This is a fantastic opportunity to be part of our warm and welcoming neonatal team and of the biggest development of Children’s services that the County has seen. Our vision is to be the best Local Neonatal Unit in the country providing the highest quality care for the babies and their families in an environment in which all staff, and in particular trainees, are supported and thrive, with greater delivery of care by Consultants in line with RCPCH recommendations. In October 2014, the obstetric and children’s services were housed in a modern high specification Shropshire Women’s & Children’s Centre at Princess Royal Hospital, Telford. The Trust is preparing for a £312 million trust wide reconfiguration of services between the 2 hospitals in Shropshire with Emergency Services concentrated at the Royal Shrewsbury Hospital and a Planned Care centre at the Princess Royal Hospital, Telford (the Hospital Transformation Programme). The Women’s & Children’s services including the neonatal service will be at the Emergency Centre.
You will work in one of the largest acute District General Hospital Paediatric departments and neonatal unit in the Country serving a catchment population of over 0.5 million. The neonatal unit has ~ 4500 deliveries a year and is designated a Local Neonatal Unit (LNU) in the West Midlands Neonatal Operational Delivery network. The Paediatric service provides not only a single large Paediatric ward for the County – 36 beds, with specialist high-dependency and oncology areas, but also a new large Children’s Assessment/Short-Stay 8-bedded unit at the Princess Royal Hospital and a Paediatric Medical Day Case Unit at the Royal Shrewsbury Hospital. Paediatric speciality services are already well developed in the Trust with the majority of sub specialities having 2 lead consultants. There are separate on-call rotas for acute paediatrics and neonatology at consultant level, separate tier 1 rotas with separate tier 2 rota except for overnight (on call 23:00-08:30). The complete separation of the Tier 2 rota is being developed.
The Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital services for nearly half a million people in Shropshire, Telford & Wrekin and mid Wales.
The Neonatal Department
The Neonatal service serves the ½ million catchment population, with over 4500 deliveries per annum. The service is designated as a Local Neonatal Unit (LNU). Our LNUs is supported by the Neonatal Intensive Care Units (or Level 3 units) mainly at the University Hospital of North Staffordshire NHS Trust. The unit consistently excels for quality of neonatal care in the NNAP audit.
Our unit is staffed and equipped to provide Conventional and synchronised ventilation, Volume targeted ventilation, and short-term High frequency oscillation, inhaled Nitric oxide therapy as well as active therapeutic hypothermia pending transfer to a NICU. Cranial sonography and echocardiography services are provided locally along with Retinopathy screening. The Unit provides care for babies born at 27 weeks gestation and above and weighing more than 800 grams.
The Neonatal Unit is an entirely new, modern-day high-specification facility. Located on the first floor, it is immediately adjacent to the Labour Suite and Maternity Theatres and Obstetric Wards, with the Postnatal Ward including Transitional Care, Children’s Ward, Assessment Unit and Outpatients facility immediately below on the ground level. There is a Seminar/Education facility within the Neonatal Unit, and a comprehensive Education and Simulation Suite immediately below on the ground floor. There are 3 Intensive Care, 3 High Dependency and 16 Special Care cots. In 2020, the Unit delivered approximately 500 intensive care days, 1120 high dependency days, 3,700 special care and 1,700 transitional care days.
The neonatal consultants operate weekly Consultant of the week system (resident 08:30-17:30 Monday to Friday and 10:00-13:00 over weekends) and provide non-resident out of hours cover (1in 6 currently, moving to 1 in 7 with these two posts). These posts will enable us to meet the RCPCH and 7-day services standards with onsite consultant presence between 08:30-19:30 on weekdays and Consultant-led review of new admissions and babies receiving intensive and high dependency care on weekend evenings. All 7 neonatal consultants will spend 2 weeks per annum at a local NICU to keep their neonatal practice up to date.
There is an entirely separate tier 1 neonatal staffing at all times consisting of 1 FY2, 3 level 1 neonatal specialty registrars (StRs) and 7 Advanced Neonatal Nurse Practitioners (ANNPs). There is separate tier 2 staffing for the neonatal unit consisting of 3 ST4+ neonatal trainees with the exception of 23:00 to 08:30hrs when there is shared tier 2 cover with the Paediatric service. We aim to fully separate the tier 2 rotas and have recently appointed a Specialty Doctor, 3 ANNPs and 2 Advanced Clinical Practitioners (ACPs) in Paediatrics to enable full separation of tier 2 cover for neonatal and paediatric services at all times.
There is an active 7-day Neonatal Outreach Service provided by 3 senior neonatal nurses and looks after babies discharged home on oxygen, early discharge of babies on home tube feeding, those with discharge weight<1.8 kg, those with neonatal abstinence syndrome on medications and other specific needs.
The Obstetric Service consists of the Consultant-led Labour Suite (approximately 3900 deliveries per annum), with approximately lower-risk 800 deliveries at the Midwife-led Delivery Unit in Telford. The Obstetric service has 17 Consultants including 3 Subspecialists in Maternal and Fetal medicine with a very active and integrated prenatal diagnostic practice supported by midwifery sonographers.
The Children’s Ward
The Children’s Ward has 36 beds, with 20 accommodated in 2- or 4-bedded bays, and 16 in cubicles, each with en-suite accommodation. The ward has a dedicated 3-bed Oncology Unit with its own parent accommodation, Treatment Rooms and office accommodation, and delivers the highest quality of care as a Level 3 Paediatric Oncology Shared Care Unit. 3 beds are dedicated, and staffed, for High-Dependency Care delivering CPAP and High-Flow Oxygen facilities. The Ward’s resuscitation room allows for initiation of PICU support, including ventilation, and there are well-established links with the Region’s PICU centres at Stoke and Birmingham and with the immensely supportive and efficient Regional Transport and PICU advice service (KIDS) based at the Birmingham Children’s Hospital.
This large new ward is ideally located, being adjacent to the Princes Royal Hospital Children’s Out-Patient facility, Neonatology, Radiology, A&E, and the new Children’s Assessment Unit.
There are currently in excess of 6,000 admissions per annum to the Children’s Ward, with a further 8000+ attendances at the Children’s Assessment Units.
The PRH Children’s Assessment Unit
Separately staffed and open 24/7 this new facility has 8 beds, with 4 as en-suite cubicles, and a separate Treatment Room for practical procedures. Length of stay is already little over 24 hours for children in Shropshire, and the CAU help further facilitate earlier discharge home and ward admission avoidance.
The RSH Paediatric Medical Day Case Unit
Reconfiguration has ensured that cost effective services are provided with an emphasis of quality of care and effective triage of patients. The Paediatric Medical Day Unit at the Royal Shrewsbury Hospital is a 6-bedded unit. Opening hours reflect the need to deliver care for peak attendance hours, 09:00-17:00hrs Mon-Fri. The unit is staffed by highly experienced Advanced Paediatric Nurse Practitioners or Associate Specialists.
Comprehensive care pathways have been developed to manage the admission of ill or injured children, whether they present to the Royal Shrewsbury Hospital or Princess Royal Hospital. The Paediatric team at RSH plays an important role in supporting the A&E Department at the Royal Shrewsbury Hospital, which is also the designated Trauma Unit for the County. This support is available from 9am to 7 pm 5 days/week and between 12pm and 10pm on a Saturday and Sunday.
At both the Royal Shrewsbury Hospital and Princess Royal Hospital, there are new, enhanced out-patient facilities. Each also contain its own treatment room, clean and dirty utility and administration areas, allowing greater delivery of care away from the in-patient unit.
Children’s general paediatric out-patient clinics are also delivered in the excellent facilities provided by a number of the local Community Hospitals (in Whitchurch, Ludlow, Bridgnorth, Welshpool and Newtown) and in the specialist Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry.
There is comprehensive provision of specialist services in the out-patients, including:
- Visiting Tertiary Specialists: Cardiology, Nephrology, Urology, Surgery, Endocrinology, Cystic Fibrosis, Oncology & Haematology, and Genetics.
- In-County Specialist Clinics: Gastroenterology, UTI/Renal, Cardiology, Allergy, Respiratory, Cystic Fibrosis, Rheumatology, Diabetes, Endocrinology, Oncology & Haematology, Metabolic, Epilepsy and Neurology