SPECIAL CARE BABY UNIT

Premature babies needing intensive care could be sent out of Derbyshire under plans to reorganise baby units across the region. It would mark the end of an era for the Special Care Baby Unit at Derby City General Hospital, which has been looking after sick babies since the 1970s. The Trent Neo-natal Network, made up of health managers, is considering downgrading baby units at hospitals in Derbyshire, Nottinghamshire and Lincolshire and creating one regional centre. This is likely to be at Nottingham City Hospital, 14 miles away from Derby, because it is bigger and it was the area's centre for specialist or neo-natal baby care before the 1970s. The City General would retain its baby unit but would only have incubators that provide support below intensive care level. But members of the network, which was launched earlier this month to improve premature care and replaces an informal network which covered five counties, have not ruled out a second centre, which could be in Derby.

Managers say reforms are needed to improve the current system. At present, there is at least one baby a day being sent to other hospitals in the region and at least half of all transfers are deemed "unnecessary". Latest figures show that 15 babies had to be sent out of Derby, which has six intensive care incubators, in 2002. It is not known how much the changes will cost, but the Government is putting £70m into specialist baby or neo-natal care nationally to improve care. Dr Sara Watkin is clinical director of neonatology at Nottingham City Hospital and the network's lead clinician. "It is expected that some of the hospitals in the network which currently provide intensive care will no longer do so. Staffing intensive care cots is hugely expensive - each cot requires five to six nurses. In our area, it's likely that only one or two units would do intensive care, I think it's fairly certain that one of the regional centres will be Nottingham."

But Dr Nigel Ruggins, the trust's service director for children's services and a consultant pediatrician at Derby City General and a member of the network, said he hoped Derby would be a regional centre. Under plans for the new superhospital, a purpose-built special care baby unit has been designed - with room for two more intensive care cots. "Taking those things into account, I think we have a strong case, but our case has to be put up against everybody else's," he said. The unit currently has four consultants, one middle grade doctor, four junior doctors and 45 nurses. It is not known what will happen to staff or equipment at Derby. The plans have been met with dismay by parents and fund-raisers. The Friends of the Baby Unit, founded in 1976, has raised hundreds of thousands of pounds.

In 2003, nearly 6,500 babies were born at Derby City General Hospital, most of whom will live in Southern Derbyshire. It is estimated that one in 10 babies are born premature, classed as born before 37 weeks, which would mean about 644 a year. Of these one in 20, or about 32 a year, will weigh less than 4lbs and will need more intensive care. Some hospitals admit premature babies who are just four weeks early, such as Lincoln County Hospital, to their special care baby unit, whereas others, like Nottingham City Hospital, only admit babies when they are at least seven weeks premature. In 2002, there were 366 babies transferred between hospitals in the old Trent region, which includes Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire and South Yorkshire. Derby City General Hospital had to transfer 15 babies and during that year received 20 from other hospitals.

There are three sections to a Special Care Baby Unit. There are simple cots, which are the same as those in the standard wards, but have more staff to look after the babies. Then there are the high dependency incubators which provide some respiratory support. The most specialised incubator is intensive care, which has a ventilator and monitoring equipment. Derby has 15 ordinary cots, three high dependency incubators and six intensive care incubators. Managers are looking into creating a regional centre to improve care across the region. This would mean that hospitals in Derbyshire, Nottinghamshire and Lincolnshire might lose their intensive care incubators. The regional centre is likely to be at Nottingham City Hospital.

Those in authority can move in mysterious ways, and what is now apparently being considered for specialist baby care in Derby certainly comes into that category. Here we are, looking forward to the much-vaunted new "superhospital", currently under construction and expected to be completed in 2008. That is supposed to include a special care baby unit, even more advanced than the highly-respected unit which forms part of the current Derby City General Hospital operation. So how's this for planning? It now seems that the new unit could be downgraded in importance before it is even built. Health chiefs are considering centralising specialist baby care in the Trent region, and no prizes for guessing which city will be the one to accommodate the centre which would deal with the most intensive care cases.

That will not mean closure for units such as Derby's. Indeed, if the centralisation policy goes ahead and it is decided that a secondary venue is also needed for intensive care, then the chances are that the superhospital will get the nod for that. But what a sense of betrayal will be felt if second division status is to be accorded to Derby in a field in which it enjoys a fine reputation. It is not fair to point the finger of blame at local or even regional managers if this proves to be the case. You need to look higher, at Whitehall, where funding decisions are taken. There the "regional is best" approach holds sway. That may make some kind of economic sense to the accountants. But it takes no account of the inconvenience and distress to parents, at the most traumatic time of their lives, not to be able to count on using expensive medical facilities in their own city or county. (Source: Derby Evening Telegraph)