Service requirements

Background: the need for change

The current provision of perinatal services in the UK is under intense scrutiny and many fundamental and far-reaching changes are in the pipeline. The impetus for these changes has come largely from the neonatal specialties, which are experiencing difficulties providing comprehensive care for very preterm and sick term infants. This chapter will review the provision of perinatal services, together with potential and proposed changes in service provision. The London region will be used as an example of service provision, but the issues discussed are relevant to the majority of regions in the UK.

Up to 10% of all newborns need admission to a neonatal unit, and 2%–3% need intensive care. In the UK we are generating large numbers of inappropriate transfers of complex cases between units, often out of specialist centres, before and after birth because of inadequate capacity in our neonatal units (Parmanum et al. 2000). The fact that our neonatal intensive care is not centralised and we have a large number of relatively small neonatal units providing some intensive care is a key issue here. These transfers cause great misery and distress to families at a time of crisis, and waste a great deal of medical and midwifery staff time. Moreover, siblings of multiple pregnancies may receive care in different neonatal units in up to one third of cases.