To provide a safe, high quality service for neonatal care workloads across the Network region, and seek to improve outcomes for all babies born and cared for within it
To maintain a framework for demonstrating the attainment of minimum quality standards, the implementation of continuous quality improvement, and adequate risk management in special and intensive neonatal care across the region
In collaboration with the Region’s Specialist Commissioners at NHS England, to agree the appropriate allocation of capital and revenue for neonatal care across the Network.
The Northern Neonatal Network is one of the largest of the neonatal networks in England in terms of geographical area covered. It stretches from the borders of Cumbria and Northumberland down past the Tees valley into North Yorkshire, where it meets the Yorkshire & Humber Neonatal Network. There are a total of 11 units within the Network. Four of these are designated as Level 3 or Neonatal Intensive Care (NICU), and seven are designated as Level 1 or Special Care Units (SCUs).
All eleven neonatal units work collaboratively with the Network and it’s dedicated neonatal transfer service (“NNeTS”) to cater for a population of over 3 million people with an annual birth rate of approximately 33,000 and annual admissions to our Units of about 3500. It covers all Local Authorities in the North East and North Cumbria and care is provided on the 11 sites by nine different NHS Foundation/Acute Hospital Trusts.
Northern Neonatal Network – Our Strategy and Vision
The Northern Neonatal Network was formally constituted as a Managed Clinical Network in early 2010 and initially built on a “Strategy Document” that had been drafted in July 2008. This set out the priorities and direction of travel for the Network and how it would operate, including its operational Terms Of Reference (TOR). A review of this document was then undertaken at the end of the Network’s first year and was subsequently ratified by the Network Board in April 2011. The TOR are periodically reviewed to take account of changing Board membership and revised/updated as required, but the latest version can be found here.
Following this review, a further piece of work was undertaken by the Network in 2012 to focus on the collective Network vision for the future of neonatal services across the North East of England and North Cumbria. This was led by Dr Steve Byrne (Network Clinical Lead at the time) and was drafted to take account of the current and anticipated changes across the NHS and associated services within Paediatrics and Obstetrics/Midwifery. This revised Network Strategy set out the clinical consensus for how services needed to be configured, with an emphasis on the future viability and sustainability of neonatal intensive care. This was agreed and ratified by the Network Board in October 2012 and recommended that the four Neonatal Intensive Care Units (NICUs) needed to be reduced in number.
Further work was undertaken on progressing this strategy which culminated in a recommendation to the Network Board that an external review should be undertaken of NICU services as no consensus on a suitable agreement between the respective Provider Trusts could be reached. A panel from the Royal College of Paediatrics & Child Health (RCPCH) undertook a comprehensive independent expert review during early 2015 at the request of NHS England who commissioned them to produce a Report with suitable recommendations. This was subsequently published in August 2015 and can be found here.
Following this Report, the Network has been busy supporting the Trusts to move towards implementing the recommendations which will see the number of NICUs reduce to three in the long term with new patient pathways to enable the care of the most premature babies less than 26 weeks gestation to be focused at Newcastle and Middlesbrough. This will enable safe, sustainable and high quality neonatal care to be maintained throughout the North East of England and North Cumbria.
The Network has agreed patient pathways that should be followed to ensure babies are cared for at the most appropriate Unit according to their needs. We attempt to audit these on an annual basis and feed back the results at Board level to highlight compliance and any potential outliers and areas for action. These have recently been revised to take account of the changes due to reconfiguration and the latest set of agreed pathways can be found here.
An Annual Workplan is drafted each year to highlight the main priority areas that the Network intends to focus on in the coming 12 months. It outlines the aims and objectives against these areas and provides a means to let the Network demonstrate it’s worth and by agreed audit and other measures, performance managed against them. The Annual Work Plan for 2017-18 was been ratified by the Network Board and can be found here.
The Network has a comprehensive Governance Framework that has been agreed by the Network Board and seeks to demonstrate that the care given within the Network maximises the quality and minimises any potential harm to babies and their families in all 11 of our NICU/SCBUs. First drafted and signed off in July 2015, this Framework is largely based on a template that was made available nationally to Operational Delivery Networks and been adapted to meet our own needs. It remains a work in progress and is revised and updated as required.
The whole Network Governance Framework consists of several documents that are complimentary and includes the Network Board ToR, the Service Level Agreement in place between the Network and its host Provider Trust (City Hospitals Sunderland NHS Foundation Trust) a general Framework document and a more detailed “Toolkit” document that summarises our performance on key criterion via a self-assessment and evaluation process that is periodically revisited. The latter two can be found here and here.
The Network also maintains a “Risk Register” to outline key issues that are assessed and highlighted for any possible or potential action required.
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Network Clinical Governance
The Network has an established and well-defined programme for discussing and reviewing issues relating to Clinical Governance. We facilitate quarterly Network meetings that focus on two main areas;
- Learning outcomes that have arisen as a result of baby death reviews at each Trust/Unit in the previous quarter following a Multi Disciplinary Team (MDT) meeting. Clinicians and senior nurses/managers also present recent “cases of interest” that are anonymised and then discussed in a peer review environment. This allows for dissemination of “lessons learned” across all our Units and where appropriate or necessary, further work to be undertaken, such as drafting new guidelines or agreeing standardised approaches to care if/where appropriate. This also meets the aims of a plan that was agreed with NHS England to try and improve mortality rates as reported in the annual MBRRACE-UK reports. All Units are expected to feed back their learning outcomes for wider dissemination and present cases from time to time.
- There are also opportunities to focus on other clinical governance issues, actions taken in response to local incidents (including Serious Untoward Incidents – SUIs) with action points collated and shared across the Network.
In addition, the Network also operates a “rapid response” system for Clinical Governance above and beyond local/Trust policies so that serious issues and/or untoward incidents can be communicated via the Network to enable an update to be sent to all Units, providing them with information so they can undertake internal reviews and thus minimise the risk of further re-occurrence.
The Board of the Northern Neonatal Network meets on a quarterly basis to discuss the latest issues affecting the Network and make decisions based on a consensus approach in the best interests of our babies, their families and our Stakeholders.
Representatives from across the Network’s Provider Trusts, the Network Officers and other key professionals and lay parent representatives make up the Board, as per the ToR found in the “Network Strategy and Vision” section.
The dates for the meetings for 2019 are as follows;
Tuesday January 22nd
Wednesday April 24th
Tuesday July 16th
Tuesday October 15th
All these meetings are scheduled to run from 1400-1600 and take place at The Durham Centre, Belmont, Durham, DH1 1TN.
Minutes are ratified at subsequent Board meetings and once agreed, are uploaded and available here. These are archived on a rolling 12-month basis and can be viewed by clicking on the links below.