About Us
From the beginning of specialised neonatal care, there has been a need to transfer babies between hospitals. With the development of regionalised neonatal intensive care in the1970 s and 1980s, the process of retrieval became a function of the tertiary regional neonatal intensive care units. Over this period, there was a progressive development of incubators and other equipment to provide adequate care to babies during transport. As a result, by the early 1980s, all regional units were equipped with specialised transport incubators and were able to perform retrieval of babies for medical neonatal intensive care. As responsibility for surgical transfers and return journeys often fell on the hospital where the baby originated, many other hospitals also had to develop an ability to transfer babies.
Ambulances for all of these transfers were provided by the local NHS ambulance service. The need for neonatologists and ambulance services to work closely together was brought into sharp focus when the London Ambulance Service renewed its ambulance fleet in the early 1990s. At this point it became clear that transport incubators could no longer be carried on front line ambulances and a transport working group was set up jointly between the London Ambulance Service, the Emergency Bed Service and the Thames Regional Perinatal Group (an association of neonatologists and neonatal nurses formed to improve neonatal care across the former Thames Regions). This transport working group identified a small fleet of ambulances which could carry transport incubators, and also began to identify issues regarding the safety and effectiveness of services for the inter-hospital transfer of sick neonates. By the mid-1990s, the group had begun to consider establishing specialised neonatal transport teams similar to those that had been operating in Australia, North America and France.
In 1996 the TRPG made a formal decision to explore the setting up of a dedicated neonatal transfer service for London and the South East of England. The transport working group broadened its membership under the chairmanship of Dr Steve Kempley and carried out a consultation of neonatal units across the Thames Regions. There was overwhelming backing for a dedicated transfer service, and the group began to draw up a specification of service. The transport working group at this stage consisted of regional representatives Drs Greenough, Calvert, Acolet, Kempley and Ducker, Group Secretary Dr Ros Thomas, LAS representative Mr Russ Mansford, EBS representative Mr Graham Hayter, Nursing representatives Ms Keeble, Kemp, O'Donnel and Stone and Medical Physics representative Mr Louis Blache.
By 1998 the group had produced a detailed and costed plan for the development of a neonatal transfer service across the former Thames Regions. The plan was for 2 full time dedicated transfer teams based in London and 2 part teams based in Kent, Surrey and Sussex, to ensure good response times to hospitals on the South Coast. The group then began to approach the health authorities to determine whether there was any possibility of the service being funded. This process proved extremely difficult, mainly because of the devolution of all spending authority to local district health authorities, of which there were 14 in London alone. Furthermore, with tight spending controls and no new monies coming to the health service at that time, the development of any new service was extremely difficult.
This situation began to change with the establishment of a regional health authority for London. The potential for the development of the service received an additional boost when the commissioning of neonatal intensive care began to take place on a London-wide basis.
The TRPG Transport Working Group performed a census of neonatal transfers to determine the likely demand for the service. Finally, when new money for neonatal intensive care was made available by the government in 2001, a decision was made that this should be spent on the development of a neonatal transfer service. A service manager (Mr Tim Fellows) was appointed in 2002 to actively set about developing the service in Kent, Surrey, Sussex and London.
During 2002 expressions of interest were invited from regional neonatal intensive care units with a background in neonatal transport, who might wish to host a neonatal transfer service. An independent process was set up to evaluate the best bases for the service in London. At this stage, there were only sufficient resources for a single transfer team, and, although there was appraisal of 2 potential bases, a decision had to be made about a single base for London. At the same time, a process took place in Kent, Surrey and Sussex to determine whether it would be possible to set up 2 teams in that region, given the ambulance service organisation and operational remits.
By December 2002, a decision had been made to site the first London neonatal transport team at the Royal London Hospital in Whitechapel, with a decision to site the second team at St Thomas' Hospital if and when further resources became available. Because of the difficulties in ambulance services crossing county boundaries within Kent, Surrey and Sussex, a decision was made to set up 4 partial teams in that region based in Medway, Canterbury, Brighton and Chertsey. The Kent, Surrey and Sussex teams started operation in January 2003 and the London team commenced operations in October 2003. Because of difficulties in appointing staff, the operations in 2003 were initially part time and restricted to day time services in many areas.
In March 2004 the London neonatal team moved to a 24 hour, 7 day, emergency service, and in 2005 an elective service was agreed for London, in addition to the emergency teams. The Kent, Surrey and Sussex teams have consolidated their services within available resources to provide 3 team; Medway, Brighton and Chertsey and offer a mainly day time service, with discussions currently underway to determine the best provision to meet the remaining unmet need.
