Birmingham Women’s Hospital (BWH) houses a 57-bedded tertiary level surgical neonatal unit (NNU) and a regional fetal medicine service. The neonatal and transitional care unit attends to over 2,000 babies annually. Southern West Midlands Newborn Network is working towards adopting the principals of family-integrated care (FIC) as the standard of care within all the network’s hospitals.

A survey was undertaken at BWH in February 2017 to investigate the barriers to parental partnership in their baby’s care and two key issues were highlighted:

• cost of parking

• lack of childcare for siblings.

Free parking has now been facilitated for parents at BWH and Noah’s Star was developed to address the need for childcare for siblings.

Noah’s Star

A volunteer project with a primary aim of providing sibling support within the NNU, Noah’s Star was set up by Jo-Anne Shellum, a mother with first hand experience of trying to balance time with her preterm twins and an older child, along with Dr Gemma Holder. The aim of the project is to offer crèche facilities for siblings to enable parents to spend quality time with their unwell baby. The service is named after Jo-Anne’s son Noah, who sadly passed away on the NNU.

To shape the service, focus groups were held with parents of babies who had previously been on the NNU, and questionnaires were distributed. The initial concept was to deliver two-hour crèche sessions as OFSTED regulations limit the amount of time that care can be provided without OFSTED accreditation. The neonatal outpatient clinic area, which is separate from but adjacent to the main unit, was identified as an area suitable for use on Thursdays to Sundays when no consultant-led clinics are held. There was liaison with the Birmingham Women’s and Children’s NHS Foundation Trust volunteer coordinator and the volunteers undergo the Trust volunteer training (FIGURE 1), in addition to specific training delivered by Jo-Anne, however the project remains separate from the Trust volunteer programme to maintain autonomy.

Figure 1 The volunteer recruitment process, training and ongoing support.

Funding for setting up the project was obtained from a charity ball. Jo-Anne applied for and was successful in achieving an additional £10,000 ‘awards for all’ lottery grant received specifically for an administrator, volunteer training, development of a training webinar and entertainment resources for siblings. She continues to actively seek grants for the project from available sources.

The service was launched on 20 October 2017. Between October 2017 and June 2018 Noah’s Star has provided 870 volunteer hours, caring for 178 siblings. There are currently 51 volunteers recruited to the service. In the absence of siblings, the volunteers conduct tea rounds on the NNU offering refreshments to staff and parents. They are also involved with our ‘beads of courage’ programme, issuing colourful beads to parents to mark milestones and achievements along their baby’s brave journey. They have undergone simulation training to give them confidence in the appropriate methods for holding and comforting babies during procedures.

The service has been well-received by both parents and children. Some praise from parents can be seen in TABLE 1.

Table 1 Noah’s Star sibling support has been well-received by parents.

Staff response to Noah’s Star

To review the effectiveness of Noah’s Star, staff members at BWH were asked to complete a short survey. The survey asked whether staff knew what Noah’s Star was, what its main role was and whether its work improved experiences for the patient, parents, siblings and staff.

Fifty-one multidisciplinary staff including medical staff, nursing staff, advanced neonatal nurse practitioners, administrative staff, psychology colleagues and managers responded to a survey. Eighty-eight per cent were aware of Noah’s Star prior to the survey and 55% had personal experience of working alongside them. Staff members were asked what they thought the main role of Noah’s Star volunteers was. Ninety-four per cent were aware that supporting siblings was part of their role, however many believed that making tea and coffee was a main role. One response revealed that although caring for siblings was their primary role, in reality they ended up doing all of the roles listed in the survey: holding babies, feeding babies, making tea/coffee for parents, making tea/coffee for staff, providing entertainment for siblings, and providing comfort for parents.

A Noah’s Star sibling pyjama party.

Volunteer Marie entertaining a graduate of the NNU in outpatients.

The survey specifically asked about FIC:

• 82% agreed or strongly agreed that Noah’s Star had improved FIC within BWH NNU

• 86% agreed or strongly agreed that Noah’s Star has meant that parents with older children can spend more time with their baby on the NNU

• 88% agreed or strongly agreed that Noah’s Star has benefitted siblings of babies on the NNU

• 55% agreed or strongly agreed that Noah’s Star has improved the staff member’s own experience of caring for families on the NNU, with 41% feeling neutral on the statement, and 4% disagreeing with it.

There has been a tremendous amount of support for the project with 92% agreeing that other NNUs across the country should adopt projects like Noah’s Star. Staff members were asked to include comments or suggestions for other services that they would like covered by the volunteers; here are some examples:

“This is a service that has been needed for many years and is very welcome. I feel it makes a real difference to the babies, parents and siblings.”

“Support for children during bereavement/ reorientation of care and more one-to-one support for children.”

“If possible extend hours even further as they are so useful.”

“Lovely friendly ladies – a credit to the NNU. What did we do before?”

“I am so grateful for Noah’s Star. They make life easier for parents and they really make staff feel cared for and appreciated. I can’t imagine day-to-day life on the unit without them! I hope they know how welcome and appreciated they are.”

Conclusions

FIC is recognised as an effective model through which we can provide excellent patient experience and service within NNUs. At BWH, the team identified a need for additional support for families with older children at home. Noah’s Star has been set up to provide entertainment, childcare and the opportunity in the future to develop one-to-one care for older siblings of babies on the NNU. There has been much support for the project and suggestions for expansion of its services.

We are very proud of the service, which we believe is integral to delivering FIC at BWH; our staff response to the survey is testimony to that and we hope to develop the project further in the future by working more closely with individual families to meet their needs. We would welcome other units to explore ways in which they might take on similar projects to help improve parent and sibling, and hence patient, experience on our NNUs.