Frequently Asked Questions

We heard feedback that the Orthodox Jewish community may be more impacted if maternity and neonatal services at the Royal Free Hospital close.

While all hospitals in North Central London have provisions that support culturally appropriate care (such as Shabbat rooms and Kosher food), we believe there are further steps we can take to support this community.

We have outlined the proposed mitigations in our integrated impact assessment, including a commitment to continue to work with the Orthodox Jewish community through the implementation period. This will help to ensure that negative impacts are reduced as much as possible.

Due to patient choice, increasing complexity of deliveries and declining births, the number of people giving birth at Edgware Birth Centre is low and has been falling for a number of years. Less than 50 babies have been born there in each of the last four years, and only 28 in 2023/24.

Women will still be able to make a choice of midwifery-led care through both the co-located midwifery-led units which are at all hospital sites in North Central London, and home births which will continue to be available.

In their totality, the agreed changes will allow us to more consistently honour the choices that women make through:

• Better staffing of all maternity units, meaning that teams that support midwifery-led care will be less likely to be pulled into support labour wards
• Improving the co-located midwifery-led units to ensure that they meet with standards and are set up to meet the needs of pregnant women and people, reflecting preferences for co-located midwife-led units close to obstetric care if needed.

The agreed changes will be carefully planned before they are implemented, and this would take time. We have set out a high-level approach to implementation which we will work through in a greater level of detail, now a decision has been made. Because we need to do significant building work to implement the changes, it will likely be several years before any changes are made to services. We will continue to communicate with service users and local communities to ensure that residents and staff are given lots of notice before any changes happen.

Because there is lots of work still to do, we don’t know exactly when changes might take effect. What we do know is that nothing will change for several years, and you will still be able to book your maternity care at the Royal Free Hospital for the foreseeable future. We are working on a more detailed timeline for implementation and will provide further communication to service users when that is clearer.

Our integrated impact assessment describes who and how communities may be impacted by the changes. Although some communities will face a potential increase in travel time and cost, we recommended the option that had the smallest impact on people living in more deprived areas.

We know however there will be some people that need additional support in navigating these changes, for example those who don’t speak English or those with a disability. We have identified a range of mitigations that will support people with these changes. For example:

• Additional information about how to travel to hospital sites and information about what to expect
• Being clear about the financial support available to patients during pregnancy and what they may be eligible to reclaim in travel expenses
• Providing information in a range of languages and formats to provide accessible communications

Putting mitigations in place to reduce the impact on particular communities identified through the integrated impact assessment.

One of the drivers of this programme is the challenge we face with vacancies in some professions, such as neonatal nursing. We aim to ensure we recruit and retain clinical staff to ensure we can provide high quality care to patients and service users through maintaining the stability of our workforce.

To support this, NHS organisations in North Central London are committed to working together to carefully plan and implement any changes.  We will ensure staff are engaged and provided with clear communications and information throughout the implementation period. There are excellent examples where this has been done elsewhere to support and retain staff and reduce the potential for any impact on services. The changes will provide opportunities for staff to enhance their skills and experience across the sites that will provide our maternity and neonatal sites in North Central London.

Staff working in these services are hugely valued and vital to the delivery of safe, quality care now and in the future. We believe there is an exciting future for maternity, neonatal and paediatric staff in North Central London. We want North Central London to be the place where staff choose to work and want to stay, with opportunities for training and ongoing career development.

Now that a decision has been made, we will of course keep talking to and supporting staff and working with our trade union partners throughout this process.

The recommendations aim to improve the quality of these important services and deliver better outcomes for families. There will be a significant amount of capital investment, an additional £67m focused on Barnet Hospital, UCLH, and Whittington Health.

This investment will ensure maternity and neonatal services are able to deliver high-quality services that will benefit local people now and in the future.

What did you hear during the consultation and what have you done with this information?

We are so grateful to everyone who shared their thoughts with us during the consultation and we heard a wide range of views. We:

• received 9,000 views of our dedicated consultation website pages
• received more than 3,100 questionnaire responses from members of the public
• attended 199 events and meetings, reaching just under 3,400 people
• undertook 46 engagement opportunities with communities that have protected characteristics or face health inequalities, reaching 503 people

We have published the independent evaluation of this feedback.

Many people agreed with us that the NHS needs to make changes to services to meet the challenges we face, and in regard to maternity services there were mixed opinions on the proposals to provide maternity services from fewer sites.

Since the consultation finished, we reflected on what we heard and carried out additional work to inform our decision-making. This includes, for example, reviewing our ‘patient flow’ modelling with the most recent data now available, updating our integrated impact assessment, and more detailed work on some aspects of maternity and neonatal pathways. We will also be publishing a You said, we did document.

We are so grateful to everyone who shared their thoughts with us during the consultation and we heard a wide range of views. We:

• received 9,000 views of our dedicated consultation website pages
• received more than 3,100 questionnaire responses from members of the public
• attended 199 events and meetings, reaching just under 3,400 people
• undertook 46 engagement opportunities with communities that have protected characteristics or face health inequalities, reaching 503 people

We have published the independent evaluation of this feedback.

Many people agreed with us that the NHS needs to make changes to services to meet the challenges we face, and in regard to maternity services there were mixed opinions on the proposals to provide maternity services from fewer sites.

Since the consultation finished, we have been reflecting on what we heard and carrying out additional work to inform decision-making. This includes, for example, reviewing our ‘patient flow’ modelling with the most recent data now available, updating our integrated impact assessment, and more detailed work on some aspects of maternity and neonatal pathways. We will also be publishing a You said, we did document.

We recognise that there are challenges at a national level in some specialties and we will continue to work with colleagues at national and regional levels to develop ways to address them, however we believe that these changes will help improve the offer to our existing and potential workforce in our units across North Central London, because:

• With rationalised services, the workforce we have can work more effectively across fewer units while maintaining their clinical skills
• All maternity and neonatal units will see an increased level of activity with a mix of cases making them interesting and attractive places to work as well as opportunities for career development
• Staff will be working in an improved physical environment, with significant investment earmarked to facilitate these changes

There will be no immediate changes to services. We will work with all NHS trusts to carry out a really detailed period of planning and transition before any changes are implemented.

This will include clear communication and information for staff and patients, and ample notice given to everyone affected.

In the meantime, all services are open and pregnant women and people should continue to attend appointments as normal.

We know that in North Central London some individuals and communities using maternity and neonatal services have poorer experiences and outcomes. We are committed to reducing these inequalities and ensuring that everyone receives high-quality care with great experience and outcomes.

The work that we have carried out through the Start Well programme is driven by the need to reduce inequalities and improve the quality of care, but we recognise that this won’t happen overnight. These plans come with a significant amount of investment for maternity and neonatal services which will improve the quality of services for all pregnant women and people and babies. It will help us to:

• Meet the changing health and care needs of local people, having the right capacity and level of care in the right places. For example, each hospital having at least a level 2 neonatal unit that can meet the needs of most newborn babies without needing to transfer them.
• Improve the consistency of quality we are able to meet in each hospital site by meeting best practice for staffing levels and keep midwife-led units open, respecting people’s preference for their birth and will improve experience for everyone, including staff.
• Improve the quality of some of our maternity and neonatal facilities by upgrading some of our hospital estate.
• Improve outcomes for pregnant women and people and babies as staff able to maintain their skills and competencies. Evidence shows that larger neonatal units achieve better outcomes for babies.

Alongside the Start Well programme, we are continuing additional work through the Local Maternity and Neonatal System. NCL’s Local Maternity and Neonatal System (LMNS) is a partnership of people involved in maternity and neonatal services, who work together to improve services, make them safer, more equitable, personal and kinder for the people who use them.

Much of the system-wide transformation work that will take place in maternity and neonatal services in the coming years is highlighted in the LMNS’ Equity and Equality Action Plan. This plan includes action to improve equal access to mental health services, personalisation and better use of digital technology.

We don’t yet know what will happen with any space at the Royal Free Hospital when these changes are implemented. There will be an opportunity however to use it for other services that will benefit local people.

West London Children’s Healthcare (covering Chelsea and Westminster Hospital and St Mary’s Hospital) and Royal London Hospital will mirror the arrangements for children being transferred from their local hospitals. In extreme circumstances where there isn’t a bed available at the receiving hospital, the paediatric surgery referral hub will help locate an appropriate bed at another site across London. The referral hub will support management of specialist paediatric capacity and speed up the identification of an appropriate bed at times when all hospitals are busy.

We have focused on surgical care for very young children because of significant issues with the existing structure and pathways. There are additional complexities for managing very young children because of the surgical and anaesthetic skills required. We expect that the majority of children over the age of 5 should be able to be cared for at their local hospital.

However, we recognise that strict age-cut offs can negatively impact clinical treatment in some circumstances (e.g., for airways, the size of the child is more important than the age in terms of skills required for treatment). The paediatric referral hub will include all children below the age of 16, to support more nuanced clinical management of children and young people.

This will need further detailed work as part of implementation planning, including reviewing current standard operating procedures.

We mapped which hospitals patients will go to based on travel times. The referral hub will help make sure that patients go to the most appropriate hospital for their care with an available bed. These patient flows are only for emergency surgery and for children under 5 years old.

For planned care pathways, some work was done to scope ways of managing follow-up care as part of the pre-consultation business case. This could be, for example, as part of a hub-and-spoke model, however more detailed work will be required as part of implementation planning. We want to make sure that the new arrangements are clear about who supports different parts of the patient pathway, as well as considering patient experience and travel, and supporting local providers to continue care locally where possible.

We do not anticipate significant amounts of routine outpatient work from the emergency pathway, and this will be considered as part of implementation planning.

For planned care, Great Ormond Street Hospital and UCLH have confirmed that they will have capacity for increased flows based on available data, and the number of elective inpatient cases is very small (under 25 per year across North Central London). UCLH are building additional capacity for the increased number of day case procedures.

For emergency care, West London Children’s Healthcare and the Royal London Hospital have confirmed that they should have capacity for increased flows based on available data. In the extreme case that capacity is not available in these hospitals, the paediatric referral hub will help identify where capacity is available to avoid delays to patient care.

Funding flows to hospitals will be adjusted to account for the changes.

Details about how we manage assessments and pre-assessments will need to be worked through as part of implementation planning.

The specialist hospitals already treat a lot of young children and can safely do more emergency work.

As part of implementation, we will need to build on and amplify the existing work done by the North Thames Paediatric Network on anaesthetics skills, competencies and confidence in order to get a more consistent offer at local hospitals.

As part of implementation planning, we will be focusing on how we expand continuing professional development (CPD) training for surgeons at local units, utilising North Central London expertise where possible. There is potential scope for advanced CPD arrangements for certain pathways, e.g. for acute emergency airway cases.

Existing arrangements for accommodation and travel support will continue to be available, but these arrangements can vary from hospital to hospital. For information on more hospital-specific services, you can contact the hospital Patient Advice and Liaison Service (PALS). Usually, a parent can stay overnight with their child with on-site facilities to buy food. As we implement the new pathways, alongside implementation of the other mitigations outlined in the Integrated Impact Assessment, we will consider developing additional comms information to support parents to understand what is available for them.

There may be some increases in travel costs for some families. Existing support for travel costs will continue to be available, for example, the Healthcare Travel Costs Scheme (HTCS). The full mitigations are available in the Integrated Impact Assessment.

This will vary on a case-by-case basis depending on the child and their condition. depend on the case. Depending on how unwell the child is, they will be transferred via tracked taxi, ambulance or through the Children’s Acute Transport Service (CATS).

Yes, if your child is known to Great Ormond Street Hospital (e.g., because they are already receiving long-term treatment or have a complex co-morbidity) in the first instance we will look to ensure that your child will be treated at Great Ormond Street Hospital for emergency care. We also agreed that Great Ormond Street Hospital will continue to see medically and surgically complex children.

As part of implementation planning, we will develop a comprehensive communication plan with the key message that parents and carers should continue to take their child to the closest emergency department if there is an emergency. There should be no change in how parents first access care, as a result of these new pathways.

The NCL ICB Board approved the changes on 30 September 2025. Whilst further work is required to create a detailed implementation timeline, we expect implementation planning to take place over next 6-9 months, with a new model fully in place by end of 2026.