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The National Toolkit for High Quality Neonatal Services—is it affordable?
  1. J Tooley1,
  2. B Suryanarayanan1,
  3. S Jones2
  1. 1NICU, St Michaels Hospital, Bristol, UK
  2. 2Department of Paediatrics, Royal University Hospital, Bath, UK

Abstract

Background/Aims The Department of Health has recently published the National Toolkit for High Quality Neonatal Services (setting new standards/principles of neonatal care within the NHS) The toolkit contains guidance on neonatal nurse staffing levels (including 1:1 nursing for intensive care patients) and provides a “Workforce calculator” spreadsheet which calculates necessary staffing levels using actual unit activity data. We aimed to determine the cost impact of these recommended nursing levels on our own network using the toolkit.

Abstract G175 Table 1

Methods Daily “cot data” are collected at midday from each neonatal unit within our network. Data collected includes the number of babies, the level of care they are requiring (intensive care (IC), high dependency (HD) or special care (SC)) and the actual numbers of nurses on each shift that day. Using the recommendations from the NHS toolkit (and workforce calculator) we analysed one complete year of data from each hospital and calculated the recommended number of nurses that should have been present on each shift and compared this to the numbers that were actually present (the number required is calculated as one nurse per IC baby, one nurse for 2HD babies and one nurse for 4SC babies (plus 1 supernumerary shift coordinator).

The table below demonstrates the number of nursing staff needed for two different activity levels:

  1. a) Average activity'ie, to cover the average number of babies on the unit over the year (provides the recommended nursing numbers on 50% of shifts)

  2. b) “The upper control limit”—which is a calculation derived from the workforce planner ensuring 99.7% of activity is covered (provides the recommended nursing numbers on 99.7% of shifts)

Conclusion The National Toolkit has set standards for neonatal nursing staffing levels. Achieving these will require substantial investment and nursing recruitment within our neonatal network alone. In order to achieve these standards (50% of the time) 71 new nurses would need to be appointed (approx cost £2.5 million per year). In order to achieve the standards using the workforce calculator (99.7% of the time) 266 new nurses would need to be employed (approx cost £9.3 million).

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