Commissioning Neonatal Transport Services

The Department of Health has commissioned neonatal transport services in many parts of the country to improve the provision of care to newborn infants requiring specialist management.

Kent, Surrey and Sussex

Funding developments in Specialised Services are managed through the Local Development Plan (LDP) process. Specialist Commissioning starts to consider the potential funding needs in the early autumn each year. This involves collection and collation of data, discussions with the PCTs involved and an assessment of other hard and soft information, to assist the decision-making process. The funding requirements are then submitted to the participating PCTs for approval.

Some but not all specialised services are managed over a number of PCTs in a financial risk sharing arrangement. This allows for a smoothing of the demand curve reventing any one PCT being financially disadvantaged by a high cost episode. It is normal for one PCT to take the management responsibility for all the other PCTs participating in the arrangement; this not only keeps management and administration costs to a minimum but also means that the Commissioners involved can obtain a level of expertise in a particular service. Alternatively, PCTs may agree to form a Network, which includes providers, purchasers, clinicians, voluntary bodies, members of the public, etc. Each Network has a manager who works solely on the one specialised service. It is the job of the Network to ensure that there are safe, effective and cost efficient services for their catchment area, which might span more than one Strategic Health Authority boundary. Networks are reliant on the PCTs they serve for financial support; however, they also may receive direct funding from central government to help pump-prime specific developments.

The Kent Surrey and Sussex Local Specialist Commissioning Group has two Perinatal Networks on its patch, one serves Kent PCTs and the other Surrey & Sussex PCTs. Vanessa Attrell, who is based at Adur Arun and Worthing PCT, is responsible for both Network Groups. Vanessa's main objective is to decrease the number of babies being treated in NICUs outside the Kent Surrey and Sussex boundaries, thus reducing costs and decreasing family trauma of being separated from their baby. The first part of this objective is the purchase of three neonatal ambulances, one each for Kent, Surrey and Sussex. These dedicated ambulances and crews, based at Ashford & St Peters, Medway Maritime and the Royal Sussex County hospitals will provide daytime and evening transfers of babies to and from the three counties. The ambulances will be able to cross county boundaries without incurring additional cost, and although it will be necessary to seek support at night from the London team, this is a significant step forward in the Perinatal Network project.

London Sector Commissioning
In April 2005 the pan London Neonatal consortium was disbanded and its work devolved to Networks, who are now responsible for commissioning this service. SCBU continues to be commissioned by PCTs. Networks are beginning to repatriate activity previously undertaken in hospitals outside their sector in order to fund additional cots within their own sector, thus bringing them closer to the 95% target of all babies being treated within sector. For London as a whole the Perinatal Steering Group has agreed two important targets, the first is that the capacity in each Network should be developed to provide at least 95% of the medical intensive and high dependency care for its population and the second is that the intensive care of babies born before 27 completed weeks of gestation should be centralised into the Level 3 units during 2006.

The Department of Health tool kit is being used to identify the shortfall of cots in the network and demonstrated how many ITU, HDU and SCBU cots are required at each of the units to meet the 95% target by 2006.

Funding for the London NTS
Capital for the London service flows from two sources of revenue, the first being modernisation money which is only to be used to either expand or improve the current quality of services, which is how NTS is funded and the second stream of funding is taken directly from PCTs allocations.