the ODN to over 90
clinicians from across Y&H. This gave us a valuable opportunity to explore with a
wider audience the emerging relationship and shared ambitions of the two Networks
and as a result of both events we are pleased that there will be representation from
the ODN on both the SCN Regional Maternity Clinical Expert Group whose first
meeting is to be held on June 13th 2014 and the SCN Regional Children’s Clinical
Expert Group which meets on June 24th 2014.
The SCN work programme for 2014/16 also contains evidence of collaborative
working between the Networks. One of the first SCN Task and Finish Groups to be
established is the ‘Term Baby’ Project. The issue of the admission of term babies to
neonatal care was raised at a national level at an NHS England Patient Safety
workshop in September 2013 in the context of the NHS Outcomes Framework 5.
Domain 5; “Treating and Caring for People in a Safe Environment and Protecting
them from Avoidable Harm”.
Representatives of Children’s and Maternity Strategic Clinical Networks (SCNs) and
Neonatal Operational Delivery Networks (ODNs) were in the audience and
experience from other parts of the country showed that improvements can be made
to the care of babies that may prevent their need for neonatal care; initial
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indications in Yorkshire and Humber are that this area would benefit from further
work.
The aim of the Y&H SCN Project is for the SCN and ODN to work with stakeholders to
ensure that babies receive consistently high quality of care in the perinatal period
and that admission to neonatal care takes place only when necessary. The first
meeting of this group will be held in June 2014 with regular reports to both
Networks.
The SCN Clinical Leads, Dr Fiona Campbell (Children), Mr Jim Dwyer (Maternity) and
the SCN Team see this as the start of important collaborative working and look
forward to developing and strengthening relationships over the coming year.
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BLISS – Karen Williams, Regional Volunteer Co-ordinator
Since coming into post as Bliss Leeds Regional Volunteer Coordinator in May 2013, I
have been working with parents, volunteers and health care professionals to
increase the family centred support available to families with a special care baby and
to establish Bliss Leeds within the region.
Primarily my role has been to increase the number of volunteers supporting parents
and families both on the special care units and once they are home. The area of
focus so far has been directed by the Department of Health and has been in the
North of the network.
Since July 2013 we have seen an increase in community and unit based Bliss Family
Groups from just 1 group in Leeds to 9 across the North of the network by April
2014. This number is set to increase in the coming months so each of the units in
the North of the network will have a Bliss Family Group in easy reach.
In May 2013 we had just 1 Bliss Champion supporting parents on the unit at LGI.
Currently we have Bliss Champions at BRI, LGI and Calderdale with further
Champions going through the process with other units. The aim is to have Bliss
Champions on each of the units to ensure parents are able to access Bliss support
from as early in their journey as possible.
Over the past 12 months I have built strong relationships with neonatal units,
outreach teams, trust volunteer services, and specialist midwifery teams as well as
Children’s Centres, CCG’s, and Health visitors etc which has been invaluable in
establishing Bliss Leeds Region. I have established a successful Steering Group
where clinical staff from each of the units and areas within the regions come
together to share ideas, concerns and good practice to ensure we are working
together to provide parents with the best family centred care possible. In addition I
also sit on the ODN Executive group and attend the clinical forum and various other
meetings where appropriate.
Through my work with the Y&H ODN I have helped to establish parent
representation on the Executive Group and helped the parents to form a Parent
Advisory Group (PAG). I have recently been working with the South of the Network
to replicate this parental representation and have recruited a parent representative
for the South with a view to establishing a South PAG.
Over the next 12 months I hope to build on the established support in the North of
the network and to work with the South of the network in increasing the number of
Bliss volunteers supporting parents and families.
Parent Representative (South) - Donna Rasdale
I am very excited to be joining the network as a parent rep, from a new PAG and to
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have the chance to represent parents in my area.
My son was born prematurely in 2008 and at that time I felt alone and lacked the
confidence to have a voice amid the daunting hospital environment. The experience
made me much stronger and I decided to become a volunteer for Bliss so I could do
what I could to ensure no parent felt alone.
Since then I have supported other parents on their journey via the Little Miracles
Support Group in Sheffield, visiting parents on the Jessop Wing Neonatal unit and
providing ongoing support when families are home. We now have a large group of
parents involved with the group, supporting one another and looking forward to
improving neonatal experiences for other families.
Parent Representatives (North)
The PAG for Yorkshire formed in August 2013. The members of the group
are: Rezvana Hassan, Claire Illingworth and Emma Gooding- Brown. We have all had
premature and/or sick babies who have been cared for in Bradford, Airedale and
Leeds Hospitals. We are now joined by Donna Rasdale as the representative for the
South Yorkshire hospitals. When we formed the group we agreed that we would
take it in turns to attend three or four Executive Group meetings each. Emma has
attended the last three Executive Group meetings on our behalf and she then feeds
back to our own PAG meeting which normally follows the week after each Executive
Group meeting. We have been welcomed by the Executive Group and feel that our
opinions and voices as parent reps are heard and valued.
Although still in its infancy, the PAG has been asked to consider the Yorkshire
Neonatal Network website and when we next meet we will feedback on the
amendments we feel are necessary to make it more 'parent friendly'. We have also
been asked to consider a plain English summary for a proposed clinical trial into the
use of steroids for premature babies. More recently, due to the collaboration
between North and South Yorkshire Executive Groups, we have spent time
discussing these changes and other planned changes to the network and how we
feel these will impact on families. We are keen to extend our involvement and for
the clinicians to come to us for any advice or help they might need from a parents’
perspective.
Rezvana also feels that the parent representative role has given her the opportunity
to make her voice heard where change can happen. Being an Asian Muslim woman
she felt the need to speak for her community who are too afraid to speak to
professionals due to the lack of confidence and language barriers.
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Activity : Annual Report Data – 1st April 2013 – 31st March 2014
Table 1: Network Admissions
(Based on Day 1 location)
ODN North
Total
ODN South
Total
Y&H Total
Neonatal
Unit
Transitional
Care Unit
Postnatal
Ward
Unknown
Total
4144
902
3
27
5076
3105
1065
248
67
4485
7249
1967
251
94
9561
Table 2: Network Care Level Days by HRG
(Includes care days for admissions prior to 1st April)
ODN North
Total
ODN South
Total
Y&H Total
HRG 1
HRG 2
HRG 3
HRG 4
HRG 5
Total
8624
9888
33093
8941
5901
66447
6380
6894
26330
6893
2061
48558
15004
16782
59423
15834
7962
115005
Table 3: Breastmilk at Discharge
[For each unit in the network, for the discharge date range chosen, shows the
number of babies delivered under 33 weeks’ gestation who were discharged home
or to ward and who were receiving any of their mother’s own breast milk.
Included in report: Gestation < 33 weeks gestation at birth and Discharged
home/foster care.]
ODN North
Total
ODN South
Total
Y&H Total
YHNODN/HB
Included Babies
Number Receiving
Breastmilk
% Receiving
Breastmilk
358
167
47%
259
119
46%
617
286
46%
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Table 4: ROP Screening
The following tables show each unit in the network, for discharges within chosen
range, the number of babies who should have had their first screen (based on NNAP
criteria) in that unit.
For these babies the numbers (%) who had first ROP screen on time/in
window/early/late are shown (based on NNAP criteria).
‘On time’ refers to babies screened appropriately while an inpatient or discharged
home before screening period starts but screened prior to discharge.
‘In window’ refers to babies discharged home before being screened but then the
screen takes place within the appropriate screening time window.
Included babies
ROP on
Time
ROP in
Window
12.2%
ROP
Screen
Early
8 1.6%
ROP
Screen
Late
7 1.4%
ODN North
Total
ODN South
Total
Y&H Total
499
413
82.8%
61
359
300
83.6%
858
713
83.1%
No ROP
Screen
10
2.0%
33
9.2%
5
1.4%
3
0.8%
18
5.0%
94
11.0%
13
1.5%
10
1.2%
28
3.3%
Table 5: <27wk Gestation Compliance
Number of Number
<27wk
delivered
Admissions at a NICU
ODN North
Total
85
Number
delivered
at LNU
67
18
78.8%
21.2%
Number
transferred
to NICU
postnatal
16
ODN South
Total
69
59
85.5%
10
14.5%
9
Y&H Total
154
126
28
25
81.8%
18.2%
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Table 6: Admission Temperatures
Only includes 1st Episodes where baby has been admitted directly from either the
labour ward or labour theatre.
All babies that were cooled have been removed from the summary.
No calculation has been performed to identify time between birth and admission.
Total 1st
Admissions
No
Admission
source
recorded
Babies
cooled
Total
Admissions
from Labour
Ward
4159
532
61
1876
3581
166
26
1236
7740
698
87
3112
ODN North
Total
ODN South
Total
Y&H Total
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22
<36oc
138
(7.4%)
86
(7.0%)
224
No temp
recorded
Total
Admissions
from Labour
Theatre
26
904
3
698
29
1602
<36oc
53
(5.9%)
52
(7.4%)
105
(6.6%)
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No Temp
Recorded
2
0
2
Y&H Neonatal ODN
Annual Report 13/14
Embrace Transport – Cath Harrison, Clare Harness, Embrace
Highlights 2013-2014

Embrace received 3408 referrals and sent teams for 2293 transfers of infants
and children across Yorkshire, the Humber and beyond.

Embrace Aero medical Service development.

Yorkshire and Humber Neonatology and Paediatric Critical Care Operational
Delivery Network collaboration.

Childrens Emergency Rescue, BBC2.
Mission Statement
Embrace aims to provide the highest quality paediatric and neonatal care for infants,
children and their families from the first point of contact to arrival at the destination
unit.
It is the mission of Embrace to provide:





A single point of telephone contact for referring clinicians.
Access to immediate specialist clinical advice.
Triage to an appropriate level of transport provision and dispatch of transport
teams within a clinically appropriate time window.
Identification of a suitable cot or bed so that the most appropriate care is
provided in the most appropriate location for any infant or child requiring
specialist care in the Yorkshire & Humber region.
Logistical support for high risk obstetric transfers by locating a suitable
maternal bed and neonatal cot
This is across the Yorkshire and Humber region taking in 15 Hospital Trusts.
Activity 2013 – 2014
During the report period Embrace took 3405 referrals which resulted in 2292
transfers and 442 in-utero transfers.
The following graphs show this activity in greater detail.
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Consolidated
activity
Apr13
May13
Jun13
Jul13
Aug13
Sep13
Oct13
Nov13
Dec13
Jan14
Feb14
Mar14
Total
Referrals
307
251
295
283
258
294
278
281
324
301
297
239
3408
Paediatric
transfers
42
32
37
43
33
47
47
66
86
70
58
46
Neonatal transfers
147
154
151
154
149
157
125
121
120
133
157
118
1686
Total transfers
189
186
188
197
182
204
172
187
206
203
215
163
2293
27
55
33
26
49
50
45
75
46
42
43
543
30
45
45
37
34
46
42
26
41
27
24
8
7
8
13
7
10
7
17
11
13
8
No transfer/advice 52
In utero transfers
45
facilitated
Other transfers
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607
442
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Embrace aeromedical service
2013/14 was a period of growth and development in the aero medical service that
Embrace provides. The philosophy is to ensure that our patients have access to the
best form of transport depending on clinical condition, distance, weather and
logistics. This will often be a road ambulance but may be a fixed wing aircraft or
helicopter
Embrace transferred patients by 10 fixed wing aircraft including 4 international
missions, Yorkshire Air Ambulance assisted us by flying Embrace team and
equipment by helicopter to 12 critically ill patients, 30 with The Childrens Air
Ambulance and 1 with the RAF.
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Stakeholder Events: 2013/14
18th June 2013
Clinical Forum North, Hatfeild Hall, Wakefield
24th June 2014
Yorkshire Neonatal Network Board Meeting, Castleford and
Normanton
2nd September 2013 Clinical Forum South, Embrace, Barnsley
18th September 2013 Yorkshire Neonatal Network Board Meeting, Castleford and
Normanton Hospital
20th September 2013 Mortality Review Meeting – South, Embrace, Barnsley
4th October 2013
Official Launch of the Yorkshire & Humber Neonatal and
Paediatric Critical Care Operational Delivery Networks, Encore
Hotel, Barnsley
15th October 2013
Clinical Forum North, Hatfeild Hall, Wakefield
20th November 2013 Clinical Forum South, Encore Hotel, Barnsley
3rd December 2013
Yorkshire Neonatal Network Board (Final) Meeting, Hatfeild
Hall
13th December 2013 Mortality Review Meeting – South, Encore Hotel, Barnsley
28th January 2014
Inaugural meeting of the Y&H Neonatal ODN Executive Group,
Encore Hotel, Barnsley
13th March 2014
Mortality Review Meeting – South, Encore Hotel, Barnsley
28th March 2014
Clinical Forum South, Encore Hotel, Barnsley
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Finances 2013/14 – David Gosling, SCH Accountant
Neonatal Operational Delivery Network
At 31st March 2014, the Neonatal Operational Delivery Network had a surplus/under
spend of £73k against the annual allocated budget of £349k:
Income:
Income from NHS England
£
349,279
Staff cost expenditure:
Medical - Consultant
Nursing
Information analyst
Admin/Support
40,559
70,491
49,406
28,694
Non-pay expenditure
189,150
160,129
13,615
146,514
One-off set up costs - Pay
One-off set up costs - Non-pay
27,714
17,791
45,505
101,009
Overheads
27,942
Surplus/(deficit)
73,067
The under spend on the Neonatal Operational Delivery Network is largely a result of
slippage on the recruitment of staff on set up of the service, alongside the two
continuing vacant consultant sessions (£40k).
Set up costs have been identified separately. These include non-recurrent staff costs
incurred in setting up the network, and non-pay costs incurred such as temporary
premises costs, website design and logo design.
Overheads have been applied to the service, at 8% of the annual budget. This is
based on an analysis of the relevant overhead functions utilised by the network Risk Management, Finance, HR and Trust Governance Costs.
The under spend of the Neonatal Operational Delivery Network was £73,067. This
balance will be carried forward into 2014/15, and will be in addition to the new
funding allocation for 2014/15. As such, all unspent funding will remain ring fenced
within the Neonatal and Paediatric Critical Care Operational Delivery Networks.
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A look forward to 2014/15:
Whilst this has been a year of tremendous change, both for networks nationally and
for the NHS as a whole, it has been one of regrouping and growth for the Yorkshire &
Humber Neonatal ODN, giving us an opportunity to build upon successes of the past
and to move forward in new partnerships.
One of the greatest challenges the ODN continues to face is to smooth pathways of
care with geographical divides within the network disappearing. Many networks
nationally have maintained the same geographical footprints that already existed for
managed clinical networks and have therefore found the transition easier.
The biggest potential advantage of a larger ODN is the greater combined influence
and buying power created which can be used to add a ‘recognised authoritative
voice’ to relevant processes and projects both locally and nationally. The
disadvantage and an additional challenge of such a large geographical entity is the
diversity of cultures and differences between provider organisations.
The ODN will need to assess and agree capacity and configurations that meet the
demands placed on services regionally and locally and support providers through
change processes if required. It will need to maintain a focus on quality and
outcomes which in turn informs the development of robust meaningful service
specifications.
ODNs must ensure their long term financial stability, whilst continuing to provide a
valuable support service that adds value at provider level. Current budgets are
already reduced compared to what previous networks were used to and in a period
of continued austerity it will be vital to ensure that leaner and smarter models and
ways of working are embraced.
Many provider units have already expressed the wish that the ODN co-ordinates a
Peer Review Process, cited as being a recognisable and valuable achievement of the
work of previous clinical networks. The ODN must engage with and be responsive to
meet the needs and ideas of all stakeholders to foster an environment of trust and
mutual respect but in order to do so we must ensure that network staff are of the
right skill mix have the right skill set in order to succeed.
A willingness to delve into challenging discussions whilst creating an ethos of
collective sharing and solving of problems is the strength of an ODN and as such it
will assess its resources and work in partnership to explore how a Peer Review type
process may be achieved alongside the continued provision of education, training
and partnership projects already underway.
Expressions of interest are currently being sought for the post(s) of
Education/Guideline Clinical Leads to address in earnest a gap that the Neonatal
teams have felt and is a priority going forward,
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Future Events:
6th May 2014
ODN Executive Group Meeting, Encore Hotel
14th May 2014
Improving Care Conference, Thackray Museum, Leeds
20th May 2014
Clinical Forum North, Encore Hotel, Barnsley
4th June 2014
Neonatal Education Event, Encore Hotel, Barnsley
13th June 2014
Mortality Review South, Woodside, Rotherham
16th July 2014
Clinical Forum South, Encore Hotel Barnsley
9th September 2014 ODN Executive Group Meeting, Holiday Inn, Barnsley
14th October 2014
Clinical Forum North, Hatfeild Hall, Wakefield
tbc November 2014 ODN AGM Meeting
9th December 2014
ODN Executive Group Meeting, Holiday Inn, Barnsley
10th March 2015
ODN Executive Group Meeting, Hatfeild Hall, Wakefield
Please visit the website www.yorkshirehumberodn.nhs.uk/neonatal and help us in
its development by providing feedback.
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