- The Observer,
- Sunday November 24 2002
When she went into premature labour with twin sons in a major Oxford teaching hospital, there were no spare cots in the specialist baby unit to give them the care they needed.
She was taken by ambulance on a three-hour trip to the West Midlands, the nearest place with a bed for the babies, where she gave birth. Nico, the smaller of the two boys at 2lbs 7oz, lived for 10 hours. Zak, weighing two pounds more, spent 10 weeks in the neo-natal unit before she could take him home.
Andree had to live in a hotel for months to be near her surviving son. She had to miss Nico's funeral because she could not leave his brother's bedside.
'It was like being torn apart, because we were burying one baby but I wanted to stay with the other, who was so poorly. I wasn't near enough home to be able to do both,' says Goodwin, a 39-year-old PA from Newbury, Berkshire.
'I wasn't eating, I wasn't sleeping, I was in the unit for 48 hours without sleep once, I just sat by the incubator. What else could I do?'
Zak is now a healthy, happy two-year-old, but his mother is at high risk of another premature birth if she conceives again. Since no local hospital can guarantee enough neo-natal cots to treat another premature baby, the couple will not risk it.
'I would love another child so that Zak's got another brother or sister, but I won't,' she says. 'The decision has been made for us by what's going on in the NHS.'
Her view is shared by senior medical specialists, who say the system is now 'seriously dysfunctional', with new-born babies and their mothers being shuttled hundreds of miles in search of intensive care cots, which offer life-saving treatment to premature and sick infants.
The Government is to publish a five-year plan next month - based on a report from its expert advisers, which Ministers have been sitting on for nearly a year. It is expected to ensure the most vulnerable babies are cared for in specialist neo-natal units near their homes.
However, under the working group's proposals, smaller units would stop treating more complex cases, slashing the number of NHS units that offer intensive care. Critics will argue that doctors and nurses may not want to work in downgraded units, potentially leading to cutbacks and closures.
'If nothing is done, I think the service will break down,' said Professor David Field, chairman of the British Association of Perinatal Medicine (BAPM) and head of the neo-natal unit at University Hospital, Leicester.
'I don't think we have had a situation yet where the mother has been told there is no bed, but there will have been situations where the staffing will have been sub-optimal, when they have kept the baby when they didn't really want to because there was nowhere to send it.
'Today we have had two hospitals ring us, desperate that we took babies because they are chock-a-block and can't cope with any more.
'That's happening all the time and it is getting worse. That's the way the system works - you get in the baby where you can, and it is miserable for the family.'
One in 10 babies born in Britain needs special care after birth, and 3 per cent require intensive care.
With busier neo-natal units running at more than 100 per cent occupancy, up to 1,000 mothers are moved every year because the hospital where they gave birth could not care for the baby.
The reforms would 'build in some certainty' for parents, Field said, by organising care into managed clinical networks, with each specialist neo-natal intensive care unit arranging in advance with smaller hospitals nearby to take their serious cases.
Reforms of NHS children's services were promised in the wake of a series of deaths of children in Bristol, following experimental heart operations. National guidelines for the hospital treatment of acutely ill children are to be published next month, alongside the neo-natal review.
The BAPM says units should ideally not be more than 70 per cent full, requiring more beds and staff. Because of the stress of the work - only one in five babies born at 23 weeks survives - turnover of staff is high.
Field calculates that in his Trent region, the proposed strategy would mean cutting the number of units offering intensive care from 16 to between six and three: the number of neo-natal nurse posts would have to rise from 530 to between 580 and 650, depending on the model cho sen. It would cost up to £10 million over up to seven years to implement in Trent alone.
New EU regulations set to limit doctors' hours - meaning more staff being recruited - would raise questions over the viability of some units.
Bengie Walden, chief executive of the premature baby charity Bliss, said the tales of distressing experiences the group hears reflect an 'urgent need for improvement in care for premature and sick newborn babies'. Any review should include recognition of parents' needs, and 'adequate funding to achieve it'.
Most maternity units provide facilities for special care, but not intensive care for life-threatening conditions.
A spokeswoman for the Department of Health said the neo-natal services review was a 'sensitive matter', adding: 'Ministers are currently considering issues highlighted in the review.'
