Reconfiguring neonatal services

The reconfiguration of clinical services report provides new insights into the drivers of reconfiguration and the underpinning evidence. It builds on a major analysis, commissioned by the National Institute for Health Research (NIHR), of reviews of service reconfigurations conducted by the National Clinical Advisory Team (NCAT).

This page summarises the report's findings on the reconfiguration of neonatal services.

Proposals reviewed by NCAT

NCAT reviewed one proposal to reconfigure a neonatal network, downgrading local neonatal units.

Key drivers of neonatal service reconfiguration

National policy and quality were the primary drivers of this type of reconfiguration.

Context and relevant policy

  • In total, around 60,000–70,000 babies (approximately 10 per cent of all births) per year will receive some type of neonatal care (ie, special care, high dependency care or intensive care services). More babies need neonatal care because of:
    • increases in fertility rates for all age groups, but particularly for women aged over 40 and under 20
    • availability of assisted conception
    • a 30 per cent increase in women admitted at 25 weeks of gestation or less whose babies need specialist care.
  • In 2003, neonatal services were organised into managed clinical networks of three tiers. The most severely ill babies requiring long-term intensive care are transferred to and cared for at a specialist neonatal intensive care unit (NICU). Second-tier neonatal units are designated local neonatal units (LNUs), with the bottom tier known as special care units (SCUs). 
  • The current NHS England commissioning contract sets out a service specification for these services – see guidance below.

The current evidence base

Women likely to give birth to very preterm babies should be encouraged to give birth at a specialist hospital with the highest levels of neonatal care. 

There is strong evidence that neonatal support can be safely provided by non-medical paediatric staff. However, the use of alternative models – where advanced neonatal nurse practitioners (ANNPs) provide this support to obstetric units instead of paediatricians – remains limited to a very small number of hospitals in England due to a lack of systematic workforce development. This model has enabled obstetric units to continue on sites where paediatric inpatient services have been closed.

Relevant guidance

Extracts from NHS England Standard Contract for Neonatal Care:

  • Services caring for babies born before 27 weeks and those in other higher risk category groups should be concentrated in relatively few centres in order to:
    • ensure that expert and experienced staff treat sufficient numbers of cases to maintain a safe, high-quality service and move towards the national standards
    • maximise the use of scarce, expensive resources (staff, facilities and equipment)
    • organise retrieval services across large enough areas to be effective and economic
    • ensure services and support are in place for families whose babies are cared for long distances from home.
  • Each unit must work towards an agreed plan with commissioners to have nurse staffing levels based on the following nurse to baby ratios:
    • 1:1 Intensive Care
    • 1:2 High Dependency
    • 1:4 Special Care.

Further reading