CSP Wales Office
1 Cathedral Road
Cardiff CF11 9SD
029 2038 24289
Briefing to Assembly Members on the Children and Young People Committee
REVIEW OF NEONATAL SERVICES
Introduction
The Chartered Society of Physiotherapy (CSP) in Wales is pleased to provide some written evidence to the Assembly Children and Young People Committee to inform the short inquiry into neonatal services.
Key points
· The CSP notes recommendation 1 of the Review undertaken by the Health and Social Services Committee in 2010 that
“Welsh Government should ensure that a review of capacity be undertaken by the All Wales Neonatal Network to include current staffing and activity trends”.
In relation to paediatric therapy service provision to neonatal units in Wales an audit was carried out across Wales, focussing on dietetic, occupational therapy, physiotherapy, psychology and speech and language therapy. (The full report can be found at appendix 1)
The audit identified how Health Boards comply with the standards of care identified by British Association of Perinatal Medicine (BAPM) and All Wales Neonatal Standards (AWNS).
Evidence from the audit showed that only 3 neonatal units comply fully with the AWNS standards in relation to physiotherapy and all others are either partially or non compliant with either the BAPM or AWNS standards across all therapies. CSP members report to the professional body that even some of the services that comply with the standards are not funded for neonatal units specifically. They are provided from generic paediatric physiotherapy service funding.
Although many units have access to paediatric therapy services, this has to be prioritised against other referrals.
The Society is concerned at the staffing levels available for neonatal services.
· The audit/recommendations for paediatric therapy service provision for neonatal units in Wales identified/suggested minimum levels for highly specialised therapy staffing within Health Communities and Health Boards in Wales.
These were based on factors including:
Ø BAPM standards for therapy staffing in Level 1, 2, 3 hospital neonatal units.
Ø The number of babies who require follow up therapy management in the community per year which is approximately 4-6 per ITU cot.
These numbers can be found in Table 4 of the full report.
To the Society’s knowledge, there has been no improvement in physiotherapy staffing levels.
· The audit also made a set of recommendations to the neonatal steering group:
Ø The audit of paediatric therapy service provision is circulated to health boards, including Directors of Therapy and Heath Services (DOTHS).
Ø Health Board therapy and neonatal teams should be asked to consider local priorities and work across health communities to develop, sustainable, high quality services that support local needs.
Ø Examples of good practice are shared across the network via the Welsh Therapy Advisory Committee (WTAC).
Ø Health Boards undertake a review of their services against the service model outlined and work towards developing services, across health communities that are in line with the recommended principles.
The CSP has heard of no progress with these recommendations to date.
Concluding remarks
The CSP is concerned that therapy provision in neonatal services does not meet All Wales Neonatal Standards or British Association of Perinatal Medicine (BAPM).
The profession hopes the Children and Young People Committee will pick this up as part of the review and encourage Welsh Government to address the staffing issues.
In conjunction with:
The All Wales Children and Young People Physiotherapy Managers Committee
Philippa Ford MCSP
CSP Policy Officer for Wales
07990 542436
September 2011
About the CSP and Physiotherapy
The Chartered Society of Physiotherapy is the professional, educational and trade union body for the UK’s 50,000 chartered physiotherapists, physiotherapy students and support workers. The CSP represents over 2,000 members in Wales.
Physiotherapists use manual therapy, therapeutic exercise and rehabilitative approaches to restore, maintain and improve movement and activity. Physiotherapists and their teams work with a wide range of population groups (including children, those of working age and older people); across sectors; and in hospital, community and workplace settings. Physiotherapists facilitate early intervention, support self management and promote independence, helping to prevent episodes of ill health and disability developing into chronic conditions.
Physiotherapy delivers high quality, innovative services in accessible, responsive and timely ways. It is founded on an increasingly strong evidence base, an evolving scope of practice, clinical leadership and person centred professionalism. As an adaptable, engaged workforce, physiotherapy teams have the skills to address healthcare priorities, meet individual needs and to develop and deliver services in clinically and cost-effective ways. With a focus on quality and productivity, physiotherapy puts meeting patient and population needs, optimising clinical outcomes and the patient experience at the centre of all it does.
Appendix 1 – Full Report
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AUDIT/ RECOMMENDATIONS for PAEDIATRIC THERAPY SERVICE PROVISION TO NNU IN WALES NEONATAL NURSING & THERAPIES SUBGROUP WELSH NEONATAL NETWORK |
1. INTRODUCTION
The purpose of this paper is to identify current paediatric therapy provision within the Welsh Neonatal Network and to compare stated provision with the standards set down by the British Association of Perinatal Medicine (BAPM) and the Children & Young People’s Specialists Healthcare Services documents (CYPSS). This paper will also make outline recommendations for bridging the gap between current service provision and described Standards.
2. BACKGROUND
Over the last 20 years there has been an increased demand demonstrated for the provision of therapy services to care for the developing preterm infant. As medical and nursing management has become more advanced, increasing numbers of preterm babies are surviving the neonatal period. However, despite state of the art medicine, nursing care and technology, neuro-developmental or physical impairment can be a major consideration for some of these babies and young children.
It has been shown that these patients have improved outcome when they are managed by a clinical network of multi-disciplinary professionals from primary, secondary and specialist care working in a co-ordinated manner in order to ensure equitable provision of high quality and clinically effective services.
BAPM Standards for Hospitals Providing Neonatal Care (2010) –
Standard 6.1, specialist dieticians have a major role in assessing and improving the nutrition of premature infants and data exists that documents the benefit of including a neonatal dietician within a NNU team for nutritional support.
Standard 6.2 states that neonatal occupational therapists and neonatal physiotherapists, with the appropriate skills, knowledge base and experience to provide developmental based neurological behavioural assessment and follow-up of high risk infants, are vital in the event of an early diagnosis.
Standard 6.3 identifies that a specialist speech and language therapist is a key member of the multi-disciplinary NNU team with a unique role of the assessment and management of infant feeding and swallowing.
Standard 6.5 reflects that all parents whose babies are admitted to a neonatal unit suffer stress, they may experience significant trauma with the possibility of post traumatic stress symptoms. All parents should have access to a trained clinical psychologist specialising in neonatal care.
All Wales CYPSS standards (2008) are less specific in the provision of therapy services to neonatal patients .Standard 3.5 states that support services including dietetics, therapy, physiotherapy and speech and language therapy should be readily available to neonatal patients , within a timescale of 1-3 years. It further indicates that all therapists caring for neonates should have a shared knowledge base and competencies in the highly specialist area of NICU. Therapists providing neonatal care should be experience in neonatal care and capable of providing network support in complex neonatal and surgical patients.
3. AUDIT OF CURRENT THERAPY STAFF PROVISION IN WELSH NEONATAL UNITS
Table 1 contains Information that has been provided by therapy managers in Wales via the WTAC, All Wales Therapy Managers Committees and an expert reference group. Audit information has also been provided via the nursing and therapies sub group of the Welsh Neonatal Network.
(i) BAPM Standards for Hospitals providing neonatal care
It can be seen that most neonatal units in Wales did not comply with the BAPM Standards for Allied Health Professionals, in particular for dietetic provision, where BAPM standards specify staffing levels equivalent to 0.01 to 0.05 WTE dietitians per ITU cot.
Only two Level 3 NNU units reported that they are able to provide care from designated neonatal therapists who are funded and trained to the level of competency as described in BAPM document.
(ii) All Wales Neonatal Standards CYPSS.
Whilst a number of therapy services in Wales report that they will accept patient referrals from neonatal units, only two have dedicated neonatal provision, see Table 2. This means that neonatal referrals to generic paediatric therapy services will need to be prioritised against all other referrals from paediatric areas within the LHB.
Table 1 also demonstrates that whilst many of the neonatal units in Wales partially comply with the CYPSS Neonatal Standards, this does not reflect their vulnerability in terms of sustainable service provision. There is also no indication that the services provided are highly specialist and that the therapy staff are trained to the level of competency as described in both Standards document.
The therapies expert reference group were also asked to give a brief description of individual therapy service links/ communication channels / joint working between the different levels of neonatal units in each LHB, and importantly how the transfer of babies into community therapy services currently functions in each health community. Table 3 contains comments from different therapy services in Wales.
4. MINIMUM RECOMMENDED SPECIALIST THERAPY STAFFING LEVELS
Table 4 identifies suggested minimal levels for highly specialist therapy staffing within Heath Communities and Health Boards in Wales. These recommendations are based on the following:
· BAPM standards for therapy staffing in Level 1, 2 and 3 hospital Neonatal units
· the number of babies who require follow up therapy management in the community per year which is approximately 4 -6 per ITU cot.
· consensus statements from therapy services in Wales
· the need for health communities to work together to provide neonatal service for their populations, as recommended by the Neonatal Network
· provision of 1 session of education and supervision per week for all neonatal therapy services within each Health Board and the wider Health Community
5. BRIDGING THE GAP
Using a modified Delphi methodology the therapies expert reference group were asked to agree the following consensus statements based on the findings above:
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LEVEL 3 UNITS |
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LEVEL 1 & 2 UNITS |
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ALL UNITS |
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NETWORK |
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