Options Appraisal: Neonatal Service Reconfiguration
The merger of St. Mary’s NHS Trust and Hammersmith Hospitals NHS Trust in October 2007 created Imperial College Healthcare Trust, one of the largest NHS Trusts. An early priority post-merger was to review those services delivered on more than one site and assess options for their future configuration.
Post-merger, the Trust had two Neonatal (level 3) Intensive Care Units, both co-located with busy maternity units. Although the neonatal service was jointly managed, the two units largely operated independent of each other. The service was facing significant financial challenges.
Tracey worked with the Clinical Director to lead an options appraisal process that explored and evaluated the potential service configuration options for the delivery of safe, sustainable, high quality, financially viable neonatal services across West London. Key activities included:
- Developed a detailed fact base to underpin the options appraisal including a detailed analysis of the activity, income and cost profile of the two units.
- Interviews with the neonatologists, neonatal nurses and obstetricians on both sites to inform an assessment of the strengths, weaknesses and the critical inter-dependencies of the current configuration.
- Meetings with the North West London Perinatal Network to understand future neonatal care needs and commissioning intentions.
- Detailed description of three short-listed options, including proposed staffing profiles, and a supporting set of proposed appraisal criteria.
- Assessment of the impact of implementing each of the shortlisted options.
- Working session with the Clinical Leadership Board to discuss and evaluate the short-listed options and agree the preferred option.
- Identification of potential risks linked to implementing the preferred option and development of mitigation plans.
The recommended option, to reconfigure the Trust’s neonatal services across two sites to create a Neonatal (Level 3) Intensive Care Unit on one site and a Local (Level 2) Neonatal Unit on the second site, was implemented in Autumn 2010.