Strengthening services in Bristol for babies born early or unwell

Thursday, 24 October 2019

The NHS in Bristol is proposing to create an integrated neonatal care service for the city, to further improve the care and treatment for some of the sickest babies who are born early or are unwell after they have been born.

Senior doctors and nurses are developing proposals to join together the running of Bristol’s two neonatal intensive care units at St Michael’s and Southmead hospitals which are four miles apart.

The proposals would mean that:

  • St Michael’s Hospital would continue to provide all levels of care, including intensive care, due to its co-location with paediatric services at the Bristol Royal Hospital for Children;
  • Southmead Hospital would provide high dependency and special care services to babies who have less serious problems but still need a great deal of observation and support*.

Currently all three levels of neonatal care are provided in units at Southmead and St Michael’s. Both units function independently and provide care to babies within the Bristol, North Somerset and South Gloucestershire (BNSSG) region as well as to babies from the wider South West Operational Delivery network (SWODN) when needed.

Around 35-40% of babies born before 28 weeks requiring intensive care at Southmead are currently transferred in a specialist neonatal ambulance to St Michael’s at some point after they have been born to receive care from paediatric specialists that are unavailable at Southmead.

The NHS believes this change will lead to:

  • Saving more babies’ lives, by bringing together Bristol’s experts into an integrated service of excellence across two sites.
  • Better care of babies and families, as fewer vulnerable babies will be transferred from Southmead to St Michael’s to see children’s hospital specialists.
  • Greater service resilience and sustainability, with the right staff with the right skills and resources in the right place for every baby.
  • Fewer Bristol mothers having to give birth outside the city, as there will be more beds overall.
  • Specialist care delivered in a Neonatal Intensive Care Unit continues to be provided in Bristol for babies who need to be transferred in from the wider geographical area.

Dr Paul Mannix, North Bristol NHS Trust clinical director for women’s and children’s services, said: “This is ultimately about saving more babies' lives by caring for our sickest and most premature babies at St Michaels where they can be more readily treated by specialists at the children’s hospital and avoid being transferred from Southmead when they are at their most vulnerable.”

Dr Anoo Jain, clinical director and consultant in neonatal medicine at University Hospitals Bristol NHS Foundation Trust, said: “We’ve developed these proposals with input from clinical experts, patient representatives, staff at both Trusts including managerial and Board-level representatives, and specialist commissioners at NHS England and believe that they will further strengthen the neonatal services in Bristol.”

Neonatal care across England is delivered through Neonatal Operational Delivery Networks commissioned by NHS England and NHS Improvement.

Rebecca Lemin, manager of the South West Neonatal Network which covers 12 neonatal units spanning 250 miles from Swindon to Truro including those in Bristol, said: “The network has been closely involved with the cross-city neonatal services project in partnership with NBT and UH Bristol for the last two years.

“We are supportive of the proposal to move towards delivering an integrated neonatal service across Bristol to provide expert care for both Bristol families and those across the South West.

“We are assured that the model is in line with national recommendations and will strengthen the long-term resilience of our neonatal pathway and ensure greater capacity at an intensive care level.

“We are confident that this proposed new model of care for Bristol will both maximise the outcome of our most sickest babies in the south west, but also provide great opportunities to develop an integrated service that is of high quality and centred around the needs of our neonatal families.”

There would be minimal impact on current maternity services with 98% of women still able to give birth at home or book for care in their maternity unit of choice.
The proposals would mean that less than 30 women a year would deliver at St. Michael’s instead of Southmead, excluding women who transfer into the area from outside of Bristol, North Somerset and South Gloucestershire.

The proposals were developed over the past two years, led by a range of clinical experts including staff from University Hospitals Bristol NHS Foundation Trust (UH Bristol, which runs St Michael’s Hospital) and North Bristol NHS Trust (NBT, which runs Southmead Hospital), and with input from patient representatives. These proposals are supported by clinical and management teams at UH Bristol, NBT and NHS England.

The next steps are to complete the detailed work needed to develop a final business plan early in 2020 and, if this is approved, to implement the new model over the next two to three years.

Find out more about the proposals here

Anyone interested in helping to continue developing the plans can contact Amanda Saunders, neonatal service project manager, by emailing Amanda.Saunders5@nhs.net
*The different levels of neonatal care are:

  • Intensive care: Generally, neonatal intensive care is for babies weighing less than 1,000g, born early (before 28 weeks) and needing significant observation and support.
  • High dependency care: This is provided for babies with less serious problems but who still need a great deal of observation and support and for those who are recovering from critical illness.
  • Special care: This is provided for babies who need short-term care or monitoring.