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NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 1 of 73
Neonatal Activity, Demand & Capacity Report
1st April 2020 to 31st March 2021
NORTH WEST NEONATAL OPERATIONAL DELIVERY NETWORK
Working together to provide the highest standard of care for babies and families
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 2 of 73
Table of Contents 1. Introduction ............................................................................................................................................. 5
1.1 Overview Summary ............................................................................................................................ 6
1.2 Key Recommendations ....................................................................................................................... 7
1.3 Data Collection and Verification Process............................................................................................. 8
1.4 Capacity Reference Tables .................................................................................................................. 9
2. Births & Admissions ................................................................................................................................10
2.1 Births by Locality & Unit ....................................................................................................................10
2.2 Neonatal Unit First Admissions ..........................................................................................................11
2.2.1 NNU first admissions across the network by locality ...................................................................11
2.2.2 NNU first admissions against the number of live births across the ODN ......................................12
2.2.3 First admissions across the NWNODN by gestation .....................................................................13
2.3 First Admissions and Birth data .........................................................................................................13
2.3.1 First Admissions and Live Births by Locality .................................................................................13
2.3.2 First Admissions and Live Births as a Percentage by Unit.............................................................13
2.4 Total admissions across the NWNODN including out of area postnatal transfers ...............................14
2.5 Term & Late Preterm Admissions ......................................................................................................15
2.5.1 Term Admissions (≥ 37 Weeks) ...................................................................................................15
2.5.2 Late Preterm Admissions (≥ 34 and <37 Weeks)..........................................................................16
2.5.3 Term Admissions (≥37 weeks) by Length of Stay .........................................................................17
2.6 Babies delivered at less than 27 Weeks’ Gestation ............................................................................18
2.6.1 <27 Week Deliveries by Locality ..................................................................................................18
2.6.2 <27 Week Deliveries by Unit .......................................................................................................19
3. Activity and workload .............................................................................................................................21
3.1 NWNODN Activity by Level of Care ....................................................................................................21
3.2 NWNODN NICU Activity by Level of Care ...........................................................................................21
3.3 NWNODN Activity and Workload ......................................................................................................22
3.3.1 NWNODN NICU Activity ..............................................................................................................22
3.3.2 NWNODN LNU Unit Activity ........................................................................................................22
3.3.3 NWNODN SCU Unit Activity ........................................................................................................24
3.3.4 NWNODN NICU Average Length of Stay by Gestations................................................................25
3.3.5 NWNODN LNU & SCU Average Length of Stay by Gestation ........................................................26
3.4 Cot Activity........................................................................................................................................27
3.5 Overall Occupancy by Care Level .......................................................................................................28
3.5.1 Average Monthly IC (XA01Z) Occupancy by locality and units .....................................................28
3.5.2 Average Monthly IC (XA01Z) Occupancy for NICUs only by Locality .............................................29
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 3 of 73
3.5.3 Average Monthly HD (XA02Z) Occupancy by locality and units ....................................................30
3.5.4 Average Combined XA01Z & XA02Z (IC & HD) Occupancy by Locality and Units ..........................31
3.5.5 Average Combined XA03Z, XA04Z & XA05Z (SC & NC) Occupancy by Locality and Units ..............32
3.5.6 Total NNU Occupancy (All HRG codes) by Locality and Units .......................................................33
4. Network and Locality Transfers. ..............................................................................................................34
4.1 Appropriate & Inappropriate Postnatal Transfers ..............................................................................34
4.2 Network and Locality out of area activity...........................................................................................35
4.3 Out of Area Activity by CCG ...............................................................................................................36
4.4 Wales Activity within the NWNODN ..................................................................................................37
4.5 North & West Midlands Activity in NWNODN ....................................................................................39
4.6 Yorkshire & Humber Activity in NWNODN .........................................................................................41
4.7 Isle of Man Activity in NWNODN .......................................................................................................43
5. Nursing & Medical Workforce .................................................................................................................44
5.1 Nurse Staffing across the NWNODN ..................................................................................................44
5.2 Nurse Staffing by Locality ..................................................................................................................45
5.3 Nurse Staffing by Unit .......................................................................................................................45
5.4 Additional Nurse Requirements .........................................................................................................47
5.5 Medical staffing across the NWNODN ...............................................................................................48
6. Greater Manchester Activity ...................................................................................................................49
6.1 GM Activity by Level of Care ..............................................................................................................49
6.3 GM Surgical Activity ..........................................................................................................................51
6.4 GM Activity and Workload ................................................................................................................51
6.4.1 GM NICU Activity and Workload Data .........................................................................................51
6.4.2 GM LNU Unit Activity and Workload Data ...................................................................................52
6.5 GM Cot Activity .................................................................................................................................53
6.6 Greater Manchester Summary ..........................................................................................................54
7. Cheshire & Merseyside ...........................................................................................................................55
7.1 CM Activity by level of care ...............................................................................................................55
7.2 CM Activity as % of locality activity by level of care ...........................................................................56
7.3 CM Surgical Activity ...........................................................................................................................57
7.4 CM Activity and workload .................................................................................................................59
7.4.1 CM NICU activity and workload data...........................................................................................59
7.4.2 CM LNU & SCU Unit Activity and Workload Data.........................................................................59
7.5 Cot Activity........................................................................................................................................60
7.6 Cheshire & Merseyside – Summary ...................................................................................................61
8. Lancashire & South Cumbria Activity & Workload ...................................................................................62
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 4 of 73
8.1 LSC Activity by Level of Care ..............................................................................................................62
8.2 LSC Activity as a % of locality activity by level of care .........................................................................62
8.3 LSC Activity and workload .................................................................................................................63
8.3.1 LSC NICU Activity and Workload Data .........................................................................................63
8.3.2 LSC LNU & SCU Unit Activity and Workload Data ........................................................................63
8.4 LSC Cot Activity .................................................................................................................................64
8.5 Lancashire & South Cumbria – Summary ...........................................................................................65
Appendix 1: Out of Area Activity Base .........................................................................................................66
Appendix 2: Medical Staffing Review in LNUs and SCUs ..............................................................................67
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 5 of 73
1. Introduction
The purpose of this report is to provide an overview of the demand, activity and capacity of the neonatal
units across the North West Neonatal Operational Delivery Network for the period April 2020 to March 2021,
inclusive.
In order to ensure clarity and consistency for the purpose of this report, capacity in neonatal services is
defined by the physical, equipped cots available and the nurse staff available to provide this care. Demand
is defined as the anticipated need for admissions in relation to the number of live births and potential case
mix, with particular regard to the number of extremely preterm births due to the high levels of neonatal care
needed with increasing prematurity.
This report is derived from the data entered by providers in to the Badgernet data system. Where
appropriate, narrative is provided to assist understanding of the data and any changes from previous years.
The impact of the COVID 19 pandemic, whilst not impacting directly on Neonatal services to the same extent
as Adult and Paediatric services, should be considered when reviewing this report. The true impact of the
pandemic on activity and demand is unclear and therefore any fluctuations this year must be carefully
considered prior to any planning assumptions being made on 20/21 data.
The tables and charts presented in this report exclude data from postnatal wards or transitional care, unless
otherwise stated. The definitions of care are:
• XA01Z Intensive Care
• XA02Z High Dependency Care
• XA03Z Special Care, Carer not resident alongside baby
• XA04Z Special Care, Carer Resident at cot side and caring for baby
• XA05Z Normal Care
Where the data in this report suggests that the capacity in any unit is not aligned to demand or activity the Provider, NWNODN and NHS England Specialised Commissioning will follow the NWNODN Cot Base Guideline to review capacity and make any changes based on system wide considerations.
The Cot Base Guideline can be viewed at https://www.neonatalnetwork.co.uk/nwnodn/wp-
content/uploads/2020/06/PD-ODN-06-Cot-Base-Guideline.pdf
Data from within this report will be used to facilitate individual Trust conversations around cot capacity and
wider strategic discussions as part of the National Neonatal Critical Care Review.
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 6 of 73
1.1 Overview Summary
Key Findings:
Activity across the region down by 3%
Intensive care days down by 6.8% compared to only a 0.4% decrease in 19/20
High Dependency care days down by only 0.3% compared to a 4 % decrease in 19/20
Special care and Normal care days down by a further 3.1% compared to a 7.6% decrease in 19/20
Birth rate down by 4.8%
Reduction of Postnatal transfers into NWNODN to 72 infants, compared to 101 in 19/20
Reduction of Antenatal transfers into NWNODN to 182 infants, compared to 247 in 19/20
Term admissions (<37 weeks) down by 0.2% bringing the average down to only 5.1% across the region
Late pre-term admissions (>34 and <37 week) have increased slightly to 44%
88% of intensive care activity delivered in NICUs compared to 92% in 19/20 and 88% in 18/19
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 7 of 73
1.2 Key Recommendations
Within each locality section the Network Clinical Leads have provided comments, observations and
recommendations for development (sections 6, 7 & 8) in each locality. These recommendations will
be discussed at locality steering groups and where appropriate be incorporated into the NWNODN
work plan.
The key recommendations for relevant for all localities within the North West ODN :
Neonatal Critical Care Review
• Use data to support ODN-led NCCR, commissioned by Specialist Commissioners
< 27week GA deliveries in non-NICU maternity units
• To revisit and agree the process of reviewing all <27week deliveries in non-NICU units (in conjunction with LMS).
• Appropriate place of birth to be monitored as part of the MatNeo Safety Improvement Programme focusing on the optimisation of the pre-term infant
Term/late pre-term admissions
• Use NWNODN Quarterly dashboard to monitor. Separation measure included on dashboard
from April 2021.
• Where >6%, work with NNU with input from the NWNODN Care Co-ordinator to understand
where QI can be made & encourage system working with Maternity
• Work with the ODN Care Co-ordinator and LMS to embed a comprehensive TC offer across
all units
Nursing and Medical Staffing
• All units to work towards being consistently BAPM Compliant for medical staffing
• NNU nurse leads to work with NWNODN Workforce & Education Lead to improve position
against national standards & develop “Quality Roles Tool” to support comprehensive
description/quantification of quality nursing workforce
• Repeat medical workforce survey annually and extend to NICUs
Data Completeness & Triangulation of data
• All units to check data completeness for admissions, discharges and LOS on a regular basis
• All units to check data completeness and accuracy for Respiratory care days, particularly
ventilation days at EPR units
• To consider reviewing the number of respiratory care days & length of stay by gestation to
understand variation between NICUs. LOS Data to be triangulated against clinical factors
from the dashboard such as incidence of chronic lung disease and infection rates alongside
duration of ventilation.
• To consider how discharge pathways may also influence variation in length of stay between
similar units.
NWNODN Neonatal Activity, Demand, and Capacity Report 2019-20 Draft v0.2
1.3 Data Collection and Verification Process
Diagram 1
Approvals and Review Process: July 2021 Greater Manchester / Cheshire & Merseyside / Lancashire & S Cumbria Neonatal
Steering Groups for agreement of locality sections August 2021 Neonatal Senior Management Team for agreement of full report September 2021 NWNODN Board for ratification October 2021 NHSE Specialised Commissioning review November 2021 Commissioner review Commissioner intentions to providers
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 9 of 73
1.4 Capacity Reference Tables
Tables 1.3.1 – 1.3.3 show an overview of NWNODN units by designation level and cot capacity for each level of care.
Unit Level colour coded:
Table 1.3.1 *SMH is also a surgical unit as well as a NICU
Cheshire & Merseyside Abbrev.
Unit
Level IC cots HD cots SC cots Total
Arrowe Park Hospital APH NICU 6 8 10 24
Countess of Chester Hospital COC LNU 1 2 10 13
Macclesfield Hospital* ECH SCU 0 1 7 8
Liverpool Neonatal Partnership LNP
• Alder Hey Hospital LNP - AHCH Surgical 0 9 0 9
• Liverpool Women’s LNP - LWH NICU 12 12 20 44
Leighton Hospital MCTH LNU 3 4 8 15
Ormskirk Hospital ODGH LNU 1 1 8 10
Whiston Hospital STHK LNU 0 2 13 15
Warrington Hospital WWH LNU 3 3 12 18
Total 26 42 88 156 Table 1.3.2
* Countess of Chester currently only accepts deliveries of 32 weeks gestation and above Macclesfield unit has been closed throughout the 2020/21 report period
Lancashire & South Cumbria Abbrev.
Unit
Level IC Cots HD Cots SC Cots Total
Blackpool Victoria BTH LNU 2 2 12 16
Burnley Hospital ELHT NICU 6 8 20 34
Royal Preston Hospital LTHTR NICU 6 8 14 28
MBHT MBHT
• Furness General Hospital MBHT - FGH SCU 0 0 4 4
• Royal Lancaster Infirmary MBHT - RLI LNU 1 2 7 10
Total 15 20 57 92
Table 1.3.3
NICU LNU SCU Surgical Trust
Greater Manchester Abbrev. Unit Level IC Cots HD Cots SC Cots Total
Manchester Foundation Trust MFT
• North Manchester MFT - NMGH LNU 2 2 15 19
• St Mary’s Hospital* MFT - SMH NICU 19 19 31 69
• Wythenshawe Hospital MFT - WYTH LNU 2 4 15 21
Royal Bolton Hospital RBH NICU 9 7 19 35
Royal Oldham Hospital ROH NICU 9 9 19 37
Stepping Hill Hospital SHH LNU 2 3 12 17
Tameside General Hospital TGH LNU 1 3 9 13
Royal Albert Edward Infirmary WWL LNU 1 3 10 14
Total 45 50 130 225
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 10 of 73
2. Births & Admissions
2.1 Births by Locality & Unit
Tables 2.1.1 to 2.1.4 show the number of births for babies born 22 weeks gestational age and above.
Therefore birth numbers may differ from those reported by the LMS which include below 22 weeks.
Locality 2016/17 2017/18 2018/19 2019/20 2020/21
Greater Manchester 37,551 36,139 35,630 35,150 34,492
Cheshire & Merseyside 28,687 27,904 26,804 26,465 24,012
Lancashire & South Cumbria 17,067 16,210 16,105 15,821 15,212
Total 83,305 80,253 78,539 77,436 73,716
Table 2.1.1
Greater Manchester 2016/17 2017/18 2018/19 2019/20 2020/21
MFT – NMGH 4,176 3,783 3,699 3,591 3,365
MFT – SMH 9,405 9,096 9,145 8,769 8,204
MFT – WYTH 4,322 4,169 4,034 4,146 4,468
RBH 5,939 5,749 5,722 5,862 5,632
ROH 5,079 4,877 5,010 5,071 4,820
SHH 3,366 3,211 3,138 3,051 3,438
TGH 2,517 2,435 2,348 2,220 2,186
WWL 2,747 2,819 2,534 2,440 2,379
Total 37,551 36,139 35,630 35,150 34,492
Table 2.1.2
Cheshire & Merseyside 2016/17 2017/18 2018/19 2019/20 2020/21
APH 3,193 3,129 2,997 3,018 2,886
COC 3,030 2,764 2,388 2,384 2,358
ECH 1,660 1,597 1,487 1,525 0
LNP - LWH 8,812 8,313 8,196 7,733 7,297
MCTH 2,820 2,920 2,801 2,838 3,162
ODGH 2,330 2,438 2,246 2,330 2,089
STHK 4,059 4,072 4,029 3,970 3,726
WWH 2,783 2,671 2,660 2,667 2,494
Total 28,687 27,904 26,804 26,465 24,012 Table 2.1.3
Lancashire & South Cumbria 2016/17 2017/18 2018/19 2019/20 2020/21
BTH 2,978 2,903 2,835 2,688 2,604
ELHT 6,426 6,176 6,112 6,156 5,737
LTHTR 4,650 4,283 4,165 4,169 4,188
MBHT - FGH 1,087 986 1,137 1,090 1,013
MBHT - RLI 1,926 1,862 1,856 1,718 1,670
Total 17,067 16,210 16,105 15,821 15,212 Table 2.1.4
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The latest Office for National Statistics provisional data of births in England and Wales in 2020 shows
the birth rate is continuing to decline with an initial decrease in of 3.6% compared to the same period
in 2019. The total fertility rate stood at 1.60 children per woman, which was 0.10 lower than in 2018.
The falling birth rate is mirrored in the most recent North West birth data with a 9.5k decrease in the
last 4 years.
2.2 Neonatal Unit First Admissions
Alder Hey is excluded from all first admission and birth data comparisons as they are a surgical unit
without maternity provision therefore all admissions into Alder Hey are following referral from a
Neonatal Unit either within the NWNODN or from out of area, where the admission will have already
been recorded.
2.2.1 NNU first admissions across the network by locality
Chart 2.2.1
201819 201920 202021
Month Cheshire & Merseyside
Greater Manchester
Lancashire and South Cumbria
Cheshire & Merseyside
Greater Manchester
Lancashire and South Cumbria
Cheshire & Merseyside
Greater Manchester
Lancashire and South Cumbria
Apr 215 285 139 192 264 126 187 267 104
May 190 314 143 197 314 130 188 308 121
Jun 224 273 142 211 290 127 164 269 125
Jul 230 257 117 194 279 115 195 302 110
Aug 239 303 136 212 265 109 200 302 120 Sep 214 284 134 210 275 104 189 275 118
Oct 217 313 119 227 325 125 180 327 135
Nov 218 332 118 204 259 101 181 269 102
Dec 226 283 124 197 281 121 195 315 127
Jan 203 309 137 190 268 123 169 311 107
Feb 180 248 118 176 251 109 174 271 94
Mar 206 289 126 181 288 104 161 296 119 Total 2,562 3,490 1,553 2,391 3,359 1,394 2,183 3,512 1,382
Table 2.2.1
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 12 of 73
2.2.2 NNU first admissions against the number of live births across the ODN
Chart 2.2.2
The admission rate to an NNU in comparison to overall birth rate across the NW has generally followed
the same pattern, apart from in December 2020 when the number of live births decreased
considerably but NNU admissions spiked. Interestingly there were similar peaks in NNU admission
rates in both October and December which also occurred the same time in the previous year. However
the above chart shows how despite continuing peaks the birth rates and admission rates have
decreased in comparison to previous years. It is difficult to conclude at this time if COVID19 had any
effect on the 2020/21 birth and neonatal admission data.
201819 201920 202021
Month Live Births Admissions Live Births Admissions Live Births Admissions
Apr 6,277 639 6,285 582 5,839 558
May 6,722 647 6,571 641 6,311 617
Jun 6,550 639 6,537 628 6,158 558
Jul 6,808 604 6,893 588 6,326 607
Aug 6,736 678 6,700 586 6,212 622
Sep 6,806 632 6,626 589 6,408 582
Oct 6,797 649 6,819 677 6,634 642
Nov 6,576 668 6,287 564 6,127 552
Dec 6,536 633 6,301 599 5,874 637
Jan 6,652 649 6,373 581 5,879 587
Feb 5,735 546 5,849 536 5,717 539
Mar 6,344 621 6,195 573 6,231 576
Total 78,539 7,605 77,436 7,144 73,716 7,077
Table 2.2.2
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2.2.3 First admissions across the NWNODN by gestation
Chart 2.2.3
2.3 First Admissions and Birth data
Tables 2.3.1 – 2.3.3 show the number of live births and NNU first admissions only. Postnatal transfers
in, including Alder Hey admissions are excluded.
2.3.1 First Admissions and Live Births by Locality
Locality 2018/19 2019/20 2020/21
L.Births
NNU
L.births
NNU
L.births
NNU
Greater Manchester 35,630 3,484 35,150 3,381 34,492 3,512
Cheshire & Merseyside 26,804 2,557 26,465 2,421 24,012 2,183
Lancashire & South Cumbria 16,105 1,439 15,821 1,443 15,212 1,382
Total 78,539 7,478 77,436 7,245 73,716 7,077 Table 2.3.1
2.3.2 First Admissions and Live Births as a Percentage by Unit
Greater Manchester Live Births NNU Admissions % 2018/19 % 2019/20 % 2020/21
MFT - NMGH 3,365 344 11% 9% 10%
MFT - SMH 8,204 978 10% 10% 12%
MFT - WYTH 4,468 352 8% 9% 8%
RBH 5,632 632 9% 10% 11%
ROH 4,820 517 12% 12% 11%
SHH 3,438 301 9% 7% 9%
TGH 2,186 177 8% 9% 8%
WWL 2,379 211 10% 9% 9%
Total 34,492 3,512 10% 10% 10%
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 14 of 73
Table 2.3.2
Table 2.3.3
Table 2.3.4
2.4 Total admissions across the NWNODN including out of area postnatal transfers
Table 2.4.1
*Includes out of area babies transferred in postnatally, as detailed in section 4, or
repatriations back to the region.
Cheshire & Merseyside Live Births NNU Admissions % 2018/19 % 2019/20 % 2020/21
APH 2,886 238 10% 8% 8%
COC 2,358 168 11% 9% 7%
ECH 0 0 8% 7% -
LNP - LWH 7,297 766 9% 10% 10%
MCTH 3,162 208 8% 7% 7%
ODGH 2,089 203 10% 11% 10%
STHK 3,726 340 9% 9% 9%
WWH 2,494 260 13% 10% 10%
Total 24,012 2,183 10% 9% 9%
Lancashire & South Cumbria
Live Births NNU Admissions % 2018/19 % 2019/20 % 2020/21
BTH 2,604 324 12% 10% 12%
ELHT 5,737 506 8% 9% 9%
LTHTR 4,188 321 8% 8% 8%
MBHT - FGH 1,013 77 5% 7% 8%
MBHT - RLI 1,670 154 9% 10% 9%
Total 15,212 1,382 10% 9% 9%
Locality NNU First
Admissions Post Natal Transfers
into NNUs* Total Admissions
Greater Manchester 3,512 9 3,521
Cheshire & Merseyside 2,183 86 2,269
Lancashire & South Cumbria 1,382 1 1,383
Total 7,077 96 7,173
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 15 of 73
2.5 Term & Late Preterm Admissions
2.5.1 Term Admissions (≥ 37 Weeks)
Table 2.5.1 shows the number of NNU first admissions of 37 weeks and over by unit and locality with
the totals shown as a percentage of live births. Trend data for previous two years is also included.
Locality/Unit
2018/19 ≥ 37 weeks admissions
2018/19 % of Live
births
2018/19 % of ≥
37 births
2019/20 ≥ 37 weeks admissions
2019/20 % of Live
births
2019/20 % of ≥ 37
births
2020/21 ≥ 37 weeks admissions
2020/21 % of Live
births
2021/21 % of ≥
37 births
Greater Manchester
1,808 5.1% 5.6% 1,721 4.9% 5.4% 1,912 5.5% 6.0%
MFT – NMGH 263 7.1% 7.7% 165 4.6% 5.0% 197 5.9% 6.3%
MFT – SMH 464 5.1% 5.6% 481 5.5% 6.1% 519 6.3% 7.0%
MFT – WYTH 176 4.4% 4.7% 192 4.6% 5.0% 211 4.7% 5.1%
RBH 237 4.1% 4.9% 265 4.5% 5.0% 370 6.6% 7.1%
ROH 297 5.9% 6.6% 315 6.2% 7.0% 274 5.7% 6.2%
SHH 145 4.6% 5.0% 94 3.1% 3.4% 160 4.7% 5.0%
TGH 96 4.1% 4.5% 102 4.6% 5.0% 89 4.1% 4.4%
WWL 130 5.1% 5.6% 107 4.4% 4.8% 92 3.9% 4.2%
Cheshire & Merseyside
1,375 5.1% 5.6% 1,306 4.9% 5.4% 1,136 4.7% 5.1%
APH 130 4.3% 4.7% 117 3.9% 4.4% 99 3.4% 3.7%
COC 131 5.5% 6.0% 103 4.3% 4.5% 86 3.6% 3.9%
ECH 81 5.4% 5.8% 52 3.4% 3.8% - - -
LNP – LWH 380 4.6% 5.2% 403 5.2% 5.7% 389 5.3% 5.9%
MCTH 112 4.0% 4.3% 95 3.3% 3.6% 91 2.9% 3.1%
ODGH 146 6.5% 6.9% 160 6.9% 7.5% 112 5.4% 5.8%
STHK 205 5.1% 5.5% 217 5.5% 5.9% 198 5.3% 5.7%
WWH 190 7.1% 8.3% 159 6.0% 6.4% 161 6.5% 6.8%
Lancashire and S.Cumbria
746 4.6% 5.2% 720 4.6% 4.9% 703 4.6% 5.0%
BTH 152 5.4% 6.2% 127 4.7% 5.2% 149 5.7% 6.3%
ELHT 328 5.4% 6.0% 322 5.2% 5.6% 270 4.7% 5.1%
LTHTR 162 3.9% 4.2% 167 4.0% 4.4% 163 3.9% 4.2%
MBHT – FGH 26 2.3% 2.7% 33 3.0% 3.2% 42 4.1% 4.4%
MBHT – RLI 78 4.2% 5.0% 71 4.1% 4.6% 79 4.7% 5.1%
Grand Total 3,929 5.0% 5.5% 3,747 4.8% 5.3% 3,751 5.1% 5.5% Table 2.5.1
*Term admissions include any baby admitted for the first episode of care onto a NNU, regardless of
whether Day 1 or later. In addition surgical admissions are included, as per the national ATAIN criteria.
Term admission data is presented on the NWNODN dashboards every quarter. The NWNODN and
locality Local Maternity Systems (LMS) have worked collaboratively over the last 4 years to reduce
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 16 of 73
term admissions. Although this work has seen some improvement and the NWNODN remains under
the 6% national target, as in 2019/20 work continues in line with CNST to improve the Transitional
Care offer across the network to further ensure mothers and babies are not separated unnecessarily.
The NNAP Report (2020) shows 86.9% of babies 37 weeks or above who are admitted to NNUs but
don’t require surgery or a transfer, had at least one day of special or normal care during their stay.
Therefore whilst continuing to decrease the percentage of term admissions is very important,
facilitating earlier discharge back to the post-natal ward, transitional care or home is essential in order
to reduce the period of separation.
2.5.2 Late Preterm Admissions (≥ 34 and <37 Weeks)
Table 2.5.2 shows the number & percentage of first admissions between ≥34 weeks to < 37 weeks by
unit and locality. Trend data for previous two years is also included.
Locality/Unit
2018/19 34-36 weeks
admissions
2018/19 % of
34-36 weeks births
2019/20 34-36 weeks
admissions
2019/20 % of
34-36 weeks births
2020/21 34-36 weeks
admissions
2020/21 % of
34-36 weeks births
Greater Manchester 896 40% 915 42% 929 44%
MFT - NMGH 92 44% 108 53% 102 50%
MFT - SMH 217 38% 195 36% 260 47%
MFT - WYTH 101 48% 92 38% 85 32%
RBH 115 29% 160 42% 147 46%
ROH 151 41% 143 45% 117 39%
SHH 91 51% 81 47% 98 44%
TGH 61 37% 68 45% 51 40%
WWL 68 41% 68 44% 69 50%
Cheshire & Merseyside 622 41% 601 37% 469 38%
APH 57 45% 64 28% 54 40%
COC 83 63% 74 54% 50 40%
ECH 29 39% 38 43% - -
LNP - LWH 174 31% 150 31% 137 33%
MCTH 51 37% 53 30% 55 31%
ODGH 50 47% 61 46% 46 43%
STHK 78 37% 83 38% 71 39%
WWH 100 63% 78 51% 56 56%
Lancashire and South Cumbria 405 41% 391 42% 336 42%
BTH 118 58% 98 51% 96 56%
ELHT 144 38% 119 38% 113 39%
LTHTR 82 37% 79 34% 64 31%
MBHT - FGH 21 37% 25 47% 24 57%
MBHT - RLI 40 31% 70 55% 39 43%
Grand Total 1,923 40% 1907 40% 1,734 42% Table 2.5.2
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2.5.3 Term Admissions (≥37 weeks) by Length of Stay
Table 2.5.3 shows the Length of Stay for babies with a first admission within the NWNODN.
LOS Hourly Group only includes care on the NNU.
First admissions 18/19
First admissions 19/20
First admissions 20/21
Locality / Unit 0-6h 7-
12h 13-24h
Over 24h 0-6h
7-12h
13-24h
Over 24h 0-6h
7-12h
13-24h
Over 24h
Greater Manchester 9% 6% 10% 76% 8% 4% 8% 80% 4% 4% 8% 85%
MFT - NMGH 5% 6% 8% 81% 4% 2% 7% 87% 4% 6% 8% 83%
MFT - SMH 6% 4% 8% 81% 5% 4% 5% 86% 1% 3% 9% 87%
MFT - WYTH 5% 5% 5% 85% 4% 1% 7% 88% 3% 1% 4% 91%
RBH 4% 5% 7% 84% 3% 3% 6% 87% 0% 2% 7% 91%
ROH 22% 9% 10% 59% 21% 8% 8% 63% 11% 4% 6% 78%
SHH 12% 6% 14% 68% 13% 4% 10% 73% 3% 8% 8% 81%
TGH 5% 2% 20% 73% 8% 3% 13% 76% 10% 6% 12% 72%
WWL 8% 5% 15% 72% 6% 10% 14% 70% 8% 2% 14% 76%
Cheshire & Merseyside 10% 6% 13% 71% 7% 7% 15% 71% 8% 7% 12% 73%
APH 10% 8% 16% 66% 6% 9% 17% 67% 11% 11% 9% 69%
COC 5% 11% 10% 74% 8% 8% 14% 69% 12% 3% 8% 77%
ECH 2% 5% 16% 77% 2% 4% 2% 92% - - - -
LNP - LWH 11% 5% 12% 72% 8% 4% 15% 73% 8% 4% 10% 78%
MCTH 6% 4% 10% 79% 2% 6% 7% 84% 5% 7% 13% 75%
ODGH 18% 10% 9% 63% 11% 14% 13% 62% 12% 9% 21% 59%
STHK 8% 4% 18% 69% 3% 7% 23% 67% 4% 10% 20% 67%
WWH 14% 5% 14% 68% 8% 9% 11% 72% 4% 8% 8% 80%
Lancashire and S. Cumbria 4% 5% 10% 82% 4% 4% 10% 82% 4% 6% 10% 81%
BTH 4% 8% 12% 76% 3% 4% 10% 83% 4% 3% 12% 81%
ELHT 4% 4% 9% 82% 3% 2% 10% 85% 2% 5% 8% 85%
LTHTR 2% 2% 9% 86% 2% 4% 8% 86% 4% 3% 8% 85%
MBHT - FGH 15% 4% 8% 73% 9% 6% 6% 78% 14% 12% 12% 62%
MBHT - RLI 0% 6% 8% 86% 12% 9% 15% 64% 5% 16% 11% 67%
Total 8% 6% 11% 75% 7% 5% 11% 77% 5% 5% 10% 81% Table 2.5.3
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2.6 Babies delivered at less than 27 Weeks’ Gestation
2.6.1 <27 Week Deliveries by Locality
Tables 2.6.1 shows the number of deliveries of less than 27 weeks or multiple births less than 28
weeks, by locality, unit and appropriate place of birth (i.e. NICU), as reported to NHSE. A multiple birth
counts as one delivery.
NWNODN
2018-19
2019-20
2020-21
Total <27/40 born in NICU 219 192 162
Total <27/40 born in LNU 33 25 24
Total <27/40 born in all categories 252 217 186
% <27/40 born in NICU 87% 88% 87%
Greater Manchester
Total <27/40 born in NICU 106 96 80
Total <27/40 born in LNU 6 11 11
Total <27/40 born in all categories 112 107 91
% <27/40 born in NICU 95% 90% 88%
Cheshire & Merseyside
Total <27/40 born in NICU 59 47 49
Total <27/40 born in LNU 17 10 10
Total <27/40 born in all categories 76 57 59
% <27/40 born in NICU 78% 82% 83%
Lancashire & South Cumbria
Total <27/40 born in NICU 54 49 33
Total <27/40 born in LNU 10 4 3
Total <27/40 born in all categories 65 53 36
% <27/40 born in NICU 84% 92% 92% Table 2.6.1
Note – The table above includes multiple deliveries between 27 to 27+6 weeks gestation and home
births, which are attributed to the neonatal unit where the 1st episode of care was delivered.
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2.6.2 <27 Week Deliveries by Unit
Tables 2.6.2 – 2.6.4 show the number of deliveries of less than 27 weeks, or multiple births less than
28 weeks, by locality and unit. A multiple birth counts as one delivery & home births are attributed to
the 1st episode of care.
Greater Manchester Unit
category 2018-19 2019-20 2020-21
Total <27/40 born in NICU 106 96 80
MFT - SMH NICU 53 37 33
RBH* NICU 25 31 16
ROH NICU 28 28 31
Total <27/40 born in LNU or SCBU 6 11 11
MFT - NMGH LNU 3 3 2
MFT - WYTH LNU 1 3 5
SSH LNU 0 3 2
TGH LNU 1 0 1
WWL LNU 1 2 1
Total <27/40 born in all unit categories 112 107 91
% <27/40 born in NICU 95% 90% 88%
Table 2.6.2
*Includes 1 twin delivery at 27-27+6 weeks gestation 20/21
Cheshire & Merseyside Unit
category 2018-19 2019-20 2020-21
Total <27/40 born in NICU 59 47 49
APH NICU 29 19 12
LNP – LWH* NICU 30 28 37
Total <27/40 born in LNU or SCBU 17 10 10
COC LNU 2 1 1
ECH LNU 0 0 0
MCTH LNU 6 5 1
ODGH** LNU 0 0 4
STHK LNU 6 3 4
WWH LNU 3 1 0
Total <27/40 born in all unit categories 76 57 59
% <27/40 born in NICU 78% 82% 83% Table 2.6.3
* Includes 1 triplet delivery at 27-27+6 weeks gestation 20/21.
** Includes 1 Home birth where first episode of care was carried out in an LNU 20/21.
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Lancashire & South Cumbria Unit
category 2018-19 2019-20 2020-21
Total <27/40 born in NICU 54 49 33
ELHT* NICU 34 26 18
LTHTR** NICU 20 23 15
Total <27/40 born in LNU or SCBU 10 4 3
BTH LNU 9 2 1
MBHT - FGH SCBU 0 1 2
MBHT - RLI LNU 1 1 0
Total <27/40 born in all unit categories 64 53 36
% <27/40 born in NICU 84% 92% 92% Table 2.6.4
*Includes 2 twin deliveries at 27-27+6 weeks gestation 20/21.
** Includes 1 in unknown birth location where first episode of care was carried out in a NICU 20/21.
For 2020/21 the NWNODN exception reporting process showed that that there was a potential missed
opportunity for an antenatal transfer for 4 of the deliveries outside of a centre with a NICU and no
babies remained in LNUs for more than 24 hours.
The NWNODN benchmarks well nationally in relation to birth in the right place. Up-date for 20/21
The following chart is an extract from the NNAP Audit Programme 2020 Annual Report, showing that in 2019 the NWNODN was one of the best performing ODNs for babies less than 27 weeks’ gestational age being born at a centre with a NICU. The full NNAP Annual Report can be accessed at https://www.rcpch.ac.uk/resources/national-neonatal-audit-programme-annual-report-2020-2019-data
Chart 2.6.2
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3. Activity and workload
3.1 NWNODN Activity by Level of Care
Table 3.1 shows the number of care level days by Locality & across the ODN, HRG (2016) codes. Excludes Alder Hey data & XA04Z care delivered in TC.
HRG 2016 XA01Z XA02Z XA03Z + XA04Z + XA05Z Total
Locality 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
Greater Manchester 9,988 10,570 9,279 15,102 15,098 14,980 37,390 35,465 34,450 62,480 61,133 58,709
Cheshire & Merseyside 5,838 5,425 4,819 6,614 6,090 6,269 22,686 20,052 19,842 35,138 31,567 30,930
Lancashire & South Cumbria 3,503 3,259 3,840 5,220 4,671 4,533 15,729 14,548 13,608 24,456 22,478 21,981
Total across the NWNODN 19,329 19,254 17,938 26,936 25,859 25,782 75,805 70,065 67,900 122,070 115,178 111,620
Table 3.1
3.2 NWNODN NICU Activity by Level of Care
Table 3.2 shows the percentage of care, for each level, delivered within NICUs. XA04Z care if delivered in TC is not included.
Table 3.2
HRG 2016 XA01Z % XA02Z % XA03Z + AX04Z + XA05Z %
NICUs 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
Greater Manchester 91% 93% 92% 76% 80% 77% 52% 55% 56%
Cheshire & Merseyside 84% 84% 82% 65% 60% 62% 39% 40% 43%
Lancashire & South Cumbria 88% 91% 90% 76% 81% 76% 63% 64% 59%
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3.3 NWNODN Activity and Workload
3.3.1 NWNODN NICU Activity
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review (2019) all NICUs should, as a minimum, look after at
least 100 very low birth weight (VLBW) infants per year and be delivering >2000 intensive care days (Health Resource Group definition, 2016 & BAPM Optimal
Arrangements for Neonatal Intensive Care Units in the UK, 2021).
Table 3.3.1 shows all NICU activity, regardless of episode number, and includes surgical care at St. Mary’s Hospital.
Table 3.3.1
3.3.2 NWNODN LNU Unit Activity
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review (2019) all LNUs should aim to undertake a minimum
of 500 days of combined intensive and high dependency care (Health Resource Group definition, 2016), which is considered the minimum requirement to
maintain expertise. LNUs providing ongoing HD should be working towards delivering 1000 combined ITU/HD days per year, in the longer term (i.e. 5 years
NICU
Intensive Care HRG XA01Z & XA02Z
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions (Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
MFT – SMH 5,749 6,026 5,516 9,090 9,597 8,467 251 195 198
RBH 1,748 1,906 1,283 4,391 4,790 3,575 136 124 95
ROH 1,592 1,944 1,735 3,282 3,569 4,095 141 128 114
APH 1,549 1,340 997 3,051 2,524 2,049 111 76 67
LNP – LWH 3,329 3,201 2,966 4,452 4,292 4,588 217 185 198
ELHT 1,457 1,663 2,230 3,500 3,346 3,641 113 100 73
LTHTR 1,616 1,307 1,211 2,920 2,657 2,513 91 80 77
Total 17,040 17,387 15,938 30,686 30,775 28,928 1,060 888 822
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from publication of NCCR in 2019). Units designated as LNUs should also admit >25 VLBW infants annually (BAPM Optimal arrangements for Local Neonatal
Units and Special Care Units in the UK, 2016).
Table 3.3.2
* COC currently only accepts deliveries of 32 weeks gestation and above
LNU
IC & HD HRG XA01Z & XA02Z
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions (Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
MFT – NMGH 829 674 878 708 537 691 72 55 54
MFT – WYTH 1,353 1,206 1,123 1112 927 918 63 57 54
SHH 1,095 752 718 964 681 677 55 36 25
TGH 607 428 481 427 351 361 43 31 27
WWL 639 705 961 556 607 880 33 40 45
COC* 592 431 305 417 332 207 42 30 24
MCTH 727 894 926 599 592 638 44 38 47
ODGH 465 692 522 350 534 410 29 24 27
STHK 583 584 670 395 393 451 42 36 43
WWH 769 601 787 571 465 530 55 28 37
BTH 1,132 664 888 928 544 774 48 30 40
MBHT – RLI 505 470 569 422 422 524 35 27 32
Total 9,296 8,101 8,828 7,449 6,385 7,061 561 432 455
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3.3.3 NWNODN SCU Unit Activity
SCU
IC & HD HRG XA01Z & XA02Z
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions (Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
ECH** 154 131 0 111 83 0 16 11 0
MBHT - FGH (SCU) 36 37 43 23 33 36 9 17 18
Total 190 168 43 134 116 36 25 28 18
Table 3.3.3
** ECH Neonatal Unit has been closed throughout 2020/21
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3.3.4 NWNODN NICU Average Length of Stay by Gestations
Length of stay for babies discharged in 2020/21, attributed to first episode of care location. Only includes babies discharged Home or to Foster Care. Babies
who died during their neonatal admission or who transferred to a non-neonatal ward have been excluded.
Chart 3.3.4
0102030405060708090
100110120130
APH LNP - LWH MFT - SMH RBH ROH ELHT LTHTR
Cheshire & Merseyside Greater Manchester Lancashire and South Cumbria
Ave
rage
LO
S in
Day
s
Babies with first admission - NICU total average LOS in days
24-25wks 26-27wks 28-29wks 30-31wks 32-33wks
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3.3.5 NWNODN LNU & SCU Average Length of Stay by Gestation
Length of stay for babies discharged in 2020/21, attributed to first episode of care location. Only includes babies discharged Home or to Foster Care. Babies
who died during their neonatal admission or who transferred to a non-neonatal ward have been excluded.
Chart 3.3.5
0102030405060708090
100110
COC MCTH ODGH STHK WWH MFT -NMGH
MFT -WYTH
SHH TGH WWL BTH MBHT -RLI
MBHT -FGH
Cheshire & Merseyside Greater Manchester Lancashire and South Cumbria
Ave
rage
LO
S in
Day
s
Babies with first admission - LNU/SCU total average LOS in days
27wks 28-29wks 30-31wks 32-33wks
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3.4 Cot Activity
Table 3.4 shows the demand (D) for cots based upon activity within each of the localities against actual (A) cots. Care Levels are based upon HRG 2016 codes
but are referred to as IC, HD & SC cots as these are the commissioned cots in each category. An element of surgical care is included in the figures as it is not
possible to separate out surgical activity within the data.
Calculation method which include 80% capacity: Cot Demand = (Number of care days/365)/0.8
NWNODN
Cots D: Demand , A: Actual
D
IC
18/19
D
IC
19/20
D
IC
20/21
A
IC
20/21
D
HD
18/19
D
HD
19/20
D
HD
20/21
A
HD
20/21
D
SC
18/19
D
SC
19/20
D
SC
20/21
A
SC
20/21
Total
D
18/19
Total
D
19/20
Total
D
20/21
Total
A
20/2
1
Greater Manchester 34 36 32 45 52 52 51 50 128 121 118 131 214 209 201 226
Cheshire & Merseyside 21 20 18 26 27 27 26 42 81 71 71 88 129 118 115 156
Lancashire & South
Cumbria 12 11 13 15 18 16 16 20 54 50 46 57 84 77 75 92
Total 67 67 63 86 97 95 93 112 263 242 236 276 427 404 391 474 Key: Short by 1 or more cot = Red, over by 1 or more cot = Amber Table 3.4
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3.5 Overall Occupancy by Care Level
3.5.1 Average Monthly IC (XA01Z) Occupancy by locality and units
XA01Z (IC) Occupancy APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Mean
Greater Manchester 55% 66% 45% 65% 63% 62% 56% 52% 47% 56% 59% 53% 56%
MFT - NMGH 25% 26% 10% 23% 27% 25% 13% 25% 31% 40% 11% 11% 22%
MFT - SMH 81% 94% 76% 87% 86% 90% 63% 84% 68% 73% 85% 68% 80%
MFT - WYTH 35% 42% 28% 24% 26% 35% 37% 32% 15% 13% 18% 18% 27%
RBH 46% 28% 9% 67% 58% 56% 20% 16% 16% 49% 52% 52% 39%
ROH 36% 72% 40% 47% 50% 37% 92% 46% 51% 51% 52% 58% 53%
SHH 23% 10% 15% 55% 13% 18% 47% 20% 8% 24% 5% 3% 20%
TGH 27% 26% 10% 16% 6% 3% 26% 17% 71% 58% 4% 0% 22%
WWL 23% 87% 13% 13% 71% 83% 87% 10% 26% 32% 43% 26% 43%
Cheshire & Merseyside 69% 57% 51% 71% 55% 58% 43% 45% 54% 49% 60% 48% 55%
APH 94% 66% 22% 69% 74% 57% 33% 22% 20% 24% 45% 21% 46%
COC 27% 16% 27% 29% 23% 60% 29% 17% 26% 13% 21% 16% 25%
LNP - AHCH 394 Days
LNP - LWH 67% 66% 81% 87% 51% 57% 54% 54% 74% 77% 80% 65% 68%
MCTH 34% 16% 1% 17% 9% 22% 13% 2% 34% 16% 13% 12% 16%
ODGH 17% 39% 30% 52% 45% 0% 19% 103% 32% 3% 64% 90% 41%
STHK 228 Days
WWH 34% 18% 22% 9% 6% 23% 18% 27% 28% 13% 21% 13% 19%
Lancashire and South Cumbria 73% 73% 73% 75% 58% 64% 60% 51% 71% 70% 93% 82% 70%
BTH 48% 50% 18% 66% 34% 48% 27% 12% 61% 21% 48% 29% 39%
ELHT 107% 108% 92% 109% 83% 106% 76% 46% 116% 127% 131% 123% 102%
LTHTR 41% 54% 74% 53% 49% 35% 61% 77% 39% 38% 79% 65% 55%
MBHT - FGH 17 Days
MBHT - RLI 117% 23% 57% 16% 6% 17% 16% 3% 0% 0% 36% 42% 27%
Grand Total 63% 64% 52% 68% 60% 61% 53% 50% 53% 56% 65% 57% 58%
NICU = pink, LNU = blue, SCU = green and surgical unit = purple. Occupancy at <80% is shown with a green background, >80% is shown in red. Table 3.5.1 As Macclesfield have been closed throughout 20/21 they have been removed from all occupancy tables
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3.5.2 Average Monthly IC (XA01Z) Occupancy for NICUs only by Locality
XA01Z (IC) Occupancy APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Mean
Greater Manchester 62% 73% 51% 72% 71% 69% 60% 58% 51% 62% 69% 62% 63%
MFT - SMH 81% 94% 76% 87% 86% 90% 63% 84% 68% 73% 85% 68% 80%
RBH 46% 28% 9% 67% 58% 56% 20% 16% 16% 49% 52% 52% 39%
ROH 36% 72% 40% 47% 50% 37% 92% 46% 51% 51% 52% 58% 53%
Cheshire & Merseyside 76% 66% 61% 81% 59% 57% 47% 43% 56% 59% 68% 50% 60%
APH 94% 66% 22% 69% 74% 57% 33% 22% 20% 24% 45% 21% 46%
LNP - LWH 67% 66% 81% 87% 51% 57% 54% 54% 74% 77% 80% 65% 68%
Lancashire and South Cumbria 74% 81% 83% 81% 66% 70% 69% 62% 78% 83% 105% 94% 79%
ELHT 107% 108% 92% 109% 83% 106% 76% 46% 116% 127% 131% 123% 102%
LTHTR 41% 54% 74% 53% 49% 35% 61% 77% 39% 38% 79% 65% 55%
Grand Total 68% 72% 59% 76% 67% 66% 58% 55% 57% 65% 75% 64% 65% Table 3.5.2
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3.5.3 Average Monthly HD (XA02Z) Occupancy by locality and units
XA02Z (HD) Occupancy APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Mean
Greater Manchester 93% 78% 72% 70% 86% 89% 91% 69% 67% 71% 97% 104% 82%
MFT - NMGH 123% 95% 70% 50% 90% 198% 85% 48% 76% 103% 143% 98% 98%
MFT - SMH 95% 63% 85% 73% 100% 79% 89% 70% 83% 83% 121% 113% 88%
MFT - WYTH 38% 105% 35% 25% 35% 81% 91% 58% 47% 40% 92% 117% 63%
RBH 122% 114% 60% 87% 117% 121% 128% 80% 92% 96% 112% 152% 107%
ROH 94% 63% 81% 92% 95% 90% 104% 89% 57% 66% 87% 91% 84%
SHH 88% 73% 63% 73% 60% 37% 41% 18% 22% 58% 64% 29% 52%
TGH 59% 52% 50% 58% 8% 29% 34% 38% 46% 14% 18% 32% 37%
WWL 98% 109% 72% 23% 60% 127% 94% 83% 24% 47% 31% 113% 73%
Cheshire & Merseyside 49% 54% 38% 40% 47% 46% 68% 56% 60% 52% 53% 45% 51%
APH 38% 66% 60% 37% 52% 30% 61% 40% 42% 25% 42% 49% 45%
COC 13% 21% 17% 19% 35% 63% 48% 40% 45% 18% 16% 13% 29%
LNP - AHCH 41% 49% 31% 37% 37% 33% 51% 51% 51% 42% 44% 20% 40%
LNP - LWH 59% 52% 35% 47% 44% 58% 86% 64% 65% 57% 73% 72% 59%
MCTH 62% 56% 38% 32% 48% 35% 47% 32% 82% 94% 49% 42% 52%
ODGH 67% 145% 43% 171% 155% 97% 77% 107% 110% 90% 93% 65% 102%
STHK 52% 55% 25% 29% 68% 83% 123% 95% 60% 77% 23% 34% 61%
WWH 66% 35% 36% 24% 28% 47% 72% 82% 76% 74% 60% 32% 53%
Lancashire and South Cumbria 88% 48% 54% 84% 80% 51% 67% 53% 43% 51% 41% 84% 62%
BTH 200% 116% 50% 108% 97% 40% 69% 52% 73% 44% 46% 98% 83%
ELHT 77% 45% 65% 81% 75% 64% 60% 28% 38% 46% 47% 81% 59%
LTHTR 66% 39% 47% 77% 80% 43% 61% 75% 43% 66% 36% 68% 59%
MBHT - FGH 26 Days
MBHT - RLI 107% 27% 42% 94% 73% 37% 113% 63% 26% 15% 34% 139% 64%
Grand Total 76% 64% 56% 61% 70% 66% 78% 61% 60% 61% 71% 79% 67% Table 3.5.3
If unit has no HD cots their HD activity has been included in the locality and network totals. Instead of a % actual count of HD days are shown in the table.
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3.5.4 Average Combined XA01Z & XA02Z (IC & HD) Occupancy by Locality and Units
XA01Z & XA02Z IC & HD Occupancy
APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Mean
Greater Manchester 75% 72% 59% 67% 75% 76% 75% 61% 57% 64% 79% 80% 70%
MFT - NMGH 74% 60% 40% 36% 59% 112% 49% 37% 53% 72% 77% 55% 60%
MFT - SMH 88% 79% 80% 80% 93% 85% 76% 77% 76% 78% 103% 90% 84%
MFT - WYTH 37% 84% 33% 25% 32% 66% 73% 49% 36% 31% 67% 84% 51%
RBH 80% 66% 31% 75% 84% 85% 67% 44% 49% 70% 78% 96% 69%
ROH 65% 68% 60% 69% 73% 63% 98% 67% 54% 59% 69% 75% 68%
SHH 62% 48% 44% 66% 41% 29% 43% 19% 16% 45% 41% 19% 39%
TGH 51% 45% 40% 48% 7% 23% 32% 33% 52% 25% 14% 24% 33%
WWL 79% 103% 58% 20% 63% 116% 92% 65% 24% 44% 34% 91% 66%
Cheshire & Merseyside 57% 55% 43% 52% 50% 51% 59% 52% 58% 51% 55% 47% 52%
APH 62% 66% 44% 51% 62% 41% 49% 32% 32% 25% 43% 37% 45%
COC 18% 19% 20% 23% 31% 62% 42% 32% 39% 16% 18% 14% 28%
LNP - AHCH 51% 61% 37% 54% 52% 57% 58% 63% 61% 48% 56% 31% 52%
LNP - LWH 63% 59% 58% 67% 47% 58% 70% 59% 69% 67% 77% 68% 63%
MCTH 50% 39% 22% 26% 31% 30% 32% 19% 62% 61% 34% 29% 36%
ODGH 42% 92% 37% 111% 100% 48% 48% 105% 71% 47% 79% 77% 72%
STHK 87% 68% 45% 60% 132% 117% 158% 133% 94% 94% 39% 71% 92%
WWH 50% 27% 29% 16% 17% 35% 45% 54% 52% 44% 40% 23% 36%
Lancashire and South Cumbria 82% 59% 62% 80% 70% 56% 64% 52% 55% 59% 63% 83% 66%
BTH 124% 83% 34% 87% 65% 44% 48% 32% 67% 32% 47% 64% 61%
ELHT 90% 72% 76% 93% 78% 82% 67% 36% 71% 81% 83% 99% 77%
LTHTR 55% 46% 59% 66% 67% 40% 61% 76% 41% 54% 55% 67% 57%
MBHT - FGH 43 Days
MBHT - RLI 110% 26% 47% 68% 51% 30% 81% 43% 17% 10% 35% 106% 52%
Grand Total 70% 64% 54% 64% 66% 64% 67% 56% 57% 59% 68% 69% 63% Table 3.5.4
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3.5.5 Average Combined XA03Z, XA04Z & XA05Z (SC & NC) Occupancy by Locality and Units
XA03Z, XA04Z & AX05Z (SC) Occupancy
APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Mean
Greater Manchester 69% 74% 76% 70% 71% 69% 84% 74% 68% 75% 68% 74% 73%
MFT - NMGH 84% 74% 86% 66% 95% 87% 84% 63% 85% 82% 68% 64% 78%
MFT - SMH 73% 72% 72% 80% 72% 69% 81% 76% 63% 78% 65% 84% 74%
MFT - WYTH 72% 75% 86% 76% 61% 77% 93% 80% 50% 75% 80% 70% 75%
RBH 47% 104% 93% 66% 86% 89% 110% 86% 103% 72% 61% 90% 84%
ROH 94% 77% 85% 79% 69% 51% 73% 85% 80% 68% 64% 56% 74%
SHH 49% 60% 50% 58% 70% 67% 72% 81% 38% 90% 68% 87% 66%
TGH 77% 76% 66% 53% 51% 44% 53% 41% 65% 57% 68% 46% 58%
WWL 33% 35% 54% 48% 36% 46% 95% 52% 42% 71% 78% 76% 55%
Cheshire & Merseyside 63% 71% 76% 64% 76% 75% 69% 72% 61% 66% 71% 76% 70%
APH 37% 40% 82% 63% 69% 106% 32% 38% 43% 46% 52% 44% 54%
COC 24% 45% 54% 32% 59% 53% 78% 50% 53% 39% 58% 34% 48%
LNP - AHCH 793 Days
LNP - LWH 91% 95% 97% 76% 98% 93% 90% 101% 81% 89% 89% 95% 91%
MCTH 117% 110% 86% 90% 96% 88% 103% 90% 51% 105% 129% 110% 98%
ODGH 41% 56% 51% 63% 58% 45% 71% 45% 54% 78% 38% 39% 53%
STHK 46% 70% 79% 50% 74% 72% 56% 68% 62% 43% 61% 66% 62%
WWH 48% 46% 43% 48% 32% 36% 34% 66% 51% 43% 40% 87% 48%
Lancashire and South Cumbria 55% 78% 68% 72% 77% 62% 66% 60% 61% 77% 53% 56% 65%
BTH 51% 106% 114% 77% 86% 64% 63% 41% 47% 96% 66% 78% 74%
ELHT 59% 50% 41% 68% 69% 64% 71% 54% 50% 90% 44% 61% 60%
LTHTR 61% 87% 92% 79% 88% 56% 63% 83% 89% 65% 61% 39% 72%
MBHT - FGH 33% 25% 30% 60% 82% 46% 32% 63% 77% 38% 59% 20% 47%
MBHT - RLI 48% 121% 42% 68% 59% 71% 78% 62% 51% 52% 35% 56% 62%
Grand Total 64% 74% 74% 68% 74% 69% 76% 70% 65% 73% 66% 71% 70%
*Note – XA04Z occupancy is not included if recorded as TC and not NNU care Table 3.5.5
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3.5.6 Total NNU Occupancy (All HRG codes) by Locality and Units
Total Occupancy APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Mean
Greater Manchester 71% 73% 69% 69% 72% 72% 80% 68% 64% 70% 73% 76% 71%
MFT - NMGH 82% 71% 76% 60% 87% 92% 76% 57% 78% 80% 70% 62% 74%
MFT - SMH 81% 76% 76% 80% 84% 78% 78% 77% 70% 78% 86% 87% 79%
MFT - WYTH 62% 77% 71% 61% 53% 73% 88% 72% 46% 62% 76% 74% 68%
RBH 62% 87% 65% 71% 85% 87% 90% 67% 78% 71% 69% 93% 77%
ROH 80% 72% 73% 74% 71% 57% 85% 76% 67% 63% 67% 65% 71%
SHH 53% 56% 48% 60% 61% 56% 63% 62% 31% 76% 60% 67% 58%
TGH 69% 66% 58% 52% 37% 37% 47% 38% 61% 47% 51% 39% 50%
WWL 46% 54% 55% 40% 44% 66% 94% 56% 37% 63% 66% 80% 58%
Cheshire & Merseyside 60% 64% 61% 59% 64% 64% 64% 63% 59% 59% 64% 63% 62%
APH 52% 55% 60% 56% 65% 68% 42% 35% 37% 34% 47% 40% 49%
COC 22% 39% 46% 30% 53% 55% 70% 46% 49% 33% 49% 29% 43%
LNP - AHCH 78% 85% 60% 87% 91% 85% 76% 81% 68% 68% 85% 77% 78%
LNP - LWH 75% 75% 76% 71% 70% 73% 79% 78% 75% 77% 82% 81% 76%
MCTH 86% 77% 56% 60% 65% 61% 70% 57% 56% 85% 85% 72% 69%
ODGH 41% 64% 48% 73% 66% 45% 66% 57% 58% 72% 46% 46% 57%
STHK 52% 69% 75% 51% 82% 78% 69% 77% 66% 50% 58% 66% 66%
WWH 49% 39% 38% 37% 27% 36% 38% 62% 52% 43% 40% 66% 44%
Lancashire and South Cumbria 65% 70% 66% 75% 75% 60% 65% 57% 59% 70% 57% 66% 65%
BTH 69% 100% 94% 79% 81% 59% 59% 39% 52% 80% 61% 74% 71%
ELHT 72% 59% 55% 78% 73% 71% 70% 46% 59% 86% 60% 76% 67%
LTHTR 58% 66% 75% 72% 78% 48% 62% 79% 65% 59% 58% 53% 65%
MBHT - FGH 35% 25% 33% 65% 87% 48% 36% 63% 82% 40% 60% 24% 50%
MBHT - RLI 67% 93% 43% 68% 56% 59% 79% 57% 41% 39% 35% 71% 59%
Grand Total 67% 70% 66% 67% 70% 67% 72% 64% 61% 67% 67% 70% 67%
Table 3.5.6
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4. Network and Locality Transfers.
4.1 Appropriate & Inappropriate Postnatal Transfers
Table 4.1.1 shows the Inappropriate Postnatal Transfers out of each locality and out of NWNODN. Inappropriate is any support, treatment or surgery that
is available within the NWNODN pathway which took place outside of the NWNODN.
PN Inappropriate Transfers Out
Out of Locality within NWNODN
18/19
Out of Locality within NWNODN
19/20
Out of Locality within NWNODN
20/21
Out of NWNODN
18/19
Out of NWNODN
19/20
Out of NWNODN
20/21
Greater Manchester 9 18 4 2 1 0
Cheshire & Merseyside 19 16 1 0 0 0
Lancashire & South Cumbria 3 5 3 0 1 0
Total 31 39 8 2 2 0 Table 4.1.1
Transfers for specialist treatment or surgery, to another unit within the NWNODN but across locality, is deemed as appropriate. Transfers both out of localities and outside of the region have decreased considerably over the past year. It is unclear if this is due to COVID or that units now adhere to the appropriate pathways. Table 4.1.2 shows appropriate Postnatal Transfers out of NWNODN. These are transfers out of the NWNODN where care is not provided within the region, for example in 2020/21 there were transfers to Leeds & Great Ormond Street for specialist treatment.
PN Appropriate Transfers Out of NWNODN
18/19 19/20 20/21
Cheshire & Merseyside 0 5 1
Greater Manchester 7 3 3
Lancashire & South Cumbria 0 1 1
Total 7 9 5 Table 4.1.2
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4.2 Network and Locality out of area activity.
The following tables show NWNODN activity for babies who are registered with a GP Practice assigned to either a Welsh Local Health Board (HLB) or a CCG
within Yorkshire & Humber, North & West Midlands or Isle of Man (IOM). It is noted that there is a decrease in the numbers transferred in both antenatally
and postnatally which is positive outcome as it means babies are being cared for in their own localities, remaining closer to home.
Table 4.2.1 Babies transferred antenatally into NWNODN units by locality.
Antenatal Admissions Wales 19/20
Wales 20/21
Yorks & Humber
19/20
Yorks & Humber
20/21
N&W Mids
19/20
N&W Mids 20/21
IOM 19/20
IOM 20/21
Other 19/20
Other 20/21
Total 19/20
Total 20/21
Greater Manchester 0 6 25 9 40 36 1 0 16 17 82 68
Cheshire & Merseyside 68 69 5 1 46 20 4 7 14 5 137 102
Lancashire & South Cumbria 2 0 15 6 6 2 0 0 5 4 28 12
Total 70 75 45 16 92 58 5 7 35 26 247 182 Table 4.2.1
Table 4.2.2 Babies transferred postnatally and admitted into NWNODN units, by locality.
PN Admissions Wales 19/20
Wales 20/21
Yorks & Humber
19/20
Yorks & Humber
20/21
N&W Mids
19/20
N&W Mids 20/21
IOM 19/20
IOM 20/21
Other 19/20
Other 20/21
Total 19/20
Total 20/21
Greater Manchester 1 0 2 1 2 2 0 0 2 1 7 4
Cheshire & Merseyside 19 15 0 1 64 51 3 0 3 0 89 67
Lancashire & South Cumbria 0 0 5 1 0 0 0 0 0 0 5 1
Total 20 15 7 3 66 53 3 0 5 1 101 72 Table 4.2.2
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4.3 Out of Area Activity by CCG
Table 4.3 shows a breakdown by region of number of babies admitted in year and the total care days in year
for all babies, whose mothers are registered with a GP whose CCG code is outside of the NWNODN.
Care Days
2020-21 Out of Area CCG into Locality No. of Babies
XA01Z (IC)
XA02Z (HD)
XA03Z & XA04Z (SC)
XA05Z (NC)
Greater Manchester 72 398 318 519 85
NHS England London 7 25 90 50 5
NHS England Midlands & East (Central Midlands) 1 0 0 10 1
NHS England Midlands and East (East) 3 7 6 9 2
NHS England Midlands and East (North Midlands) 35 140 90 308 58
NHS England Midlands and East (West Midlands) 3 29 46 20 2
NHS England North (Cumbria and North East) 3 18 31 46 0
NHS England North (Yorkshire and Humber) 10 145 16 49 14
NHS England South East (Hampshire, Isle of Wight
& Thames Valley) 1 0 0 3 0
NHS England South East (Kent, Surrey and Sussex) 2 0 1 3 2
NHS England South West (South West North) 1 0 0 0 1
WALES 6 34 38 21 0
Cheshire & Merseyside 169 894 1,198 1,331 107
Isle of Man 7 16 92 98 2
NHS England London 2 11 0 0 0
NHS England Midlands and East (North Midlands) 69 91 473 805 59
NHS England Midlands and East (West Midlands) 2 129 4 0 0
NHS England North (Cumbria and North East) 1 4 4 2 0
NHS England North (Yorkshire and Humber) 2 1 1 8 7
NHS England South East (Hampshire, Isle of Wight
and Thames Valley) 2 0 4 5 0
NHS England South East (Kent, Surrey and Sussex) *0 0 0 1 0
NHS England South West (South West North) *0 42 17 2 0
WALES 84 600 603 410 39
Lancashire and South Cumbria 13 78 15 38 16
NHS England Midlands and East (North Midlands) 2 0 0 7 10
NHS England North (Cumbria and North East) 3 0 1 4 2
NHS England North (Yorkshire and Humber) 7 78 14 17 2
NHS England South East (Kent, Surrey and Sussex) 1 0 0 10 2
Grand Total 254 1,370 1,531 1,888 208 Table 4.3
*Babies admitted in previous year.
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4.4 Wales Activity within the NWNODN
Table 4.4.1 shows a summary of all care days across the network for patients registered to GP Practices within Welsh LHBs.
The table only includes units where Welsh activity took place over the period Apr 2020 – Mar 2021. The table also shows the Welsh care days as a percentage
of the total care days on NNU ward within the NWNODN by level of care. Commissioning within Wales continues to be based upon BAP2011.
Activity for Patients registered to GP Practices within Welsh LHBs
Locality / Unit Name
Admissions XA01Z days
XA01Z as % of Unit XA01Z
XA02Z days
XA02Z as % of Unit XA02Z
XA03Z, 04Z & 05Z
days
XA03Z+XA04Z+ AZ05Z
as % of Unit total
Total days % Total
Greater Manchester 7 34 0.4% 38 0.3% 21 0.1% 93 0.2%
MFT – SMH 4 30 0.5% 35 0.6% 18 0.2% 83 0.4%
RBH 1 4 0.3% 3 0.1% 0 0.0% 7 0.1%
ROH 1 0 0.0% 0 0.0% 2 0.0% 2 0.0%
SHH 1 0 0.0% 0 0.0% 1 0.0% 1 0.0%
Cheshire & Merseyside 163 600 11.5% 603 7.9% 449 2.2% 1652 4.9%
APH 22 243 24.4% 243 18.4% 64 3.2% 550 12.8%
COC 40 14 15.2% 28 13.1% 239 13.6% 281 13.6%
LNP – AHCH 21 79 20.1% 170 12.8% 60 7.0% 309 12.0%
LNP – LWH 45 264 8.9% 162 6.3% 86 1.3% 512 4.2%
Total 135 634 3.5% 641 2.4% 470 0.7% 1745 1.5% Table 4.4.1
See Appendix 1 for LHB list for Wales.
*Note – Due to pathways babies may be cared for at both LNP - LWH & Alder Hey and therefore count as more than one admission.
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Table 4.4.2 shows the NNU cot demand for Wales based on activity in table 4.4.1.
XA01Z Cots XA02Z Cots XA03Z+04Z+05Z Cots Total Cots
Locality / Unit Name 2019/20 2020/21 2019/20 2020/21 2019/20 2020/21 2019/20 2020/21
Greater Manchester 0.0 0.1 0.0 0.1 0.0 0.1 0.1 0.3
MFT – SMH 0.0 0.1 0.0 0.1 0.0 0.1 0.1 0.3
RBH 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
ROH 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
SHH 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Cheshire & Merseyside 1.8 2.0 1.7 2.1 0.8 1.5 4.3 5.6
APH 0.9 0.8 0.6 0.8 0.0 0.2 1.5 1.8
COC 0.0 0.0 0.1 0.1 0.6 0.8 0.7 0.9
LNP – AHCH 0.3 0.3 0.7 0.6 0.0 0.2 1.0 1.1
LNP – LWH 0.6 0.9 0.4 0.6 0.2 0.3 1.1 1.8
Total 1.8 2.1 1.8 2.3 0.8 1.6 4.4 5.9 Table 4.4.2
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4.5 North & West Midlands Activity in NWNODN
Table 4.5.1 shows a summary of all care days across the network for patients registered to GP Practices within North & West Midlands CCGs.
The table only includes units where North & West Midlands activity took place over the period Apr 2020 – Mar 2021. The table also shows the North &
West Midlands care days (divided into HRG codes) as a percentage of the total care days on NNU ward within the NWNODN by level of care.
Activity for Patients registered to GP Practices within North & West Midlands CCGs
Locality / Unit Name Admissions
XA01Z days
XA01Z as % of Unit XA01Z
XA02Z days
XA02Z as % of Unit XA02Z
XA03Z, 04Z &
05Z days
XA03Z+XA04Z+ AZ05Z as % of Unit total
Total days % Total
Greater Manchester 48 169 1.8% 136 0.9% 388 1.1% 693 1.2%
MFT - SMH 11 127 2.3% 71 1.2% 56 0.7% 254 1.3%
ROH 3 13 0.7% 11 0.4% 7 0.1% 31 0.3%
SHH 33 29 19.6% 54 9.5% 315 10.9% 398 11.1%
TGH 1 0 0.0% 0 0.0% 10 0.5% 10 0.4%
Cheshire & Merseyside 95 220 4.2% 477 6.3% 864 4.2% 1561 4.7%
APH 3 5 0.5% 15 1.1% 10 0.5% 30 0.7%
COC 4 2 2.2% 10 4.7% 117 6.7% 129 6.3%
LNP - AHCH 30 41 10.4% 151 11.4% 165 19.3% 357 13.9%
LNP - LWH 14 154 5.2% 121 4.7% 42 0.6% 317 2.6%
MCTH 43 18 10.3% 178 23.7% 522 18.3% 718 19.0%
WWH 1 0 0.0% 2 0.3% 8 0.4% 10 0.3%
Lancashire & South Cumbria 2 0 0.0% 0 0.0% 17 0.1% 17 0.1%
BTH 2 0 0.0% 0 0.0% 17 0.5% 17 0.4%
Total 145 389 2.1% 613 2.3% 1269 1.8% 2271 2.0% Table 4.5.1
See Appendix 1 for North Midlands and West Midlands CCG Codes.
*Note – Due to pathways babies may be cared for at both LNP - LWH & Alder Hey and therefore count as more than one admission
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Table 4.5.2 shows the NNU cot demand based on the Midlands activity in table 4.5.1.
XA01Z Cots XA02Z Cots XA03Z+04Z+05Z Cots Total Cots
Locality / Unit Name 2019/20 2020/21 2019/20 2020/21 2019/20 2020/21 2019/20 2020/21
Greater Manchester 1.1 0.5 0.9 0.4 1.4 1.3 3.4 2.2
MFT - NMGH 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0
MFT – SMH 0.9 0.4 0.3 0.2 0.1 0.2 1.3 0.8
MFT – WYTH 0.0 0.0 0.0 0.0 0.2 0.0 0.2 0.0
RBH 0.1 0.0 0.3 0.0 0.0 0.0 0.4 0.0
ROH 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
SHH 0.1 0.1 0.3 0.2 1.0 1.1 1.4 1.4
TGH 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Cheshire & Merseyside 1.9 0.7 1.8 1.6 3.3 2.9 7.1 5.2
APH 0.1 0.0 0.1 0.1 0.0 0.0 0.2 0.1
COC 0.0 0.0 0.0 0.0 0.0 0.4 0.0 0.4
ECH 0.0 0.0 0.1 0.0 0.7 0.0 0.8 0.0
LNP – AHCH 0.1 0.1 0.7 0.5 0.4 0.6 1.2 1.2
LNP – LWH 1.5 0.5 0.6 0.4 0.4 0.1 2.5 1.0
MCTH 0.1 0.1 0.4 0.6 1.7 1.8 2.2 2.5
WWH 0.1 0.0 0.0 0.0 0.1 0.0 0.2 0.0
Lancashire & South Cumbria 0.0 0.0 0.1 0.0 0.3 0.1 0.4 0.1
BTH 0.0 0.0 0.1 0.0 0.3 0.1 0.4 0.1
Total 3.0 1.2 2.8 2.0 5.0 4.3 10.9 7.5 Table 4.5.2
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4.6 Yorkshire & Humber Activity in NWNODN
Table 4.6.1 shows a summary of all care days across the network for patients registered to GP Practices within Yorkshire & Humber CCGs.
The table only includes units where Yorkshire & Humber activity took place over the period Apr 2020 – Mar 2021. The table also shows the Yorkshire &
Humber care days (divided into HRG codes) as a percentage of the total care days on NNU ward within the NWNODN by level of care.
Activity for Patients registered to GP Practices within Yorkshire & Humber CCGs
Locality / Unit Name Admissions
XA01Z days
XA01Z as % of Unit XA01Z
XA02Z days
XA02Z as % of Unit XA02Z
XA03Z+ 04Z+05Z
days
XA03Z+04Z +05Z as % of
Unit Total Total days % Total
Greater Manchester 15 145 1.6% 16 0.1% 63 0.2% 224 0.4%
MFT – NMGH 1 1 0.6% 0 0.0% 0 0.0% 1 0.0%
MFT – SMH 8 100 1.8% 12 0.2% 34 0.4% 145 0.7%
RBH 1 0 0.0% 0 0.0% 2 0.0% 2 0.0%
ROH 4 44 2.5% 2 0.1% 14 0.3% 60 0.6%
TGH 1 0 0.0% 2 0.5% 13 0.7% 15 0.6%
Cheshire & Merseyside 2 1 0.0% 1 0.0% 15 0.1% 17 0.1%
LNP – AHCH 1 1 0.3% 1 0.1% 8 0.9% 10 0.4%
ODGH 1 0 0.0% 0 0.0% 7 0.4% 7 0.3%
Lancashire & South Cumbria 8 78 2.0% 14 0.3% 19 0.1% 111 0.5%
ELHT 8 78 3.5% 14 0.8% 19 0.4% 111 1.3%
Total 25 224 1.2% 31 0.1% 97 0.1% 352 0.3%
See Appendix 1 for Yorkshire & Humber CCG Codes. Table 4.6.1
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Table 4.6.2 shows the NNU cot demand based on Yorkshire & Humber activity in table 4.6.1.
XA01Z Cots XA02Z Cots XA03Z+04Z+05Z Cots Total Cots
Locality / Unit Name 2019/20 20/21 2019/20 20/21 2019/20 20/21 2019/20 20/21
Greater Manchester 0.6 0.5 0.6 0.0 0.3 0.1 1.5 0.6 MFT - NMGH 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 MFT – SMH 0.1 0.3 0.2 0.0 0.0 0.1 0.3 0.4 MFT – WYTH 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 RBH 0.1 0.0 0.2 0.0 0.1 0.0 0.4 0.0 ROH 0.3 0.2 0.1 0.0 0.1 0.0 0.5 0.2 TGH 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.0 Cheshire & Merseyside 0.0 0.0 0.2 0.0 0.1 0.0 0.3 0.0 LNP – AHCH 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.0 LNP – LWH 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.0
0 MCTH 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 ODGH 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Lancashire & South Cumbria 1.0 0.3 0.3 0.0 0.2 0.1 1.5 0.4 BTH 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 ELHT 0.8 0.3 0.3 0.0 0.1 0.1 1.2 0.4 LTHTR 0.2 0.0 0.0 0.0 0.0 0.0 0.2 0.0 Total 1.6 0.8 1.1 0.0 0.6 0.2 3.3 1.0
Table 4.6.2
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4.7 Isle of Man Activity in NWNODN
Table 4.7.1 shows a summary of all care days across the network for patients registered to GP Practices within Isle of Man. The table only includes units where
Isle of Man activity took place over the period Apr 2020 – Mar 2021. The table also shows the Isle of Man care days as a percentage of the total care days on
NNU ward within the NWNODN by level of care.
Activity for Patients registered to GP Practices within Isle of Man
Locality / Unit Name
Admissions XA01Z days
XA01Z as % of Unit XA01Z
XA02Z days
XA02Z as % of Unit XA02Z
XA03Z+ 04Z+05Z
days
XA03Z+04Z+ 05Z as % of Unit Total
Total days % Total
Cheshire & Merseyside 14 16 0.3% 92 1.2% 100 0.5% 208 0.6%
LNP – AHCH 5 9 2.3% 66 5.0% 26 3.0% 101 3.9%
LNP – LWH 9 7 0.2% 26 1.0% 74 1.1% 107 0.9%
Total 14 16 0.1% 92 0.3% 100 0.1% 208 0.2%
Table 4.7.1
Table 4.7.2 shows the NNU cot demand based on Isle of Man activity in table 4.7.1.
Table 4.7.2
XA01Z Cots XA02Z Cots XA03Z+04Z+05Z Cots Total Cots
Locality / Unit Name 2019/20 2020/21 2019/20 2020/21 2019/20 2020/21 2019/20 2020/21
Greater Manchester 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0
MFT – SMH 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0
Cheshire & Merseyside 0.1 0.0 0.3 0.3 0.2 0.4 0.6 0.7
LNP – AHCH 0.0 0.0 0.1 0.2 0.1 0.1 0.2 0.3
LNP – LWH 0.1 0.0 0.2 0.1 0.1 0.3 0.4 0.4
Total 0.1 0.0 0.3 0.3 0.3 0.4 0.7 0.7
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5. Nursing & Medical Workforce
Nurse staffing calculations in previous ACD reports have been based the Clinical Reference Group (CRG) 2013/14
nursing workforce calculator (NWC), previously known as the Dinning Tool. Following a review by the national Lead
Nurse group a new calculator, which includes a more accurate calculate for uplifts, has been introduced. Therefore
for the 2020/21 report the new Neonatal Nursing Workforce Tool (2020) has been used. An additional summary of
medical staffing in NW units has also been added.
5.1 Nurse Staffing across the NWNODN
Table 5.1 shows the WTE agreed establishment (as budgeted), vacancies and additional requirements against the Neonatal Nursing Workforce Tool (2020). The 2020/21 staffing information was collected from each NNU and depicts the staffing numbers as of the 31st March 2021.
Locality
WTE Agreed Establishment
(Budget). WTE
In Post.
WTE Vacancies (Establishment minus in post)
Neonatal Nursing WF Tool(2020) Requirements
(Based on Activity)
Neonatal Nursing WF Tool(2020)
shortage against Agreed Establish.
(Budget)
2021 Overall
Shortage
GM 551.3 488.3 63.0 576.2 24.8 87.8
CM 355.9 322.8 33.1 343.4 -12.4 20.7
LSC 223.4 212.2 11.2 229.9 6.4 17.6
NWNODN 1130.6 1023.3 107.3 1149.5 18.8 126.1 Table 5.1
Chart 5.1 shows that there are currently 108 WTE vacancies across the NWNODN with a further 19 WTE nurses required to achieve BAPM compliance, as recommended by the CRG Nursing Workforce Tool.
119311311103
1023
12221150
0
200
400
600
800
1000
1200
1400
NWNODN 2019/20 NWNODN 2020/21
Summary of Nurse Staffing ODN Requirements
WTE Agreed Establishment(Budget). WTE In Post WTE Neonatal Nursing WF Tool(2020)
Chart 5.1
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 45 of 73
The agreed establishment (budgeted WTE nurses) across the NWNODN is 62.3 WTE less than in 19/20. This is possibly a result of on-going work to reduce variance in data submissions. Further standardisation will continue when the new Network Workforce and Education Lead comes into post. The Neonatal Nursing Workforce Tool shows the number of nurses required to be BAPM compliant, based upon the activity for 2020/21 is 72 less than the previous year; however there were more vacancies at the end of March 2021, compared to the previous year.
5.2 Nurse Staffing by Locality
5.3 Nurse Staffing by Unit
551
356
223
1131
488
323212
1023
576
343230
1150
0
200
400
600
800
1000
1200
1400
Greater Manchester Cheshire & Merseyside Lancashire & SouthCumbria
NWNODN
Summary of Nurse Staffing ODN/Locality Requirements WTE Agreed Establishment(Budget). WTE In Post
WTE Neonatal Nursing WF Tool(2020)
28
209
47
97 94
27 25 2432
186
33
85 84
24 20 2339
227
41
91 97
30 22 28
0
50
100
150
200
250
MFT -NMGH
MFT - SMH MFT -WYTH
RBH ROH SHH TGH WWL
Summary of Nurse Staffing ODN RequirementsGreater Manchester
WTE Agreed Establishment(Budget). WTE In Post. WTE Neonatal Nursing WF Tool(2020)
Chart 5.2
Chart 5.3.1
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 46 of 73
*Note - LNP - AHCH nurse staffing is for the Neonatal surgical unit only as in table 7.1a
Charts 5.1 to 5.3 highlight there is a shortfall in the number of nurses required to meet the BAPM2011 requirements. It is important to note that the number of WTE in agreed establishment in this report is for those providing direct patient / cot side care only. Therefore nurses in non-direct care roles, including Ward Managers, Clinical Educators and other quality/link roles described in DOH Toolkit (2010) are not included here. It should also be recognised that this is a snap shot in time and recruitment or attrition rates will cause fluctuations in these figures.
52
29 26
141
2719
30 3245
29 26
128
2520 24 26
51
19
32
129
3221
31 27
0
20
40
60
80
100
120
140
160
APH COC LNP - AHCH LNP - LWH MCTH ODGH STHK WWH
Summary of Nurse Staffing ODN RequirementsCheshire & Merseyside
WTE Agreed Establishment(Budget). WTE In Post. WTE Neonatal Nursing WF Tool(2020)
30
8171
14
2729
7771
1323
35
93
68
1221
0
20
40
60
80
100
BTH ELHT LTHTR MBHT - FGH MBHT - RLI
Summary of Nurse Staffing ODN RequirementsLancashire and South Cumbria
WTE Agreed Establishment(Budget). WTE In Post. WTE Neonatal Nursing WF Tool(2020)
Chart 5.3.2
Chart 5.3.3
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 47 of 73
5.4 Additional Nurse Requirements
Chart 5.4.1 shows the number and percentage of additional nurses required to be BAPM compliant as calculated using the Neonatal Nursing Workforce Tool (2020), against the agreed establishment (budgeted nurses).
Chart 5.4.2 shows the number and percentage of additional nurses required to be BAPM compliant, as calculated using the Neonatal Nursing Workforce Tool (2020), plus current vacancies against the agreed establishment (budgeted nurses). Therefore across the region an additional 126 WTE nurses would need to be in post to meet the BAPM recommendation for Nurse Staffing.
25
-12
6
19
4.5
-3.5
2.9 1.7
-15
-10
-5
0
5
10
15
20
25
30
Greater Manchester Cheshire &Merseyside
Lancashire & SouthCumbria
NWNODN
Act
ual
No
. & %
of
Nu
rses
Summary of Nurse Staffing ODN Requirements
Neonatal Nursing WF Tool(2020) WTE against Agreed Establishment(Budget).
% of Agreed Establishment(Budget) to reach WTE Neonatal Nursing WF Tool(2020)
88
21 18
126
18.06.4 8.3 12.3
0
20
40
60
80
100
120
140
Greater Manchester Cheshire &Merseyside
Lancashire & SouthCumbria
NWNODN
Act
ual
No
. & %
of
Nu
rses
Summary of Nurse Staffing ODN Requirements
Overall Shortfall 2021.
% of In Post to reach WTE Neonatal Nursing WF Tool(2020)
Chart 5.4.1
Chart 5.4.2
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 48 of 73
5.5 Medical staffing across the NWNODN
In March 2021 a self-reporting survey was carried out across all the LNUs and SCUs within the NW region. The
purpose of the survey was to re-assess compliance against BAPM standards across all NWNODN LNUs and SCUs.
Table 5.5 shows compliance against the Tier 1, Tier 2 and Tier 3 recommendations, as outlined in the BAPM Guidance:
Optimal arrangements for Local Neonatal Units and Special Care Units in the UK (2016), for all the LNUs and SCUs
within the NWNODN. It is recognised that the lack of compliance at Tier 1 and Tier 2 is a problem across the country
and the ODNs will be working with units as part of the NCCR to support improvements in the provision of medical
staffing.
Unit Designation Tier 1
compliant? Tier 2
compliant? Tier 3
compliant?
CM
Chester LNU No No Yes
Leighton LNU No No Yes
Macclesfield* LNU N/A N/A N/A
Ormskirk LNU No No Yes
Warrington LNU No No Yes
Whiston LNU No Yes Yes
LSC
Blackpool LNU No No Yes
Lancaster LNU No No Yes
Furness SCU Yes No Yes
GM
North Manchester
LNU Yes Yes Yes
Stockport LNU No No Partial
Tameside LNU No No Yes
Wigan LNU No Yes Yes
Wythenshawe LNU Yes No Partial Table 5.5.1
*Macclesfield was not open throughout this period (2020/21)
A summary of the findings, including the standards for each Tier, is presented in a report (See Appendix 2).
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 49 of 73
6. Greater Manchester Activity
6.1 GM Activity by Level of Care
Table 6.1 shows the total care level days by unit and across the GM locality. XA04Z care if delivered in TC is not included.
HRG 2016 XA01Z XA02Z XA03Z + XA04z + XA05Z Total
Unit Name 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
MFT – NMGH 149 103 163 680 571 712 4,857 4,469 4,280 5,686 5,143 5,146
MFT – SMH 5,749 6,026 5,516 6,298 6,806 6,076 8,129 8,178 8,354 20,176 21,010 19,946
MFT – WYTH 265 210 196 1,088 996 927 4,968 4,581 4,079 6,321 5,787 5,202
RBH 1,748 1,906 1,283 3,066 3,156 2,728 5,801 5,436 5,832 10,615 10,498 9,843
ROH 1,592 1,944 1,735 2,114 2,065 2,760 5,387 5,821 5,103 9,093 9,830 9,598
SHH 224 174 148 871 578 570 3,034 2,347 2,878 4,129 3,099 3,596
TGH 135 79 81 472 349 400 2,705 2,207 1,903 3,312 2,635 2,384
WWL 126 128 157 513 577 804 2,509 2,426 2,021 3,148 3,131 2,982
Total 9,988 10,570 9,279 15,102 15,098 14,980 37,390 35,465 34,450 62,480 61,133 58,709
Table 6.1
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6.2 GM Activity as % of locality activity by Level of Care
HRG 2016 XA01Z % XA02Z % XA03Z + XA04Z + XA05Z % Total %
Unit Name 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
MFT – NMGH 1% 1% 2% 5% 4% 5% 13% 13% 12% 9% 8% 9%
MFT – SMH 58% 57% 59% 42% 45% 41% 22% 23% 24% 32% 34% 34%
MFT – WYTH 3% 2% 2% 7% 7% 6% 13% 13% 12% 10% 9% 9%
RBH 18% 18% 14% 20% 21% 18% 16% 15% 17% 17% 17% 17%
ROH 16% 18% 19% 14% 14% 18% 14% 16% 15% 15% 16% 16%
SHH 2% 2% 2% 6% 4% 4% 8% 7% 8% 7% 5% 6%
TGH 1% 1% 1% 3% 2% 3% 7% 6% 6% 5% 4% 4%
WWL 1% 1% 2% 3% 4% 5% 7% 7% 6% 5% 5% 5%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Table 6.2
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6.3 GM Surgical Activity
Table 6.3 shows the surgical activity in St Mary’s Hospital for the period 2020/21 and trend data from previous
years. Surgical care days are included in the activity tables 6.1 for Greater Manchester. The data for table 6.3 is collected locally. For the purpose of this report a surgical cot day is defined as ‘any patient
with a surgical diagnosis which requires input from the surgical team and for whom a Consultants Surgeon is
named alongside the neonatologist’.
The surgical cots shown in the table are cot demand based on the total surgical days using the following
calculation:
Required Capacity = (Total annual surgical days/365)/0.8)
St Mary's Hospital Surgical Activity Surgical Days Cot Demand
2016/17 5,962 20.4
2017/18 6,515 22.3
2018/19 6,626 22.7
2019/20 7,314 25.0
2020/21 5690 19.5 Table 6.3
6.4 GM Activity and Workload
6.4.1 GM NICU Activity and Workload Data
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review (2019) all
NICUs should, as a minimum, look after at least 100 very low birth weight (VLBW) infants per year and be delivering
>2000 intensive care days (Health Resource Group definition, 2016 & BAPM Optimal Arrangements for Neonatal
Intensive Care Units in the UK, 2021).
Table 6.4.1 shows all NICU activity, regardless of episode number, and includes surgical care at St. Mary’s Hospital.
Table 6.4.1
NICU
Intensive Care
(HRG XA01Z)
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions
(Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
MFT - SMH 5,749 6,026 5,516 9,090 9,597 8,467 251 195 198
RBH 1,748 1,906 1,283 4,391 4,790 3,575 136 124 95
ROH 1,592 1,944 1,735 3,282 3,569 4,095 141 128 114
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6.4.2 GM LNU Unit Activity and Workload Data
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review (2019) all
LNUs should aim to undertake a minimum of 500 days of combined intensive and high dependency care, which is
the minimum requirement to maintain expertise. LNUs providing ongoing HD should be working towards delivering
1000 combined ITU/HD days per year, in the longer term (i.e. 5 years from publication of NCCR in 2019). Units
designated as LNUs should also admit >25 infants annually (BAPM Optimal arrangements for Local Neonatal Units
and Special Care Units in the UK, 2016).
LNU Unit
IC & HD HRG XA01Z & XA02Z
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions (Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
MFT - NMGH 829 674 878 708 537 691 72 55 54
MFT - WYTH 1,353 1,206 1,123 1112 927 918 63 57 54
SHH 1,095 752 718 964 681 677 55 36 25
TGH 607 428 481 427 351 361 43 31 27
WWL 639 705 961 556 607 880 33 40 45 Table 6.4.2
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6.5 GM Cot Activity
Table 6.5 shows the demand (D) for cots based upon activity within each of the providers against actual (A) cots. Care Levels are based upon HRG 2016
codes but are referred to as IC, HD & SC cots as these are the commissioned cots in each category. Surgical care included in the figures as it is not possible
to identify surgical activity within the data.
Calculation method which include 80% capacity: Cot Demand = (Number of care days/365)/0.8
Greater
Manchester
Cots D: Demand , A: Actual
D
IC
18/1
9
D
IC
19/2
0
D
IC
20/2
1
A
IC
20/2
1
D
HD
18/1
9
D
HD
19/2
0
D
HD
20/2
1
A
HD
20/2
1
D
SC
18/1
9
D
SC
19/2
0
D
SC
20/2
1
A
SC
20/2
1
Total
D
18/1
9
Total
D
19/2
0
Total
D
20/2
1
Total
A
20/2
1
MFT – NMGH 0.5 0.4 0.6 2 2.3 2.0 2.4 2 16.6 15.3 14.7 15 19.4 17.7 17.7 19
MFT – SMH 19.6 20.6 18.9 19 21.5 23.2 20.8 19 27.8 27.9 28.6 31 68.9 71.7 68.3 69
MFT – WYTH 0.9 0.7 0.7 2 3.7 3.4 3.2 4 17.0 15.6 14.0 15 19.7 19.7 17.9 21
RBH 6.0 6.5 4.4 9 10.5 10.8 9.3 7 19.8 18.6 20.0 19 36.3 35.9 33.7 35
ROH 5.4 6.6 5.9 9 7.2 7.1 9.5 9 18.4 19.9 17.5 19 31.0 33.6 32.9 37
SHH 0.8 0.6 0.5 2 3.0 2.0 2.0 3 10.4 8.0 9.9 12 14.2 10.6 12.4 17
TGH 0.5 0.3 0.3 1 1.6 1.2 1.4 3 9.2 7.5 6.5 9 11.3 9.0 8.2 13
WWL 0.4 0.4 0.5 1 1.8 2.0 2.8 3 8.6 8.3 6.9 10 10.8 10.7 10.2 14
Total 34 36 32 45 52 52 51 50 128 121 118 131 214 209 201 226 Key: Short by 1 or more cot = Red, over by 1 or more cot = Yellow Table 6.5
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6.6 Greater Manchester Summary
Dr Ajit Mahaveer, Clinical Lead for GM & Karen Mainwaring, Lead Nurse for GM
Summary:
• Admission rates have steadily decreased for the last 4 years mirroring our other two localities in the region. This is a combination of reduction in term admissions and late preterm admissions around 200 babies. There has also been in declining birth rate in the region.
• Term admission remains still high within the locality and above 6%.
• There has been left shift to the LOS in many hospitals with ROH decreasing LOS from 22 to 11%
• There is sustained work around delivering preterm babies at the right place and remains around 90% in GM
• All 3 NICU currently meet national standards of NICU activity. It is also noted there has been a decrease in intensive care (HRGXA01Z) activity at Royal Oldham hospital and Royal Bolton Hospital with a downward trend of VLBW admissions.
• St Mary’s Hospital continues to provide neonatal surgical care for GM and the cot numbers has decreased.
• There has been a marked decrease in postnatal inappropriate transfers within GM from 18 to 4
• Medical workforce survey has shown a significant variation and workforce gap within the locality and does not meet BAPM workforce standards.
• The Nurse staffing budgeted establishments in Greater Manchester neonatal units did not meet BAPM Standards for activity with the gap increasing with 63 WTE vacancies noted at the time of reporting
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 55 of 73
7. Cheshire & Merseyside
7.1 CM Activity by level of care
Table 7.1 shows the total care level days by unit and across the CM locality. XA04Z care if delivered in TC is not included.
HRG 2016 XA01Z XA02Z XA03Z + XA04Z + XA05Z Total
Unit Name 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
APH 1,549 1,340 997 1,749 1,446 1,323 2,132 2,265 1,975 5,430 5,051 4,295
COC 107 74 92 485 357 213 2,321 1,978 1,756 2,913 2,409 2,061
ECH 24 25 0 130 106 0 1,255 794 0 1,409 925 0
LNP – LWH 3,329 3,201 2,966 2,535 2,195 2,592 6,772 5,820 6,655 12,636 11,216 12,213
MCTH 239 233 174 488 661 752 2,445 2,369 2,849 3,172 3,263 3,775
ODGH 125 140 150 340 552 372 2,162 2,112 1,562 2,627 2,804 2,084
STHK 174 165 228 409 419 442 2,945 2,603 2,950 3,528 3,187 3,620
WWH 291 247 212 478 354 575 2,654 2,111 2,095 3,423 2,712 2,882
Total 5,838 5,425 4,819 6,614 6,090 6,269 22,686 20,052 19,842 35,138 31,567 30,930
Unit Name 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
LNP – AHCH 331 508 394 1,275 1,711 1,327 1,011 769 854 2,617 2,988 2,575
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7.2 CM Activity as % of locality activity by level of care
HRG 2016 XA01Z % XA02Z % XA03Z + XA04Z + XA05Z Total %
Unit Name 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
APH 27% 25% 21% 26% 24% 21% 9% 11% 10% 15% 16% 14%
COC 2% 1% 2% 7% 6% 3% 10% 10% 9% 8% 8% 7%
ECH 0% 0% 0% 2% 2% 0% 6% 4% 0% 4% 3% 0%
LNP – LWH 57% 59% 62% 38% 36% 41% 30% 29% 34% 36% 36% 39%
MCTH 4% 4% 4% 7% 11% 12% 11% 12% 14% 9% 10% 12%
ODGH 2% 3% 3% 5% 9% 6% 10% 11% 8% 7% 9% 7%
STHK 3% 3% 5% 6% 7% 7% 13% 13% 15% 10% 10% 12%
WWH 5% 5% 4% 7% 6% 9% 12% 11% 11% 10% 9% 9%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Table 7.2
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7.3 CM Surgical Activity
Table 7.3.1 shows the neonatal surgical activity (care days) at Alder Hey for the period 2010/21, which took place both on the Neonatal Unit and other surgical care
wards. Only data from the NNU is recorded on the neonatal Badgernet system so additional data for PICU, HDU and other wards has been provided by the LNP - AHCH
data team.
Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-20 Feb-21 Mar-21 Total
PICU 56 32 59 53 50 77 70 60 40 57 92 53 699
HDU 17 20 0 9 30 22 22 18 43 49 49 33 312
Other Wards 172 190 176 133 36 108 162 48 63 80 101 128 1,397
Total 245 242 235 195 116 207 254 126 146 186 242 214 2,408
Neonatal Unit 210 236 163 242 255 229 213 218 189 191 215 214 2,575
Grand Total 455 478 398 437 371 436 467 344 335 377 457 421 4,983 Table 7.3.1
Table 7.3.2 shows the demand (D) for cots based upon activity at Alder Hey as reported in Table 7.3.1(IC Proxy for non NNU care days factored in).
Surgical Activity at Alder Hey 2017/18
Care Days 2017/18
Cot Demand 2018/19
Care Days 2018/19
Cot Demand 2019/20
Care Days 2019/20
Cot Demand 2020/21
Care Days 2020/21
Cot Demand
HDU & Special Care (Both within & outside NNU) 4,029 13.8 4,128 14.1 4,298 14.7 3,903 13.4
IC Care (NNU IC + IC Proxy for care outside of NNU) 631 2.2 635 2.2 1,098 3.7 1,073 3.7
Total Care Days (Both within & outside NNU) 4,660 16 4,763 16.3 5,396 18.4 4983 17.1
Calculation method which include 80% capacity: Cot Demand = (Number of care days/365)/0.8 Table 7.3.2
As it is not possible to derive full care levels for the non NNU activity a proxy of invasive ventilation has been used as an indicator for some intensive care activity,
therefore care days are included for babies who meet the following criteria:
• All babies (excluding cardiac) <60 weeks Post Conceptual Age at admission.
• Only babies where source of referral is a recognised neonatal unit With the proxy for Intensive care being babies which were receiving IC where we used ventilator support:
1. Days: Invasive ventilation via endotracheal tube 2. Days: Invasive ventilation via tracheostomy tube
NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version Page 58 of 73
3. Advanced ventilation support (Jet or Oscillatory ventilation)
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7.4 CM Activity and workload
7.4.1 CM NICU activity and workload data
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review
(2019) all NICUs should, as a minimum, look after at least 100 very low birth weight (VLBW) infants per year
and be delivering >2000 intensive care days (Health Resource Group definition, 2016 & BAPM Optimal
Arrangements for Neonatal Intensive Care Units in the UK, 2021).
Table 7.4.1 shows all NICU activity, regardless of episode number, but excludes surgical care at Alder Hey.
Table 7.4.1
7.4.2 CM LNU & SCU Unit Activity and Workload Data
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review
(2019) all LNUs should aim to undertake a minimum of 500 days of combined intensive and high dependency
care, which is the minimum requirement to maintain expertise. LNUs providing ongoing HD should be
working towards delivering 1000 combined ITU/HD days per year, in the longer term (i.e. 5 years from
publication of NCCR in 2019). Units designated as LNUs should also admit >25 infants annually (BAPM Optimal
arrangements for Local Neonatal Units and Special Care Units in the UK, 2016).
LNU Unit
IC & HD HRG XA01Z & XA02Z
Respiratory support days
(Ventilation/CPAP/HFT)
VLBW admissions (Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
COC* 592 431 305 417 332 207 42 30 24
ECH** 154 131 0 111 83 0 16 11 0
MCTH 727 894 926 599 592 638 44 38 47
ODGH 465 692 522 350 534 410 29 24 27
STHK 583 584 670 395 393 451 42 36 43
WWH 769 601 787 571 465 530 55 28 37 Table 7.4.2
* COC currently only accepts deliveries of 32 weeks gestation and above ** ECH Neonatal Unit was closed throughout 20/21
NICU
Intensive Care
(HRG XA01Z)
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions
(Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
APH 1,549 1,340 997 3,051 2,524 2,049 111 76 67
LNP - LWH 3,329 3,201 2,966 4,452 4,292 4,588 217 185 198
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7.5 Cot Activity
Table 7.5 shows the demand (D) for cots based upon activity within each of the providers against actual (A) cots. Care Levels are based upon HRG 2016 codes but are
referred to as IC, HD & SC cots as these are the commissioned cots in each category
Calculation method which include 80% capacity: Cot Demand = (Number of care days/365)/0.8 as it is a leap year
Cheshire & Merseyside
Cots D: Demand , A: Actual
D
IC
18/19
D
IC
19/20
D
IC
20/21
A
IC
20/21
D
HD
18/19
D
HD
19/20
D
HD
20/21
A
HD
20/21
D
SC
18/19
D
SC
19/20
D
SC
20/21
A
SC
20/21
Total
D
18/19
Total
D
19/20
Total
D
20/21
Total
A
20/21
APH 5.3 4.6 3.4 6 6.0 4.9 4.5 8 7.3 7.7 6.8 10 18.6 17.2 14.7 24
COC 0.4 0.3 0.3 1 1.7 1.2 0.7 2 7.9 6.8 6.0 10 10.0 8.3 7.0 13
ECH 0.1 0.1 0.0 0 0.4 0.4 0.0 1 4.3 2.7 0.0 7 4.8 3.2 0.0 8
LNP – AHCH 1.1 1.7 1.3 0 4.4 5.8 4.5 9 3.5 2.6 2.9 0 9.0 10.1 8.7 9
LNP – LWH 11.4 10.9 10.2 12 8.7 7.5 8.9 12 23.1 19.9 22.8 20 43.2 38.3 41.9 44
MCTH 0.8 0.8 0.6 3 1.7 2.3 2.6 4 8.4 8.1 9.8 8 10.9 11.2 13.0 15
ODGH 0.4 0.5 0.5 1 1.2 1.9 1.3 1 7.4 7.2 5.3 8 9.0 9.6 7.1 10
STHK 0.6 0.6 0.8 0 1.4 1.4 1.5 2 10.1 8.9 10.1 13 12.1 10.9 12.4 15
WWH 1.0 0.8 0.7 3 1.6 1.2 2.0 3 9.1 7.2 7.2 12 11.7 9.2 9.9 18
Total 21 20 18 26 27 27 26 42 81 71 71 88 129 118 115 156 Key: Short by 1 or more cot = Red, over by 1 or more cot = Yellow Table 7.5
See Appendix 1 for Cot activity against BAPM 2011 categories of care
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7.6 Cheshire & Merseyside – Summary
Dr Nim Subhedar, Clinical Lead for CM & Kelly Harvey, Lead Nurse for CM
Summary
• Sustained trend in decreasing births, admissions (including out of area) and activity across
network units
• Excess capacity, low occupancy in majority of units (except LNP-AHCH)
• Decreasing admissions/activity at APH (now well below BAPM activity threshold)
• LNUs (except Chester) meet current BAPM activity thresholds
• Significant proportion of babies <27week GA babies still being born in non-NICU units
(17%)
• Nursing/medical workforce shows a diminishing nursing shortfall but widespread non-
compliance with BAPM medical workforce standards
• A sustained reduction in term admission over the last 3 years • 27% of term admissions have a length of stay < 24h (range between units of 20-41 %) • Reduction in out-of-ODN postnatal transfers into C&M by 25%
CM specific recommendation
• Re-distribution of cot designation at STHK and LNP-AHCH. Changes to IC/HD/SC configuration only and not total cot numbers.
(Addditional recommendations are incorporated within the joint Key Recommendations shown
on page 7)
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8. Lancashire & South Cumbria Activity & Workload
8.1 LSC Activity by Level of Care
Table 8.1 and 8.1a show the total care level days by unit and across the LSC locality. XA04Z care if delivered in TC is not included.
HRG 2016 XA01Z XA02Z XA03Z + XA04Z + XA05Z Total
Unit Name 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
BTH 328 155 282 804 509 606 3,088 2,551 3,252 4,220 3,215 4,140
ELHT 1,457 1,663 2,230 2,418 2,207 1,721 5,285 5,005 4,398 9,160 8,875 8,349
LTHTR 1,612 1,307 1,211 1,563 1,582 1,711 4,568 4,296 3,682 7,743 7,185 6,604
MBHT – FGH 11 22 17 25 15 26 759 763 687 795 800 730
MBHT – RLI 95 112 100 410 358 469 2,029 1,933 1,589 2,534 2,403 2,158
Total 3,503 3,295 3,840 5,220 4,671 4,533 15,729 14,548 13,608 24,452 22,478 21,981
Table 8.1
8.2 LSC Activity as a % of locality activity by level of care
HRG 2016 XA01Z % XA02Z % XA03Z + XA04Z + XA05Z Total %
Unit Name 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
BTH 9% 5% 7% 15% 11% 13% 20% 18% 24% 17% 14% 19%
ELHT 42% 51% 58% 46% 47% 38% 34% 34% 32% 37% 39% 38%
LTHTR 46% 40% 32% 30% 34% 38% 29% 30% 27% 32% 32% 30%
MBHT – FGH 0% 1% 0% 0% 0% 1% 5% 5% 5% 3% 4% 3%
MBHT – RLI 3% 3% 3% 8% 8% 10% 13% 13% 12% 10% 11% 10%
Total 100% 100% 100% 18/19 19/20 100% 100% 100% 100% 100% 100% 100%
Table 8.2
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8.3 LSC Activity and workload
8.3.1 LSC NICU Activity and Workload Data
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review
(2019) all NICUs should, as a minimum, look after at least 100 very low birth weight (VLBW) infants per year
and be delivering >2000 intensive care days (Health Resource Group definition, 2016 & BAPM Optimal
Arrangements for Neonatal Intensive Care Units in the UK, 2021).
LNU Unit
Intensive Care HRG XA01Z
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions (Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
ELHT 1,457 1,663 2,230 3,500 3,346 3,641 113 100 73
LTHTR 1,612 1,307 1,211 2,920 2,657 2,513 91 80 77
Table 8.3.1
8.3.2 LSC LNU & SCU Unit Activity and Workload Data
In-line with the recommendations included as part of the Neonatal Critical Care Transformation Review
(2019) all LNUs should aim to undertake a minimum of 500 days of combined intensive and high dependency
care, which is the minimum requirement to maintain expertise. LNUs providing ongoing HD should be
working towards delivering 1000 combined ITU/HD days per year, in the longer term (i.e. 5 years from
publication of NCCR in 2019). Units designated as LNUs should also admit >25 infants annually (BAPM Optimal
arrangements for Local Neonatal Units and Special Care Units in the UK, 2016).
LNU Unit
IC & HD HRG XA1Z & XA02Z
Respiratory support days (Ventilation/CPAP/HFT)
VLBW admissions (Less than 1500g)
18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21
BTH 1,132 664 888 928 544 530 48 30 40
MBHT - FGH (SCU) 36 37 43 23 33 36 9 17 18
MBHT - RLI 505 470 569 422 422 524 35 27 32
Table 8.3.2
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8.4 LSC Cot Activity
Table 8.4 shows the demand (D) for cots based upon activity within each of the providers against actual (A) cots. Care Levels are based upon HRG 2016 codes.
Calculation method which include 80% capacity: Cot Demand = (Number of care days/365)/0.8 as it is a leap year
Lancashire & South Cumbria Cots D: Demand , A: Actual
D
IC
18/19
D
IC
19/20
D
IC
20/21
A
IC
20/21
D
HD
18/19
D
HD
19/20
D
HD
20/21
A
HD
20/21
D
SC
18/19
D
SC
19/20
D
SC
20/21
A
SC
20/21
Total
D
18/19
Total
D
19/20
Total
D
20/21
Total
A
20/21
BTH 1.1 0.5 1.0 2 2.7 1.7 2.1 2 10.5 8.7 11.1 12 14.3 10.9 14.2 16
ELHT 5.0 5.7 7.6 6 8.3 7.5 5.9 8 18.0 17.1 15.1 20 31.3 30.3 28.6 34
LTHTR 5.5 4.5 4.1 6 5.3 5.4 5.9 8 15.6 14.7 12.6 14 26.4 24.6 22.6 28
MBHT - FGH 0.0 0.1 0.1 0 0.1 0.1 0.1 0 2.6 2.6 2.4 4 2.7 2.8 2.6 4
MBHT - RLI 0.3 0.4 0.3 1 1.4 1.2 1.6 2 6.9 6.6 5.4 7 8.6 8.2 7.3 10
Total 12 11 13 15 18 16 16 20 54 50 47 57 84 77 75 92 Key: Short by 1 or more cot = Red, over by 1 or more cot = Yellow Table 8.4
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8.5 Lancashire & South Cumbria – Summary
Dr Richa Gupta, Clinical Lead for LSC & Catherine Nash, Lead Nurse for LSC
Summary
• Overall livebirths in LSC are 4% less in 2020-2021 than the previous year (2019-2020);
marginally less than 3.6% decrease in livebirths for England & Wales
• Proportion of first admissions is the same (9%), but actual numbers of babies admitted is
11% less than previous year
• First admissions of preterm babies 25-26 weeks and 34 and 37 weeks is reduced over the
whole NWNODN, although fluctuation in term admissions and increases in 20/21, rather
than reductions, at some units
• 92% of <27week gestation babies were born in a NICU – indicating robust antenatal/ in-utero
pathways
• Significant reduction in out of area admissions especially from Yorkshire and Humber
• Significant reduction in VLBW admissions (<1500g) in both NICUs – to 73 at LTH and 77 at
ELTH; 25% less than recommended 100 VLBW admissions per year.
• Significant variance between IC days in ELTH NICU (3641) and LTHTR NICU (2513) despite
similar numbers of VLBW babies admitted.
• Medical staffing not meeting BAPM recommendations and nurse staffing not BAPM
compliant at all LSC units
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Appendix 1: Out of Area Activity Base
LHB Code Welsh - LHB Name LHB Code Welsh - LHB Name
7A1 Betsi Cadwaladr University LHB 7A5 Cwm Taf LHB
7A2 Hywel DDA University LHB 7A6 Aneurin Bevan LHB
7A3 Abertawe Bro Morgannwg University LHB 7A7 Powys Teaching LHB
7A4 Cardiff & Vale University LHB
Q76 - North Midlands Q77 - West Midlands
CCG Code
CCG Name CCG Code
CCG Name
03Y NHS HARDWICK CCG 05A NHS COVENTRY AND RUGBY CCG
04E NHS MANSFIELD AND ASHFIELD CCG 05C NHS DUDLEY CCG
04J NHS NORTH DERBYSHIRE CCG 05F NHS HEREFORDSHIRE CCG
04K NHS NOTTINGHAM CITY CCG 05J NHS REDDITCH AND BROMSGROVE CCG
04L NHS NOTTINGHAM NORTH AND EAST CCG 05L NHS SANDWELL AND WEST BIRMINGHAM CCG
04M NHS NOTTINGHAM WEST CCG 05R NHS SOUTH WARWICKSHIRE CCG
04R NHS SOUTHERN DERBYSHIRE CCG 05T NHS SOUTH WORCESTERSHIRE CCG
04Y NHS CANNOCK CHASE CCG 05Y NHS WALSALL CCG
05D NHS EAST STAFFORDSHIRE CCG 06A NHS WOLVERHAMPTON CCG
05G NHS NORTH STAFFORDSHIRE CCG 06D NHS WYRE FOREST CCG
05N NHS SHROPSHIRE CCG 15E NHS BIRMINGHAM AND SOLIHULL CCG
05Q NHS SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CCG
15E NHS Birmingham and Solihull CCG
05V NHS STAFFORD AND SURROUNDS CCG 05W NHS STOKE ON TRENT CCG 05X NHS TELFORD AND WREKIN CCG
15M NHS DERBY AND DERBYSHIRE CCG
Q72 - Yorkshire & Humber
CCG Code
CCG Name CCG Code
CCG Name
02N NHS AIREDALE, WHARFEDALE AND CRAVEN CCG 03H NHS NORTH EAST LINCOLNSHIRE CCG
02P NHS BARNSLEY CCG 03J NHS NORTH KIRKLEES CCG
02Q NHS BASSETLAW CCG 03K NHS NORTH LINCOLNSHIRE CCG
02R NHS BRADFORD DISTRICTS CCG 03L NHS ROTHERHAM CCG
02T NHS CALDERDALE CCG 03M NHS SCARBOROUGH AND RYEDALE CCG
02W NHS BRADFORD CITY CCG 03N NHS SHEFFIELD CCG
02X NHS DONCASTER CCG 03Q NHS VALE OF YORK CCG
02Y NHS EAST RIDING OF YORKSHIRE CCG 03R NHS WAKEFIELD CCG
03A NHS GREATER HUDDERSFIELD CCG 13Q NATIONAL COMMISSIONING HUB 1
03E NHS HARROGATE AND RURAL DISTRICT CCG 15F NHS LEEDS CCG
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Appendix 2: Medical Staffing Review in LNUs and SCUs
A Review of Medical and ANNP Workforce in LNUs and SCUs in the NWNODN (March 2021)
Dr. Nim Subhedar, Neonatologist, Clinical Lead, Cheshire & Merseyside
Background
A skilled medical and nursing workforce is essential for delivery of high-quality neonatal care. Standards
relating to medical staffing were originally published in 2009 and recent recommendations were made
specifically for LNU/SCU staffing in 20181. A survey of workforce in September 2019 revealed a large
proportion of shifts below rostered level at tier-1 and tier-2 and significant reliance on locum cover2. Non-
compliance with national standards was high with fewer than half of LNUs/SCUs meeting out-of-hours
staffing recommendations. However, there is little robust local network-level data. A C&M medical/ANNP
workforce review in October 2016 showed the majority of local neonatal units in C&M were non-compliant
with national standards at tier-1 and 2 levels. Similarly, a more recent NWNODN GIRFT report showed that
fewer than 10% of network units were BAPM-compliant and that the North-West was one the most poorly
ranked networks for medical workforce3.
Aim
The purpose of this review was to re-assess compliance against BAPM standards across all NWNODN LNUs
and SCUs.
Methodology
A link to an online survey (Survey Monkey) was sent to all local neonatal unit clinical leads in March 2021
(appendix 1) with a request to complete a snapshot survey of medical/ANNP workforce in their unit. The
findings were collected and collated by the NWODN team. Compliance was assessed against the BAPM
2018 LNU/SCU standards (summarised in appendix 2).
1 Toolkit for High Quality Neonatal Services (DH, 2009); A Framework for Practice: Optimal arrangements for LNUs and SCUs in the UK including guidance on staffing (BAPM, 2018). 2 A Snapshot of Neonatal Services and Workforce in the UK (RCPCH, 2020). 3 Getting it Right First Time (NWNODN report, 2020).
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Key findings4
Unit Designation Tier 1
compliant? Tier 2
compliant? Tier 3
compliant?
Chester LNU No No Yes
Leighton LNU No No Yes
Macclesfield* LNU N/A N/A N/A
Ormskirk LNU No No Yes
Warrington LNU No No Yes
Whiston LNU No Yes Yes
Blackpool LNU No No Yes
Lancaster LNU No No Yes
Furness SCU Yes No Yes
North Manchester
LNU Yes Yes Yes
Stockport LNU No No Partial **
Tameside LNU No No Yes
Wigan LNU No Yes Yes
Wythenshawe LNU Yes No Partial***
* Macclesfield was not open throughout this period (2020/21)
** Not all consultants on-call have daytime neonatal unit commitments
***24/7 separate consultant rota, but 1:5 on call frequency
Comments
1. Only three units declared full compliance with tier-1 staffing with 24/7 dedicated availability to the
neonatal service, although many other units were partially-compliant in that dedicated tier-1 staff
were available on weekdays/daytime, but not out-of-hours.
2. Four units declared full compliance against tier-2 standards and the rest were partially-compliant
with dedicated tier-2 staff being available at least for weekday/daytime duties.
3. Two units (Wythenshawe and NMGH) were able to deliver a totally separate neonatal tier-3 rota.
Units typically each had one or two consultants who declared a special interest in neonatal
medicine; one unit had five such consultants (Wythenshawe).
4. All units had NIPE-trained midwives contributing to newborn examinations.
Summary
In this self-reported survey, there was generally poor compliance among NWNODN LNUs with current
BAPM medical/ANNP workforce standards, particularly at tier-1 and tier-2 levels.
Only one unit declared full compliance against all tier-1, 2 and 3 standards.
4 Two units (Macclesfield and Furness) are designated SCUs; all others are LNUs. Activity in all LNUs was below 1000 respiratory care days and <400 IC days in 2020/21.
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Units were least compliant against tier-1 standards where immediate availability of dedicated staff is
required 24 hours a day. This was presumed to be the consequence of out-of-hours cross-cover
arrangements with the paediatric service.
The questionnaire also asked for information about ongoing work towards achieving compliance. Several
units reported initiatives including recruitment of ANNPs and overseas doctors through MTIs to support
tier-1 and tier-2 neonatal rotas as well as APNPs to support the paediatric service, releasing shared staff for
neonatal duties. Some units had bids/plans in place to augment their consultant workforce and increase
tier-3 availability.
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Appendix A: NWNODN medical/ANNP LNU/SCU workforce survey questions
Tier-1 1. Do you have immediately available at least one resident Tier 1 practitioner (ANNP/ Doctor) dedicated to providing emergency care for the neonatal service at all times, day/night? 2. If the answer to Q1 is no, how many hours a week is there a Tier 1 practitioner dedicated solely to covering the neonatal unit?' 3. Do you have midwives trained in delivering NIPE assessment? If not, is this the sole responsibility of the tier 1 doctor or ANNP? Tier-2 4. Do you have an immediately available resident Tier 2 practitioner (ANNP/ SPR-grade doctor) dedicated solely to the neonatal service, 24/7? 5. Do you have an immediately available resident Tier 2 practitioner (ANNP/ SPR-grade doctor) dedicated solely to the neonatal service in the daytime (between approx. 09.00-22.00), 7 days a week? 6. If the answer to Q5 is no, how many hours a week is there a Tier 2 practitioner solely dedicated to covering the neonatal unit? Tier-3 7. Do you have a separate, Tier-3 consultant rota dedicated solely to the neonatal unit 24/7? 8. If the answer to Q7 is no, how many hours a week is there a consultant solely dedicated to covering the neonatal unit?' 9. Day time Tier-3 rota: a. How many consultants contribute to Tier-3 cover (total number)? b. How many of these consultants have a declared special interest in neonatology? 10. Night-time tier-3 rota: a. What is the frequency of the (neonatal cover) Tier-3 on-call rota? b. How many consultants contribute to Tier-3 cover (total number)? c. How many of these consultants have a declared special interest in neonatology? d. Do all consultants covering the neonatal at night also have daytime commitments to the neonatal unit?
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Appendix B
BAPM Standards (2018) - Optimal Arrangements for LNUs and SCUs
Tier 1 LNU SCU
Standard 1 Immediately available at least one resident Tier 1 practitioner dedicated to providing emergency care for the neonatal service 24/7.
SCUs should provide a resident Tier 1 practitioner dedicated to the neonatal service in day-time hours on weekdays and a continuously immediately available resident Tier 1 practitioner to the unit 24/7. This person could be shared with a co-located Paediatric Unit out of hours if this does not reduce quality of care delivery and safety to the neonatal unit assessed using national standards
Standard 2 Provision of newborn infant physical examination should not be the sole responsibility of this individual and midwives should be trained to deliver this aspect of care.
SCUs delivering higher than recommended activity levels should provide a dedicated Tier 1 practitioner as required for LNUs
Standard 3 In large LNUs (>7000 births) there should be two dedicated Tier 1 practitioners 24/7 to support emergency care.
In stand-alone SCUs without co-located paediatric services this resident Tier 1 practitioner would be dedicated to the neonatal service alone
Tier 2 LNU SCU
Standard 1 LNUs should provide an immediately available resident Tier 2 practitioner dedicated solely to the neonatal service at least during the periods which are usually the busiest in a co-located Paediatric Unit e.g. between 09.00-22.00, seven days a week .
SCUs should provide a resident Tier 2 to support the Tier 1 in SCUs admitting babies requiring respiratory support or of very low admission weight <1.5kg. This Tier 2 would be expected to provide cover for co-located paediatric services but be immediately available to the neonatal unit.
Standard 2 LNUs undertaking either >1500 RCDs or >600 IC days annually should have immediately available a dedicated resident Tier 2 practitioner separate from paediatrics 24/7.
SCUs delivering higher than recommended activity levels should provide a Tier 2 practitioner as required for similar activity levels in LNUs.
Tier 2 LNU SCU
Standard 3 LNUs undertaking either >1000 RCDs or >400 IC days annually should strongly consider providing a 24/7 resident Tier 2 dedicated to the neonatal unit and entirely separate from paediatrics; a risk analysis should be performed to demonstrate the safety, timeliness and quality of care delivery to both paediatrics, delivery suite, maternity unit and neonatal services if the Tier 2
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is shared at any point 24/7 in these units. Considerations should include the level of activity of any Paediatric Unit including peak activity times and the geography of the site including the location of A&E and the Paediatric wards.
Standard 4 The Tier 2 should be immediately available at all times to the neonatal unit and the labour ward. If the site of the paediatric unit makes this immediate response impossible separate Tier 2 rotas are required.
Tier 3 LNU SCU
Standard 1 Units designated as LNUs providing either >2000 RCDs or >750 IC days annually should provide a separate Tier 3 consultant rota for the neonatal unit.
In SCUs there should be a Lead Consultant for the neonatal service and all consultants should undertake a minimum of continuing professional development (equivalent to a minimum of eight hours CPD in neonatology).
Standard 2 LNUs providing >1500 RCDs or >600 IC days annually should strongly consider providing a dedicated Tier 3 rota to the neonatal unit entirely separate from the paediatric department; a risk analysis should be performed to demonstrate the safety & quality of care if the Tier 3 is shared with paediatrics at any point in the 24 hours in these LNUs.
Standard 3 All LNUs should ensure that all Consultants on-call for the unit also have regular weekday commitments to the neonatal service. This is best delivered by a ‘consultant of the week’ system and no consultant should undertake <4 ‘consultant of the week’ service weeks annually.
Standard 4 No on-call rota should be more onerous than one in six and all new appointments to units with separate rotas should either have a SCCT in neonatal medicine or be a general paediatrician with a special interest in neonatology or have equivalent neonatal experience and training.
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Working together to provide the highest standard of care for babies and families
NORTH WEST NEONATAL OPERATIONAL DELIVERY NETWORK
Contact us:
@NWNeonatalODN
www.neonatalnetwork.co.uk
Working together to provide the highest standard of care for babies and families