The Future of Neonatal Outreach Care in Manchester and the potential impact for parents and other services.

1. The Future of Neonatal Outreach Care in Manchester and the potential impact for parents and other services. Clinical Lead Christine Peters R.M. BSC Hons. S.O.M.

2. Manchester Neonatal Outreach TeamHistory • Established 1945 • Government recommendations • Infant mortality substantially higher in Manchester – 25.6 per 1000 live births in Manchester in 1944 • One midwife was employed • 2008 low birth weight - infant mortality in Manchester 8.2% compared to the England & Wales 7.5% • 2007 Deprivation Index – Manchester 4th

3. Current Service provision • 66 years on there is still not a uniform national service • Neonatal Outreach Teams exist in various guises up and down the country. Currently there is no consistent approach or standardised model which has been adopted but in the areas where teams do exist it is recognised that they are a much needed support service for the parents of preterm, high risk infants (Forsythe, Maher Kerchick et al 2007).

4. Current Service Provision • Neonatal Outreach Teams give much needed support to families at home. • The service they provide ensures that NICU’s are able to discharge babies home sooner, of lower birth weights, on home oxygen, being tube fed, and supporting babies for palliative care etc. • This service means that NICU’s have a better turnover of babies with good support at home and thereby this frees up cots sooner for more sick babies.

5. Reconfiguration of Neonatal and Maternity Services • 2007 Making it better document • Neonatal & Maternity Network Boards • Neonatal Toolkit (DOH November 2009)

6. Neonatal Toolkit • Organisation of neonatal services • Staffing of neonatal services • Care of the baby and family experience • Transfers • Professional competence, education and training • Surgical services • Clinical governance • Data requirements

7. Reconfiguration of services • The Greater Manchester Neonatal Network Board - Neonatal Outreach Clinical Reference Group • From 12 units down to 8

8. Neonatal Network Clinical Reference group • Subgroup of the network board • Gold standard service • Standardisation of services and care

9. Manchester Neonatal Outreach TeamCurrent referral criteria • Babies who weigh 2.5kg or less • Babies up to 36/40 i.e. 35/40 plus 7days • Babies who have been on the NNMU for 48 hours or more regardless of weight • Babies with congenital abnormalities e.g. Cardiac anomalies, Chromosome abnormalities Down syndrome, cleft lip and/or palate • Babies whose mothers abuse substances • Babies who are terminally ill • Oxygen Dependant infants • Any baby for whom there are concerns about its physical health – e.g. Babies who require tube feeding • Babies referred must reside within Manchester/Trafford

10. Proposed referral criteria • Written referral from the neonatal unit to outreach team • Length of stay on neonatal unit for ≥ 7 days • Birth weight < 2201g • Gestational age <35 weeks • Complex medical needs, e.g. oxygen dependent, short term palliative care, neonatal abstinence syndrome, tube feeding, cardiac anomalies etc. • Any other medical concerns Referral into neonatal outreach services should be incorporated as a key element of all neonatal discharge pathways when appropriate.

11. Other proposals for the MNORT Working with the ward midwives and parents as a resource on the wards on a daily basis. • Babies of 2.5kg or less and babies below 37/40 - Giving advice re regular feeding, temperature control and maintenance in order to prevent admission to NICU and support the women prior to discharge to the CMW’s

12. Other proposals for the MNORT • Increased geographical area – From November taking on part of Salford area. • ? What is happening in North and South Manchester areas whether they will decide to form their own outreach teams based within their own SCBU’s • Dependent upon these decisions will be whether or not to increase the size of the team

13. Impact on other services • Community midwifery services at SMH, Wythenshawe and NMGH will all be affected. • Out of 1074 babies referred to the outreach team between 01/02/10 – 31/01/11 330 families if the new referral criteria were applied would have been referred to the general community midwives. • This means in real terms that these babies would receive fewer visits than they would have received from MNORT. • Possible impact of this would be more attendances at A&E, more call outs to emergency GP services, more calls/appointments to CMW’s, GP’s and Health visitors – all of these services are already stretched to capacity.

14. The Future of MNORT • Historically MNORT staffed by Neonatal Midwives • Succession planning – for various reasons Midwives no longer choose neonates as a career pathway • Neonatal Nurses will be the people who staff The Manchester Outreach Team of the future • Supervisors of Midwives and the Neonatal Midwives currently working within the team need to work to ensure that the service of the future continues to be a first class service

15. Any Questions