Dear Sir am to you to respond to the concerns raised by Mr Thomas Osborne's investigation into the circumstances surrounding the tragic death of Jennifer Clark, which led to him making regulation 28 report with respect to the issues discussed at the conclusion of the Inquest on 10 January 2017. Mr Osborne was concerned that without adequate neonatal facilities at Watford General Hospital there is high risk of babies' lives at risk in the future. Based on the latest figures available, in 2015 5451 babies were delivered at Watford General Hospital. The Neonatal Intensive Care Unit (NICU) is designated Level 2 unit which provides neonatal care for the population within the West Hertfordshire catchment area, except for the sickest babies who require complex or longer-term intensive care in Level 3 unit_ We have a total of 24 cots (3 intensive care cots; 5 high dependency cots and 16 special care Babies requiring Level 3 intensive care are transferred to the nearest Level 3 Intensive Care Unit within our regional neonatal network Within the East of England Neonatal Operational Network there are eight units. Department of Health Toolkit for High Quality Neonatal Services suggest that planned capacity should not exceed an average occupancy of 80%. Our aggregate occupancy rate for all cots in 2015 was 69%. The Trust has, since 2015, Neonatal Unit Admissions and Escalation Policy (enclosed): which sets out what actions are required when the Unit reaches 90% capacity_ http:Ilwww londonneonatalnetwork org uklwp-contentluploads/2015/09/Toolkit-2009 pdf Charr: Professor Steve Barnett Chief Executive Katie Fisher westhems iOspials nhsu.k #ar 0 MCE AOlL writing being cots) .

Reflecting on the available data and Department of Health guidance set out within the Toolkit, the Trust considers that for the number of births there is adequate facilities available at Watford General Hospital. We do however recognise that the Neonatal Unit, along with many of our buildings, requires modernisation: On 2 February 2017 the Trust Board approved redevelopment plan as part of the Your Care Your Future Programme; which will include extensive redevelopment of hospital estates and facilities and this will include plans for development of the NICU. The Trust's Strategic Outline Case is due to be considered at the Herts Valley Clinical Commissioning Group Board meeting; at the time of writing a date is to be set. hope that the information provided offers assurances that the area highlighted in the prevention of future deaths report is being adequately managed and that there are wider plans that are going to improve services across the whole site for patients who require variety of the services we are able to offer: We will continue to work with Level 3 Neonatal Intensive Care Units in ensuring the safety of babies born at Watford General Hospital who may require intensive care_