How can we make sure that, even in these challenging circumstances, parents feel empowered to do what parents naturally want to do — care for their baby?
What is Family Integrated Care?
Family Integrated Care (FICare) is a model of neonatal care that promotes a culture of partnership between families and healthcare professionals. It enables and empowers parents to become confident, knowledgeable and independent primary caregivers.1 Put simply, parents are part of the neonatal team.
This represents a significant shift as, like in many areas of medicine, the approach to parental involvement was often superficial. They were allowed to “visit” the neonatal unit, information about their baby’s progress was intermittent and limited. Thankfully, things have changed. FiCare is becoming increasingly embedded within neonatal practice, recognising that parents are not visitors. They are an essential part of their baby’s care, irrespective of their baby’s size, gestation or clinical condition.
There are various ways parents can be involved, and these activities help to restore the sense of being a parent and include:
- changing nappies and providing other aspects of personal care
- providing skin-to-skin contact, also known as kangaroo care
- giving tube feeds
- comforting their baby during procedures
- joining ward rounds and actively contributing to discussions about their baby.
These may sound like relatively small things, but they can have enormous significance and help parents reclaim the feeling of being their baby's mum or dad. Neonatal services have an important role in creating a culture in which parents can participate meaningfully. This cultural shift requires more than goodwill and shouldn't be reliant on the enthusiasm of a few individuals; it needs to be embedded into the way neonatal teams work.
Why does FICare matter?
FICare has been associated with improved communication and outcomes, reductions in parental stress and anxiety, and better preparation for the transition to home. Perhaps just as importantly, it changes the relationship between parents and professionals. It says to parents:
You belong here. Your voice matters. You know your baby. We want you to be part of their care.
Neonatal professionals bring specialist knowledge, clinical expertise and experience. Parents bring something different, but equally important. They get to know their babies.
They learn their baby's expressions, movements, preferences and subtle changes. They notice what comforts them, what unsettles them and what is different from yesterday. They are often the one constant presence through staff changes, ward rounds and transfers between hospitals. Recognising this knowledge is not about diminishing professional expertise; it is about combining two different forms of knowledge to provide better safer care.
Equity in FiCare
FICare must work for all families. Families differ enormously in their circumstances, experiences and values. Some parents may be able to spend long periods on the neonatal unit, others may need to divide their time between work and other caring responsibilities. We shouldn't equate the amount of time a parent spends on the unit with their level of commitment.
Services need to be culturally responsive, offering different ways for parents to participate. Otherwise, an approach designed to empower families could unintentionally favour those who have more time, money, flexibility and resources. Equity must be at the heart of FiCare.
Remembering Oliver
Dr Oliver Rackham, who passed away in July 2026, understood this.
FICare reminds us that excellent neonatal care is not simply about treating a baby’s condition. Dr Oliver Rackham understood this. He recognised the importance of FiCare and embraced it enthusiastically.
I first met Oliver in 2004, at St Mary’s Hospital, Manchester when he was one of the neonatal registrars. Even then, he came across as a thoughtful, compassionate and hardworking doctor. Over the following years, our paths crossed intermittently at meetings and conferences. In May this year I bumped into him at the RCPCH conference where he was leading a workshop “Working together: Family engagement to prevent and address harm”. Quite fitting as parent engagement and support were two of his great passions.
In 2018, the neonatal transformation programme undertook peer review visits of every neonatal unit in England. I was assigned to visit Arrowe Park Hospital, where Oliver was working as a consultant. He told us how he had made FiCare an integral part of neonatal practice, at a time when it was still far from widespread. He understood the pivotal role that families play in caring for their babies and had made it part of the culture of his unit.
Together with a neonatal matron, he had established NeoMates™, a parent support initiative. What began as a small, face-to-face gathering for parents subsequently spread to many neonatal units across the UK. Oliver also introduced parent-led ward rounds,2 enabling parents to take an active role in providing clinical information. A video of parents participating on his ward round is available on X (formerly Twitter).3
Clinical skill is vital, but parents remember how a doctor spoke to them.
I left that visit deeply impacted. It demonstrated, very clearly that our role as clinicians is not simply to provide clinical care. It is also to support families to have the best possible experience, whatever the eventual outcome. Clinical skill is vital, but parents remember how a doctor spoke to them. Whether their fears were taken seriously and whether they were helped to feel like parents.
Oliver’s advocacy for parent involvement embodied the spirit of Family Integrated Care. He challenged the idea that expertise belongs only to healthcare professionals and recognised that excellent neonatal care depends on listening, partnership and respect.
Perhaps most importantly, he understood that behind every neonatal patient is a family — a family who needs care too.
Rest in peace, Oliver.
Your commitment to parents and families left a lasting mark on neonatal care, and your example continues to remind us of what compassionate, truly family-centred care can look like.
For more information on safety in paediatrics and child health, visit the RCPCH Patient Safety Portal. And look out for our Safety eBulletins, which are emailed every two months to members opted in get College updates (you can check your contact preferences on your online account).
- 1
British Association of Perinatal Medicine (BAPM), Family Integrated Care: A Framework for Practice, November 2021.
- 2
Rackham, O. “Parent-led ward rounds on the neonatal unit.” Infant Journal, 2019, Vol. 15, Issue 3.
- 3
Oliver Rackham, parent-led ward rounds, X/Twitter, 2018. https://twitter.com/OliverRackham/status/1048247824222175234?s=19