NORTH WEST NEONATAL OPERATIONAL DELIVERY NETWORK

NWNODN Neonatal Activity, Demand, and Capacity Report 2020-21 SMT Version 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


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


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


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


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.

https://www.neonatalnetwork.co.uk/nwnodn/wp-content/uploads/2020/06/PD-ODN-06-Cot-Base-Guideline.pdf

https://www.neonatalnetwork.co.uk/nwnodn/wp-content/uploads/2020/06/PD-ODN-06-Cot-Base-Guideline.pdf


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


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


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


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


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



Greater Manchester


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


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


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%


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


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 % of Live

births

2019/20 % of ≥ 37

births


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%


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


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


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



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


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




% <27/40 born in NICU 95% 90% 88%





% <27/40 born in NICU 78% 82% 83%

Lancashire & South Cumbria




% <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.


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


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


APH NICU 29 19 12

LNP – LWH* NICU 30 28 37


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



* 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.


Lancashire & South Cumbria Unit

category 2018-19 2019-20 2020-21


ELHT* NICU 34 26 18

LTHTR** NICU 20 23 15


BTH LNU 9 2 1

MBHT - FGH SCBU 0 1 2

MBHT - RLI LNU 1 1 0



*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

https://www.rcpch.ac.uk/resources/national-neonatal-audit-programme-annual-report-2020-2019-data

https://www.rcpch.ac.uk/resources/national-neonatal-audit-programme-annual-report-2020-2019-data


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%


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


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



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


3.3.3 NWNODN SCU Unit Activity

SCU




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


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


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


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


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


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


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%


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%


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


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


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%


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%


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%


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.


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


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%


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%


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%



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


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%


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%


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


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


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%


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%


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


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


19/20


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


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


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 (West Midlands) 2 129 4 0 0



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 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.


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


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.


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


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


XA02Z days


XA03Z, 04Z &

05Z days

XA03Z+XA04Z+ AZ05Z as % of Unit total

Total days % Total


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%


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


Table 4.5.2 shows the NNU cot demand based on the Midlands activity in table 4.5.1.




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


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


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


XA02Z days


XA03Z+ 04Z+05Z

days

XA03Z+04Z +05Z as % of

Unit Total Total days % Total


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%


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


Table 4.6.2 shows the NNU cot demand based on Yorkshire & Humber activity in table 4.6.1.



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


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


XA02Z days


XA03Z+ 04Z+05Z

days

XA03Z+04Z+ 05Z as % of Unit Total

Total days % Total


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




MFT – SMH 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0


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


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


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


*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


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


Chart 5.3.2

Chart 5.3.3


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


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


Overall Shortfall 2021.

% of In Post to reach WTE Neonatal Nursing WF Tool(2020)

Chart 5.4.1

Chart 5.4.2


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).


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


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


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)


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


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




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


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


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


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


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.


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


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


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


3. Advanced ventilation support (Jet or Oscillatory ventilation)


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


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


(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


Respiratory support days

(Ventilation/CPAP/HFT)


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)


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


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



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


See Appendix 1 for Cot activity against BAPM 2011 categories of care


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)


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.


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


8.3 LSC Activity and workload

8.3.1 LSC NICU Activity and Workload Data


(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


LNU Unit

Intensive Care HRG XA01Z



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


(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




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


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



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


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


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).


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.


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.


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?


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


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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