New report shows unacceptable variation in neonatal care

This includes ensuring the right resources are there so services can deliver good care, while collecting and analysing data to find out where improvements are needed.

To have the best chance of survival and a good quality of life, babies born too early or with other extra health needs must be cared for in a neonatal intensive care unit (NICU) after birth, with the best quality clinical care and the right number of specialist staff.

But the National Neonatal Audit Programme (NNAP), published on 12 October 2023, reveals a wide variety in the quality and availability of neonatal care in different parts of the UK.

Neonatal care is organised into ‘neonatal networks’ with nearby hospitals working together. As well as national data, NNAP reports on the standard of care that is delivered by these neonatal networks. Their report shows unacceptable variation in care between networks.

The report shows how a crisis in recruiting and keeping staff in the NHS is affecting outcomes for families whose babies need extra care to live, and the crisis is getting worse.

Rob Wilson, Head of the Sands and Tommy’s Joint Policy Unit, says: 

“We have repeatedly raised concerns that the Government is off-track to meet its 2025 target to halve the rate of babies dying in England relative to 2010. Ensuring services are delivering optimal care is critical to meet that target and save more babies’ lives.

“Our Progress Report, published earlier this year, described how antenatal, maternity and neonatal care that does not meet nationally-agreed standards is contributing to deaths that could and should be avoided. This requires a much stronger commitment from Government, to put in the resources required to improve care for all." 

The NNAP report shows:

• Across the UK, 6.5% of babies admitted to a NICU who were born before 32 weeks sadly died before they could leave the unit
• The rate of lives lost ranged from 4.8% to 8% across different neonatal care networks: an unacceptable difference between different areas
• On average, there were not enough neonatal nurses available in units on almost a third of shifts across the year. The number of shifts not meeting recommended staffing has increased every year for 3 years 
• 1 in 5 babies born before 27 weeks were not born in a hospital with an onsite NICU
• In the worst performing neonatal networks, 67.6% of babies born before 27 weeks were born in a hospital with an onsite NICU, compared to 93.2% in the best performing networks

Our Pregnancy and Baby Charities Network partners at Bliss - the charity for babies born premature or sick - have also highlighted that the NNAP report shows little progress in how involved parents are with their baby’s care in NICU, even though we know babies have better outcomes and quality of life when their parents are partners in their baby’s care.

The report showed variation in parental involvement on NICU ward rounds, ranging from just 36.8% to 60.3% between neonatal networks.

Caroline Lee-Davey, Chief Executive of Bliss, said: 

“It is incredibly concerning that there continues to be such significant variation in the care that babies receive in neonatal care – with nurse staffing levels falling, some of the smallest babies still being born in a location unsuited to their needs, and parents facing barriers to being involved in their baby’s care.

“Overall this report highlights clear opportunities to deliver significantly improved outcomes for babies. Bliss urgently calls on governments and NHS bodies across the UK to tackle this variation to ensure that all babies in neonatal units receive the best quality care, wherever they live.”

More than 50,000 babies are born prematurely – before 37 full weeks of pregnancy – each year in the UK.

For more than 30 years our researchers have been working hard to find out the causes of premature birth and ways to predict it and prevent it, resulting in new tests and treatment which have helped save babies’ lives. Find out more about our premature birth research.