BLISS, which is funded almost entirely through donations and grants, is the leading national charity focusing on neonatal care and has been established for more than 25 years. I appreciate the support that the charity has provided to me in making me aware of the amazing work that goes on in neonatal care, as well as some of the challenges. I understand that my hon. Friend the Minister will be presenting an award at the inaugural BLISS ceremony on 24 October, which confirms the Government’s respect for BLISS.
One in eight babies born in the UK requires neonatal care, which represents 80,000 children, 17,000 of whom will require intensive care. About 11,000 babies in London each year need the extra care provided in neonatal units. The majority of the babies in neonatal units are there because they were born prematurely. However, there are a diverse range of other causes. For example, a child born with an infection might require antibiotics, some children need help to breathe via a ventilator, and other children with a serious case of jaundice may need to kept under observation in a neonatal unit.
The strides taken forward in the past two decades are there for us all to see. In the mid-1980s only one in five babies weighing less than 1 kg at birth could survive. That proportion has increased rapidly and stands at four in five babies. The fact that four in five babies now survive, compared with one in five in the 1980s, is testament not only to the technological advances achieved in this period, but to the tireless efforts of doctors and nurses who, as I am sure hon. Members on both sides of the House will agree, can never receive too much praise.
The number of babies born prematurely has also increased significantly in recent years. A number of social factors have contributed to the escalating numbers of premature births. The increased prevalence of fertility treatment has resulted in a corresponding rise in multiple births, which are more likely to result in premature labour. When women have children later in life there is an increased prospect of obstetric complications, particularly if mothers are over 40 years of age at the time of giving birth. Babies born as a result of teenage pregnancy are also at high risk of being born premature and/or at a low birth-weight. Unfortunately, the UK still has the highest rate of teenage pregnancies in western Europe. Mothers from ethnic minority backgrounds are more likely to give birth to a baby with a low birth-weight.
The need for effective neonatal care is becoming ever more apparent and growing. However, the capacity of neonatal services is not sufficient to cope with the current demand, let alone future needs. I welcomed the Government’s additional targeted funding of £72 million between 2003 and 2006, which among other benefits helped to establish five neonatal networks across London, a neonatal transfer service to transport babies to an alternative hospital when necessary, and an increase in capacity.
The Greater London authority report, “Counting the Cots”, which was published in May this year, also highlighted the point that the number of neonatal cots in London has increased by 12 per cent. in the past four years. London has 77 more neonatal cots in 2006 than it had in 2002. The report concluded that
“neonatal care services are generally working well”,
for which the Government deserve huge praise.
Notwithstanding that encouraging progress, I hope that my hon. Friend the Minister recognises the urgent need to go even further. In July this year, I visited the neonatal unit at St. George’s hospital in my constituency for the second time in recent months. The visit provided me with the opportunity to meet the parents of premature babies and the staff, who make an invaluable contribution. Visiting a neonatal unit is a reminder of how our NHS does a fantastic job giving hope and joy to the parents of those tiny miracles. Premature babies are some of the most vulnerable patients, and they are looked after by skilled, specialist caring staff, who also provide tremendous support to understandably distressed parents.
St. George’s hospital plays an integral role in the provision of neonatal care in south-west London. The Department of Health review, which was published in April 2003, recommended that neonatal care should be reconstructed into clinical networks with units divided into three levels depending on the level of care that the hospital can provide. First, there are intensive care units, where one nurse looks after one baby. Those units are necessary for babies with particularly complicated medical needs. Secondly, there are high-dependency units, where a nurse should be responsible for no more than two babies. Those units are necessary for babies weighing less than 1 kg who do not need intensive care, but who still require treatment, such as intravenous feeding. Finally, there are special care units, where a nurse should not have responsibility for more than four babies. Those units are necessary for babies who require regular monitoring.
The system ensures that each region has at least one hospital that can offer so-called level 3 intensive care support for the mothers of premature or ill babies. I am pleased that the hospital in my constituency where my two daughters were born not so long ago—I was also born there slightly longer ago—offers the most advanced neonatal care in south-west London. The Government recommend that 95 per cent. of premature babies should be cared for within their local network, but too many mothers still have to travel hundreds of miles to obtain the appropriate level of neonatal care.
More than 90 per cent. of units were compelled to transfer patients last year because of lack of capacity. The neonatal units at St. George’s hospital accepted transfer cases from areas such as Brighton, Farnborough, Southampton and Wrexham Park, which is near Slough. While I accept that a system of networks is the most effective method of supporting parents, we cannot escape the fact that there needs to be an increase in the number of specialist nurses, cots and dedicated transport services to alleviate those concerns. In that regard, many hon. Members hope that the Minister’s excellent relationship with the Treasury, as result of his previous ministerial experience, will enable him successfully to lobby the Treasury in the 2007 spending review for an even greater prioritisation of funding to health services for sick and premature babies.
The British Association of Perinatal Medicine believes that the average occupancy of neonatal units should be 70 per cent. to ensure that capacity is available in unforeseen circumstances. Recent research undertaken by BLISS highlighted that 78 per cent. of units nationwide have been forced to close to new admissions as a result of insufficient capacity. Furthermore, St. George’s hospital has an average occupancy rate of 91 per cent. of its cots. In 2005, it had to turn away 518 babies because of the lack of staffed cots. In fact, the unit had to be closed to new admissions as recently as 3 October, which is one of 71 days in the past six months in which that situation arose. More alarmingly, I have been advised thatSt. George’s is currently 27 nurses short of the standard set by BAPM, if it is to achieve the level 3 target of one nurse caring for no more than one child.
I realise that resources in the NHS are finite, but it is clear that the lack of national nursing standards and of a national focus mean that local trusts and PCTs are not giving neonatal units the funding that they require. When difficult choices about the allocation of resources need to be made, neonatal units suffer. Research from BLISS found that only 3 per cent. of units in the UK can provide one-to-one nursing for premature babies in intensive care. It estimates the nursing shortfall to be about 2,700, including 540 in London alone. Moreover, a third of the most highly qualified neonatal nurses currently employed in hospitals will retire within the next three years.
Health professionals and specialists were keen to stress to me that the recruitment and retention of doctors in neonatal units has markedly improved under this Government. However, there is a problem with regard to suitably qualified and experienced neonatal nurses. One of the main reasons for that is the uncertainty generated by the lack of national guidance and primary care trusts not funding staff at the appropriate levels. I hope that my hon. Friend is in a position to reassure the House that the Government are listening to those concerns and will urgently investigate them.
Many of the health professionals to whom I spoke welcome the Government’s proposed reforms in neonatal health care. Nevertheless, they have stressed the need for improved delivery mechanisms within neonatal care. There is a particular problem with a commissioning system that appears disjointed. Neonatal intensive care is deemed to be a “specialist service” and is therefore commissioned by a number of PCTs sharing the investment and associated risk of commissioning funding to this important area. In contrast, level 1 neonatal care is commissioned by the relevant PCTs individually.
