Authors' objectives: The aim of this proposed research is to understand national neonatal care demand and to investigate configurations of service that best meet the needs of both service providers and parents. Organisation of neonatal care is complex. Hospitals work together in networks to provide care and different levels of care are provided in different locations. An infant may receive intensive care at a central hub hospital but then receive lower levels of care at a hospital closer to home. Network boundaries may affect where their infants receive care; care will frequently be sought first within a designated network before looking for care outside of the network. It is possible that some parents who live near network boundaries may end up travelling further than if all cots were equally available to their infant(s). There are competing aims in organisation of neonatal care. Centralisation of services has potential benefits, for example: 1) increasing the throughput (the number of infants seen by a unit each year) leads to increased specialism and expertise which is expected to benefit the infant, and 2) reduction in the spare capacity needed to deal with peaks and troughs in workload. Centralisation of services will however increase average distances that parents must travel to the point of care. Using the simulation model we plan to look at how increased centralisation might affect both throughput and travel distances in different parts of the country. We will look at the effect of changing the number or type of units, and also look at methods for identifying the best locations for units if there are a limited number of units (or a limited number of a particular type of unit). This part of the modelling will also incorporate all birth episodes (not just those requiring neonatal care) so that potential effects on both maternity and neonatal services and examined side by side. In order to better understand these-trade-offs we have previously developed a computer simulation model that mimics the behaviour of a regional network of neonatal care. In the model we can change either the number of units, or the type of unit (what level of care it is able to provide). We can change either the number or type of cots, or change the number of nurses (the unit may then close to new admissions when full, increasing the travel distance of the rejected infant). We plan to expand this model to a national model to enable a national and multi-network analysis. As well as increasing the geographic coverage we intend to develop stronger models on the effect of service reconfiguration on health and economic outcomes. In our regional model we found that there was little information on what contributes to the cost of neonatal care. We would like to strengthen that part of our understanding, so as we look at different configurations of service (e.g. increased centralisation) we are better able to understand how total costs change. We intend to explore the contributing costs in four different types of unit, and also use the data from a recent BLISS survey of parents to better predict the costs to the parents of care and investigate how that is likely to change with increase centralisation. We believe that developing the understanding outlined above will inform the planning of both neonatal and maternity services, and inform a wider debate on centralisation of healthcare services.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/141908

Year Published: 2015

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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