Further information

The documents on this page explain the work that took place before we moved to a public consultation, the post-consultation phase and how decisions are taken.

Publication of independent consultation reports (6 November 2024)

Two independent reports published today summarise the responses received to our North Central London Integrated Care System (NCL ICS) consultation into proposed changes to maternity, neonatal and children’s surgical services.

We would like to express our thanks and appreciation to everyone who took the time to share their views on the consultation proposals. All the feedback was collated and analysed by an independent research organisation. They have produced two consultation reports and executive summaries:

• Proposed changes to maternity and neonatal services in North Central London: Public consultation feedback report – Full report
• Proposed changes to maternity and neonatal services in North Central London: Public consultation feedback report – Executive summary
• Proposed changes to children’s surgical services in North Central London: Public consultation feedback – Full report
• Proposed changes to children’s surgical services in North Central London: Public consultation feedback – Executive summary

The independent reports, along with a wide range of evidence and information, will be used to develop a decision-making business case for consideration by senior clinicians and other NHS leaders in north central London and NHS England London in early 2025.

Post-consultation documents published (17 July 2024)

The following post-consultation documents were published which outline the approach taken to the Start Well public consultation, emerging themes from the consultation feedback, and proposed next steps (which were subject to ICB Board approval at their meeting on 23 July 2024):

• Start Well programme consultation methodology and activity report– this report outlines the approach taken to consultation, the activities undertaken and the reach achieved.
• Consultation interim findings– this is a report written by the independent organisation that are analysing the consultation feedback. It provides high level emerging themes on the three elements of the proposals and highlights several areas where further work is needed before agreeing how to proceed and to ensure that feedback received during the consultation is taken into account. There will be a more detailed full evaluation report published later this year once all the feedback has been thoroughly analysed.
• Start Well programme proposed next steps– this report outlines the additional work that will be taking place over the coming months (subject to ICB Board approval) before any decisions are taken in relation to implementation of the proposals.

Documents which supported decision making to move to a public consultation

• • Maternity and neonatal services pre-consultation business case; Edgware Birth Centre addendum to the maternity and neonatal pre-consultation business case; and Paediatric surgery pre-consultation business case: These are long technical documents for the formal decision makers (NCL ICB and NHS England for specialised commissioning) setting out the proposals for public consultation. They also set out the proposed approach to public consultation. They were published by NCL ICB on 28 November 2023, and considered and approved by NCL ICB Board at a public meeting on 5 December 2023. They were separately approved via NHS England. These versions have alternative text and some of the exhibits have been simplified to make them accessible for those that use screen readers: Maternity and neonatal services pre-consultation business case; Edgware Birth Centre addendum to the maternity and neonatal pre-consultation business case; and Paediatric surgery pre-consultation business case.
  • Maternity and neonatal services interim integrated impact assessment and Paediatric surgery interim integrated impact assessment : An integrated impact assessment is a document to assess whether something we are planning to recommend might have unintended consequences, including impacts on particular groups of people, on the environment in which they live, or other unforeseen impacts that may need to be mitigated. These interim IIAs were published alongside the ICB Board papers on 28 November 2023, and considered by NCL ICB Board at its public meeting on 5 December 2023. They were separately considered by NHS England as part of their decision making. They will inform the approach to public consultation and will continue to be updated after the consultation.
  • Maternity and neonatal services pre-consultation engagement report: Over the summer of 2023, the Start Well programme conducted engagement about maternity and neonatal services to identify potential impacts changes to services might have. This qualitative research was independently evaluated, and this document is the independent report of the findings of the engagement. The findings were used to inform the proposals including the interim integrated impact assessments.
  • London Clinical Senate review – North Central London Start Well programme: A review by the Clinical Senate is an integral part of the process for all major service change in the NHS. The review has a focus on ensuring that there is a clear clinical evidence base for the changes proposed, which is a key test for NHS major service change. The Clinical Senate review of the Start Well programme took place in July 2023 and the report of their findings was finalised in November 2023.

Other supporting documents

• • Start Well case for change and Start Well case for change summary: This was the first formal stage of the Start Well programme, development of which took place from November 2021 to June 2022.  Based on feedback from clinical staff and extensive data analysis – with a strong population health focus – the Start Well case for change identified what currently works well in maternity, neonatal and children and young people’s services in NCL and the areas where there are opportunities for improvement.  It did not seek to set out potential solutions.  It was approved by NCL CCG Governing Body (the predecessor body to the ICB) on 30 June 2022 with an agreement to start a period of engagement on its findings.
  • Start Well case for change engagement report: Following approval of the case for change in June 2022 a 10-week programme of engagement started on 4 July 2022. The engagement had two aims. Firstly, to identify whether the themes highlighted in the case for change resonated with patients, residents, staff and stakeholders. Secondly, to capture the views of patients, residents, staff, and stakeholders on the opportunities to improve care in NCL. The feedback from the engagement was independently evaluated and a report of the findings was published in September 2022. The feedback was used to inform the proposals.
  • NCL ICB Board of Members: Start Well paper, 22 November 2022 and NCL ICB Board of Members: Start Well paper, 28 March 2023: These papers set out proposed future care models for both maternity and neonatal care and children and young people’s hospital care. At their public meeting in November 2022, the ICB Board agreed to start an options appraisal in relation to the implementation of the proposed maternity and neonatal care models and the proposed emergency and planned surgical children and young people’s care models. A further report in March 2023 report updated the recommendation in respect of proposed emergency and planned surgical children and young people’s care models.
  • Proposed children’s surgical pathways by specialty: This document sets out the proposed future children’s surgical pathways by age and by specialty. It is an appendix to the paediatric surgery pre-consultation business case and reproduced separately here as it is referenced in the consultation document.
  • Raising concerns or accessing support after care: This leaflet explains the support available if you have concerns about NHS care you have received or would like to access support.
  • Letter to NCL NCL Joint Health Overview and Scrutiny Committee 15 March 2024: We have written to NCL Joint Health Overview and Scrutiny Committee in accordance with The Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, to notify the NCL JHOSC of the date by which we need the committee to provide comments on our proposals for maternity, neonatal and paediatric surgical services under the 2013 Regulations. Additionally, we informed the committee of the date by which we intend to make a decision about whether to proceed with our proposals.