Neonatal intensive care unit services - demand and capacity modelling: final report

Executive Summary

Introduction and Aims

In 2017, the Scottish Government published ‘The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland’. The Best Start outlined a new model of neonatal service provision that suggests that care for the smallest and sickest babies should be consolidated to deliver the best possible outcomes. The plan emphasises parents as key partners in caring for their babies and aspires to keep mothers and babies together as far as possible, with services designed around them.

The implementation of the new model includes:

• Consolidation of neonatal intensive care unit (NICU) services into three designated NICUs for Scotland for pre-term, very low birth weight, and critically ill babies, based on evidence to support better outcomes.
• A new networked model of three NICUs working alongside local neonatal units (LNUs) and special care units (SCUs), supported by transitional and community care services; and
• Leveraging lessons learnt from successful transformation of neonatal services across the rest of the UK.

An important part of planning for the implementation stage of the model of care is the modelling of demand and capacity requirements. This report outlines this modelling approach, inputs, and interpretation of the outputs to support the future of NICU services. This aligns with the Best Start recommendations and focuses on the three regional NICU sites chosen for adoption in Scotland. To further support local implementation plans, this report also outlines a series of considerations for implementation that can be taken forward beyond this commission.

Approach

The approach to this work has included data collection and modelling alongside engagement with both operational and strategic stakeholders, to validate data, generate and test planning assumptions. Activity and capacity data was collected from each of the eight units included within the model scope, as well as Public Health Scotland (PHS) and Scottish Specialist Transport and Retrieval (ScotSTAR) / Scottish Ambulance Service (SAS).

The baseline data period is October 2022 to September 2023, and the model planning horizon is 2026/27^[1]. A series of change assumptions have been identified for inclusion in the model, including the process for identifying the smallest and sickest babies who will move in the future model of care, principles for the flow of babies between neonatal units, and operational assumptions to help predict the impact of changes on Neonatal and wider services.

High level findings and conclusions

Table A includes a breakdown of:

• Declared capacity (current available physical cot capacity, irrespective of utilisation / staffing).
• Baseline capacity requirement (capacity required to accommodate baseline activity levels); and
• Projected capacity requirement (the final predicted capacity required to meet activity to 2026/27, given the modelled flow of babies into and out of each unit).

For implementation planning a meaningful comparison can be made between baseline and projected capacity requirements, as these are both measures of the required staffed capacity to meet demand under the current and future model of care. A comparison against declared capacity is helpful in understanding any potential physical capacity constraints under the new model of care. Overall baseline capacity requirements are lower than current declared capacity (in total, by 23 cots across the eight units, with the biggest differences seen in early implementer sites where activity shifts are already reflected in baseline activity levels), future projection changes vary by site due to the flow of babies, with a small overall change due to a combination of population and incidence changes.

The largest projected increase in required capacity for the new model of care is for Royal Hospital for Children, Glasgow, with an overall increase of approximately 12 cots. This requirement may be mitigated through the use of additional capacity for neonates requiring high dependency or special care in either of the two LNUs within the Glasgow and Greater Clyde Health Board. The Simpson Centre, Edinburgh, and Aberdeen Maternity Hospital are projected to see increases in demand and required capacity, though at a lower level. Decreases in required future capacity are predicted for other sites, with the largest decrease seen at Wishaw, predominantly in intensive care (IC) capacity, and an overall increase in special care cots which will support the timely repatriation of babies in the new model of care. The projected impact at both Victoria Hospital, Fife, and Crosshouse, Kilmarnock, is minimal - these sites are already early implementers of the new model of care, and as such they would not expect to see significant additional shifts in activity beyond that already reflected in the baseline period.

Implementation considerations

As a part of the engagement with operational and strategic stakeholders throughout the modelling process, a range of feedback has been provided, that will need to be considered during the implementation of the future national model of care. This has been captured and summarised into four key themes: Workforce; Capacity and occupancy; NICU flows and repatriation; and Implementation enablers. Each of these themes and implementation considerations has been shared and refined during the final set of workshops with stakeholders and will be for consideration of Scottish Government and Regional Planning teams to take forward. Based on feedback the most pressing need will be for detailed consideration of workforce requirements, with this area significantly interlinking with capacity and NICU flows.

Limitations

Due to the compressed timeframes available for data collection, there have been differences in extraction approaches across units and variability in the quality and coverage of data received. These limitations have been mitigated where possible and also validated with stakeholders. A full list of data limitations and assumptions made can be found in Annex A. The scope of this report excludes existing LNUs and SCUs in Scotland, under the assumption that activity in these units will not change under the new model. A full analysis of maternity capacity was also not included within the remit of this commission, but the additional demand on the three future NICU sites has been estimated. Workforce requirements have been excluded from this exercise and will form part of ongoing regional implementation planning work.