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Frequently Asked Questions

You can find answers to some of the most frequently asked questions about our proposals and consultation on this page, which we will be updating throughout the consultation. We will make it clear when a new question and answer have been added to the list by including the date they are added.

This section covers why we started the Start Well programme, who is involved and what we hope to achieve

 

Why did you start the Start Well review?

There were several reasons for starting this work, which is being co-ordinated by North Central London Integrated Care System (NCL ICS) and overseen by North Central London Integrated Care Board (NCL ICB), working with NHS England, as the commissioner of neonatal services and some specialist children’s surgery.  These include:

  • We know there are unacceptable variations in health, with some groups more likely to live with poor health and have poorer health outcomes than others. These groups may find it harder to access the right services at the right time. We want to reduce these inequalities in outcomes and access.
  • The opportunity to build on existing partnership working as an ICS and achieve our collective ambition to give every child the best start in life.
  • The clear calls to action set out in both the NHS Long Term Plan and the Ockenden Report.
  • The learning in NCL during the COVID-19 pandemic.
  • External reviews of services by the Care Quality Commission (CQC) and NHS England.
What is the North Central London Integrated Care System?

NCL ICS brings together local health and care organisations, councils and the voluntary, community and social enterprise sector to work in joined-up ways to improve health outcomes for residents of Barnet, Camden, Enfield, Haringey and Islington and to tackle current inequalities.

What is the North Central London Integrated Care Board?

The NCL ICB is responsible for developing a plan to meet the health needs of the local population, managing the NHS budget for our Integrated Care System, and arranging the provision of health services in our area.

Which hospitals are involved with the Start Well programme?

The programme is focused on planned and emergency surgical services for children and young people, and maternity and neonatal services at:

  • North Middlesex University Hospital NHS Trust
  • Royal Free London NHS Foundation Trust (including Royal Free Hospital, Barnet Hospital and Edgware Birth Centre)
  • University College London Hospitals NHS Foundation Trust
  • Whittington Health NHS Trust
  • Great Ormond Street Hospital for Children NHS Foundation Trust.

The links between local and specialist hospitals, particularly Great Ormond Street Hospital for Children NHS Foundation Trust, have also been considered.

Who is affected by the proposed changes?

The proposed changes could potentially impact anyone who uses services in North Central London.  In particular, residents in Barnet, Camden, Enfield, Haringey and Islington and some neighbouring areas, such as Brent, Harrow and City and Hackney and to a lesser extent Hertfordshire.  The proposed changes could also potentially impact staff working at the hospitals.

The potential impacts of the proposals, including by geography, are set out in detail in the Start Well consultation document and also on the Key Information page for both maternity and neonatal services and paediatric surgery.

 

This section covers questions relating to the proposals for maternity and neonatal care.

 

Why do we believe things need to change for maternity and neonatal services?

There are many areas of excellent care across North Central London, and we know our staff work incredibly hard and are committed to achieving the best possible outcomes for patients. There are opportunities for us to improve the quality of services and outcomes for local people, address areas of difference, and provide a better experience for our patients, their families, carers, and our staff.

Some of the challenges and opportunities include:

  • The needs of local people are changing and our services need to adapt to the falling number of babies being born and the care needed during pregnancy and after birth becoming more complex.
  • Our services are not currently set up to meet the needs of everyone that uses them and this can impact on their quality.
  • The use of midwife-led care at Edgware Birth Centre is particularly low. On average fewer than 50 pregnant women and people (less than one a week) gave birth there over each of the last three years.
  • We need to make sure there is sufficient neonatal care in the right places. Our neonatal units at UCLH and GOSH, which care for the most premature and unwell babies, are often full meaning babies are sometimes transferred to units further away from home. In contrast, half of the cots at the Royal Free Hospital neonatal unit, which cares for least babies requiring the lowest level of neonatal care, are not in use on any given day.
  • We want everyone using services in North Central London to have the best hospital environment. For example, labour rooms with en-suite bathrooms and neonatal units with enough space for parents to comfortably spend time with their baby. Some hospitals offer this, but some don’t.
  • We need to address the staffing challenges we face. There are currently high numbers of staff vacancies in midwifery, neonatal nursing, and other health professions that care for babies. Not having enough staff can sometimes impact on the quality of care we are able to provide, for example staffing shortages sometimes mean that we need to temporarily close midwife-led units which impacts on patient choice.
What would the proposed changes to maternity and neonatal care mean for the range of maternity and neonatal services available in NCL? (Added 11/01/24)

Pregnant women and people would still be able to choose to give birth at home, at a unit run by midwives or in a hospital, either in NCL or in a neighbouring area.

If choosing to give birth in NCL there will be a choice of care at either UCLH, North Mid and Barnet Hospital and one other hospital, depending on which option is implemented. Under option A, pregnant women and people would also be able to choose to give birth at Whittington Hospital. Under option B, pregnant women and people would also be able to choose to give birth at Royal Free Hospital. If we implement either of these proposed options, we would ensure that all units in NCL have at least a level 2 neonatal unit and that care would be provided in modern facilities that meet modern building standards guidance.

In addition, there is a proposal to close the birthing suites at the standalone midwifery-led birth centre at Edgware Community Hospital. This would mean that this standalone midwifery-led unit would no longer be a choice for people to give birth. We are proposing that ante and post-natal care remains at Edgware, and midwifery-led care would continue to be offered as a choice through home births and alongside midwifery-led units at other hospital sites. This proposal is being consulted on separately to the overall number of maternity and neonatal units in NCL.

We are proposing to continue to provide antenatal and postnatal care locally in out of hospital settings such as children’s centres. However, for birth and appointments that need to be at a hospital site, women would need to travel to one of the four remaining maternity units in NCL, or to the unit of their choice outside NCL.

How did you decide on the two proposed options for public consultation?

Our proposed care model reduces the number of maternity and neonatal units overall: this will increase birth numbers and neonatal care days at all units within North Central London making them more sustainable in terms of staffing and births, when considering the declining birth rate. It also ensures that all neonatal units are at least level 2, with one level 3 NICU so that all sites have the specialist staff to care for the needs of premature or unwell newborn babies. For more detail about this proposed care model see the paper that went to the ICB Board in November 2022. Through an options appraisal process we looked at the different possible combinations of options for the location of the proposed four neonatal and maternity units.

There are currently five maternity and neonatal units in NCL, and not all currently provide the proposed model of care. These are at Barnet Hospital (Barnet), North Middlesex University Hospital (North Mid), Royal Free Hospital, University College London Hospital (UCLH) and Whittington Hospital. UCLH currently has a NICU (level 3), which is a regionally designated service. All partners (including NHS specialised commissioning) agree that moving this unit would be very difficult because of co-located services and current networks. Therefore, it is proposed that the NICU (level 3) remains at UCLH and becomes a fixed point in each option. We therefore considered four options as the remaining possible combinations

We evaluated the strengths and weaknesses of each of the four remaining options against the same criteria (quality of care; workforce; access to care; affordability and value for money).

We ruled out the options that entailed the closure of Barnet and North Mid services, as they would involve outflows of births in such high numbers to neighbouring areas (Hertfordshire and West Essex for Barnet and North East London for North Mid). The neighbouring integrated care systems confirmed that their hospitals would not be able to deliver the additional activity.

Following this options appraisal process, two options were therefore found to be implementable– option A, which would see maternity and neonatal services close at Royal Free Hospital and option B, which would see services close at Whittington Hospital. Under both options, there would continue to be a choice of an obstetric unit, midwife-led unit and home birth and all sites would have at least a level 2 neonatal unit able to care for babies born prematurely or unwell. Both options would also see a significant investment in estate, supporting the privacy and dignity for pregnant women and people giving birth. As both options are implementable, we are consulting on both with an open mind.

 

 

 

 

Why is having maternity and neonatal services at Barnet Hospital, North Mid, UCLH and Whittington Hospital and closing the maternity and neonatal unit at the Royal Free Hospital the preferred option?

Based on an assessment by experts, including local clinicians and patient representatives, we have identified the strengths and limitations of each option. Whilst both options are implementable and would deliver an improved quality of care, at this stage option A (Barnet, North Mid, Whittington, UCLH) has been recommended as the option preferred by the ICB for the future. This is because:

  • It would mean fewer staff needing to move to a new location.
  • Option B (where maternity and neonatal services at Whittington Health would close) would mean some people would need to go to hospitals in North East London that would struggle to have capacity for this because of rising birth rates in some parts of North East London.
  • While option A would mean some people would need to go to hospitals in North West London, those hospitals have confirmed they have capacity for this as the number of births in North West London is falling.
What does 'preferred' option mean? Does it mean a decision has already been made?

Option A is our preferred option because, on balance, we think it has more advantages than option B. No decision has been taken and the consultation is a chance to listen to other evidence that the public, staff or stakeholders might share. There may also be other solutions to our case for change which we haven’t yet identified. We will consider any viable solutions that are suggested.

Why is there a public consultation if there is a preferred option?

The ICB would need to consult on proposals for changes to services in order to obtain views on proposals, regardless of how many options there are for implementation and whether there is a preferred option.

Option A is our preferred option as we believe on balance it has greater benefits than option B, both option A and option B were evaluated as implementable during the options appraisal process. We are therefore consulting with an open mind on both options.

There may be additional evidence that comes to light during the consultation that we haven’t yet considered. The purpose of the consultation is to capture views and feedback on both options and to listen to alternative views and solutions that we might not have identified.

 

 

How many pregnant women and people would be impacted if Royal Free Hospital closes its maternity and neonatal unit? (Added 11/01/24)

Around 2,500 births happen at the Royal Free Hospital each year. This means that should the unit at the Royal Free Hospital close, around this number of births and any related neonatal care that is needed would take place at an alternative location. Pregnant women and people would be able to choose an alternative site for their maternity and neonatal care – and this could either be in one of the four other hospitals within NCL (UCLH, Barnet Hospital, North Mid or Whittington Hospital) or a hospital of their choice outside NCL.

 

 

How many pregnant women and people would be impacted if Whittington Hospital closes its maternity and neonatal unit? (Added 11/01/24)

Around 3,400 births happen at the Whittington Hospital each year. This means that should the unit at the Whittington Hospital close, around this number of births and any related neonatal care that is needed would take place at an alternative location. Pregnant women and people would be able to choose an alternative site for their maternity and neonatal care – and this could either be in one of the four other hospitals within NCL (UCLH, Barnet Hospital, North Mid or Royal Free Hospital) or a hospital of their choice outside NCL.

 

 

What about antenatal and postnatal care?

As is the case now, pregnant women and people would continue to have access to a wide range of routine and, where needed specialist, care and support while trying for a baby, during pregnancy and after giving birth. This would include routine midwife-led antenatal and postnatal care, scans and antenatal screening, access to mental health support before, during and after pregnancy as well as specialist services such as maternal and fetal medicine.

We want to provide antenatal and postnatal care as close to home as possible, making use of virtual appointments where appropriate. If the proposed model of care is implemented then as is currently the case, a significant proportion of antenatal and postnatal care would be provided out of hospitals, at community and family centres and in community hospitals. For example, antenatal and postnatal care would continue to be provided at Edgware Hospital.

Some antenatal care, such as scans and screening tests, would continue to be provided at each of the four hospitals with obstetric and midwife-led birth units. This means there would be four hospital locations providing antenatal and postnatal care in the future, compared to five currently.

The detail of how this would work would need to be worked through in the next phase of the process, post consultation.

What would happen to the space in the hospital if a maternity and neonatal unit closes?

It would be an opportunity to use that space to provide other services which could benefit local people. No decisions have been made and this would need to be a conversation between commissioners and providers post-consultation.

Can I still give birth at the Royal Free Hospital and Whittington Health? (Added 11/01/24)

Yes, you can still give birth at each of these locations for the time being, as we are still consulting on the proposed changes. All current services remain open, and you should continue to access them as normal. Should a decision be taken to make changes to services in future, it would be some time before any changes would be implemented and the ICB would communicate clearly regarding when that would happen.

What mitigations are you thinking about in respect of the proposed reduction of birth units on hospital sites from five to four? (Added 11/01/24)

We know that if we implement changes, it may mean some pregnant women and people may need to access maternity care from a different hospital from that which they might currently choose. This could slightly increase journey times for some people and mean that people have their maternity care in a hospital that is less familiar. Through the development of our options, we thought about different patient groups, and different types of support they may need to navigate these changes should they be implemented in future. The areas in which we think mitigations may be needed to remove or reduce any negative impact of the proposed changes include:

  • Communicating with the public and patients around implementation should a decision be taken to make changes
  • Providing extra support, such as information and site visits for people who may need help to access an unfamiliar hospital
  • Publishing information about how to travel to a hospital site
  • Ensuring that maternity services continue to provide as much care locally as possible
  • Raising awareness of financial support available with the costs of travel to hospital.

More information about the work we have done to date can be found in our consultation document and integrated impact assessment.

Through consultation we are seeking to better understand what the proposed changes would mean for local people, and what we could put in place to reduce any negative impact.

What choices do I have about where to give birth? (Added 11/01/24)

You can give birth at home, in a unit run by midwives or in hospital.

Pregnant women and people, in conversation with clinicians, are supported to choose a birth setting that best meets their needs. Those with higher risk pregnancies are often advised to give birth in a unit run by doctors in a hospital which has all the additional support nearby should there be any complications during labour or birth.

If the proposed changes were implemented in the future, it would mean that there is no longer the choice of a standalone midwifery-led unit. This is a unit run by midwives that is separate to a hospital site. Although, there would still be the choice of midwifery-led units that are located at hospital sites.

The proposals could also mean that the choice of hospital sites within NCL changes, and there would be four hospital sites where people could give birth, as opposed to the current five.

Pregnant women and people would continue to have the choice to give birth outside of NCL.

What happens if my baby needs neonatal care? (Added 11/01/24)

Neonatal care can be needed if your baby is born unwell, or if it is born early (premature). If you give birth in hospital, neonatal units are almost always in the same building or close by.

The NHS organises neonatal care into different levels that can look after babies with different needs. This ranges from a level 1 neonatal unit that cares for babies with the least complex conditions, level 2 which is the next step up in care, and level 3 units which look after the most unwell or premature babies.

Under our proposals, we are suggesting that all neonatal units are able to provide the same minimum level of neonatal care, i.e. all units would be level 2 or above and we would no longer have a level 1 unit. Under option A this would mean retaining and expanding the level 2 neonatal unit at Whittington Health, and under option B this would mean upgrading the Royal Free Hospital neonatal unit from a level 1 unit to level 2.  We think that this will mean that fewer babies would need to be transferred from the Royal Free Hospital (where they are born) to a different hospital site for neonatal care in an emergency, which will improve the experience for families and outcomes for babies.

Why are care needs getting more complex? (Added 11/01/24)

Pregnant women and people having increasingly complex care needs and risk to the baby during pregnancy can be due to several factors, including the age of the pregnant woman or person, lifestyle factors and pre-existing health conditions such as diabetes and obesity. Staff have reflected that the complexity of births in NCL is increasing, and the average age of pregnant women and people is increasing. Also, in NCL we have more babies being born in more deprived areas, which can be associated with increased complexity during pregnancy.

There is a link between the complexity of a woman or person’s pregnancy and the likelihood that their baby will need additional support in a neonatal unit when they are born. This is likely to explain why admissions to neonatal units are not declining in line with the birth rate in NCL. Due to medical advancements, NICUs (level 3) can look after babies born at very young gestational ages (in some instances down to 24 weeks) or with additional complexities. These babies can spend months on neonatal units, which means this type of specialist capacity can often be over-stretched.

How many pregnant women and people give birth at each hospital in NCL per year? (Added 11/01/24)

Between April 2021 and March 22, the data shows the following birth numbers at NCL hospital sites:

  • Barnet Hospital: 5,152
  • Edgware Birth Centre: 45
  • North Middlesex University Hospital: 3,868
  • Royal Free Hospital: 2,560
  • UCLH: 5,101
  • Whittington Health: 3391
  • Total: 20,117.

This section covers proposals relating to the closure of the birthing suites at Edgware Birth Centre.

 

Why are you proposing to close Edgware Birth Centre?

A key consideration in this proposed closure is the very low number of pregnant women and people choosing to give birth there each year, balanced against the NHS resources needed to keep the centre running. Having a centre that is delivering less than one baby a week, and birth suites that are used once a month, does not represent a good use of resources.

As a result of this, our proposals include the closure of the birthing suites at Edgware Birth Centre at Edgware Community Hospital.

This would mean fewer than fifty pregnant women and people a year would no longer be able to give birth there. Antenatal and postnatal care would still be provided at Edgware Community Hospital and the rooms that make up the birth centre would be reconfigured so that more people could be seen there.

If the proposal is implemented we would continue to offer the choice of midwife-led care through high-quality alongside midwife-led units and home birth services. The decision about the proposed closure of the birth suites at Edgware Birth Centre is independent of the decision about our other proposals for hospital-based maternity and neonatal care.

Can I still give birth at Edgware Birth Centre? (Added 11/01/24)

Yes, you can still give birth at each of these locations for the time being, as we are still consulting on the proposed changes. All current services remain open, and you should continue to access them as normal. Should a decision be taken to make changes to services in future, it would be some time before any changes would be implemented and the ICB would communicate clearly regarding when that would happen.

Will I still be able to have antenatal and postnatal care at Edgware? (Added 11/01/24)

Yes. If a decision is taken to close the birthing suites at Edgware Birth Centre, we are proposing to continue and potentially expand the antenatal and postnatal care that is provided there. This means that more pregnant women and people would be able to have appointments close to home if they live locally.

What would be the impact of closing Edgware Birth Centre?

We have carefully considered the impact of the proposed closure of birth suites at the Edgware Birth Centre.

Because a very small number of pregnant women and people give birth at the centre each year, and because they would have the choice to have a home birth instead, the proposals are very unlikely to impact on access or inequalities.

Evidence shows that there are no significant differences in outcomes for babies who are born in an alongside or standalone midwife-led unit. By continuing to offer the choice of an alongside midwife-led unit, pregnant women and people would still have access to the benefits of midwife-led care.

We recognise that some people may not agree with the proposed closure of the birth suites at Edgware Birth Centre. During the consultation we are keen to hear about the potential impact of this proposal, ways to reduce any negative impact and potential solutions or opportunities that you think we may not have considered.

The decision about the proposed closure of the birth suites at Edgware Birth Centre is independent of the decision about our proposals for hospital-based maternity and neonatal care.

Why can’t you increase the number of births at Edgware Birth Centre?

The Edgware Birth Centre is available for women and people who are deemed to have low risk pregnancies. Those that are considered to be high risk for example due to a pre-existing health condition or one that develops during pregnancy are ineligible to give birth there.

Around 70% of births in North Central London are assessed as being moderate to high-risk. This means that the group of pregnant women and people considered suitable to give birth at Edgware, should they choose to do so, is relatively small. Of this proportion of eligible pregnant women and people, an even smaller number would be within close travelling distance of the unit.

The declining birth rate in NCL and increasing number of moderate to high-risk pregnancies means it is unlikely that we would be unable to increase the number of births at the unit.

Instead, we want to focus on the choice of homebirth services and alongside midwife-led units to enhance this offer – and also to increase utilisation.

What would it mean for patients who would have chosen to give birth at Edgware Birth Centre?

We would continue to offer pregnant women and people the choice of high-quality midwife-led care through enhancements to home birth services and alongside midwife-led units.

What would happen to the space at Edgware Birth Centre?

Antenatal and postnatal care would continue to be provided at the centre, and rooms could be reconfigured to allow more people to be seen for this care at the centre.

 

This section covers the proposals to change some children’s surgery (also known as paediatric surgery).

 

Why do we believe things need to change for children’s surgical services?

The case for change, published in June 2022, identified a number of opportunities to improve the quality, timeliness and consistency of children’s surgical services in NCL. We know that services cannot continue as they currently are for several reasons, including:

  • A lack of consistent and clearly defined emergency surgical pathways, meaning that clinicians have to make multiple enquires to secure the right pathway for individual children who present to emergency departments.
  • Multiple emergency surgical transfers required to find babies or children a bed in the right setting.
  • Lack of clarity on the role of GOSH in caring for local NCL children and young people requiring surgery, alongside its more specialist work.
  • Access to workforce to deliver emergency surgical activity in children under three years or under five years (general surgery and urology) and planned surgery in children aged between one and two years is not consistent across NCL.
  • Low volumes of some planned surgery being delivered at some local units means there is reduced exposure to children’s surgery and children’s anaesthesia for staff. This can make it challenging to learn and practice the necessary skills and maintain their competencies.

These challenges mean that some children and young people are being transferred multiple times, sometimes to units outside NCL to receive emergency surgical care. For staff at local units, the fragmentation and lack of clarity on the emergency surgical pathway can mean a lot of time is spent trying to locate a bed and therefore delays in accessing the right care.

Why we believe services can’t stay as they are?

The vision for paediatric surgery is to deliver high-quality services and ensure that any child or young person requiring planned or emergency surgery is seen by the right people, at the right place and in the right setting. We are not consulting on an option of leaving things as they are. That is because this would mean:

  • A paediatric surgical care model that does not deliver the best practice or achieve the clinical standards as set out by professional bodies such as Getting It Right First Time (GIRFT).
  • The opportunities for improvement of paediatric surgery would not be realised. This would mean that surgical services would remain fragmented, and surgical care for children aged under three or five years would continue to be delivered at local units where the expertise required to deliver the best quality care is not readily available. For surgical staff at local units, it would continue to be difficult to maintain and develop the skills and capabilities to deliver this service locally.
  • Staff at local units would continue to spend time trying to find a suitable bed for young children requiring surgical assessment and treatment. This may mean being transferred multiple times and to units outside NCL.
Is the proposal to move children’s surgery from local hospitals about saving money?

The proposal is not about saving money. Developing the centres of expertise at UCLH and GOSH would require some additional financial investment which would be used to increase capacity and bed numbers at both sites, in particular setting up a surgical assessment unit at GOSH.

The proposals would allow us to deliver services in line with best practice standards of care, which would in turn improve outcomes and experience of care for children and young people, and their families and carers. For our staff the proposal would help to clarify the emergency pathway and reduce the time taken to find an appropriate bed for the very young children requiring emergency surgery.

How many babies and young children get transferred outside NCL for surgery? (Added 11/01/24)

From April 2020 to March 2021, 144 children and young people were transferred from an NCL provider to other hospitals for an emergency surgical procedure, with almost 30 of these children moved to hospitals outside NCL.

 

This section covers wider considerations of the proposals, decision making and next steps.

 

Why should I take part in the consultation? (Added 11/01/24)

The consultation is an opportunity for you to tell us what you think about our proposals. Giving your views is really important as it will help us understand what the impact of the proposals could be on local people. Your feedback may highlight impacts that we haven’t yet considered, or you might be able to suggest alternative solutions to the challenges we face. We want to hear from people from all backgrounds and perspectives to make sure that we have considered all relevant information thoroughly. All feedback received during the consultation will be taken into account before we take any decisions to make changes.

How will my feedback be incorporated?

We want to hear from a wide range of people during the consultation and everyone’s views are important.

After the consultation closes on 17 March 2024, all the feedback we receive will be analysed by an independent research organisation, Opinion Research Services (ORS). They will prepare a report for us setting out what people think about the proposals.

We will then consider all the feedback, alongside other evidence and information, to decide how to proceed.

How will you take the final decision?

The response to consultation will be analysed by an independent company, Opinion Research Services (ORS), and written up into a report which will be published by the ICB on its website.

The decision on how to proceed will be taken by the NCL ICB Board and NHS England, as the commissioner of neonatal services and some children’s surgery, considering the Opinion Research Services (ORS) report as well as all the feedback from the consultation period and any additional information that is identified during consultation.

What’s the timetable for this? When would this take effect?

This is a long-term piece of work and there is lots of work to do before any changes are implemented. We expect a final decision to be made over the autumn or winter of next year (2024/25), and – if the decision is taken to make changes – then implementation would need to be planned carefully before any changes are made, working with system partners to do this.

What came out of the engagement with staff, patients and stakeholders to inform this decision? What data is there to support it?

The pre-consultation business cases (PCBCs) set out the proposals and how and why they have been developed in great detail, including engagement with staff, patients and other stakeholders. These have been presented in a more accessible way in the consultation document and summary, which are both available on the ICS website and will be widely shared.  Published separately are the evaluation of the 10 week engagement period on the case for change, which took place over the summer of 2022 and the independent report of the pre-consultation engagement on maternity and neonatal services over the summer of 2023, which informed the interim integrated impact assessments (IIAs).

What would happen to maternity and neonatal staff under each option?

We are not seeking to cut costs or reduce the overall number of staff working in maternity, neonatal or paediatric care in North Central London.

One of the drivers of this programme is the high levels of vacancies in these services and we are keen to recruit and retain clinical staff to ensure we can provide high-quality care to patients and service users.  The pre-consultation business case also sets out the benefits for staff in having more resilient services.

If a decision to change how services are organised is made in autumn/winter 2024/25, there will need to be detailed and careful planning to implement any changes. We would envisage supporting staff working in maternity and neonatal care at any site that closes to move to other hospitals in North Central London.

We believe there is an exciting future for maternity, neonatal and paediatric staff in North Central London and want NCL to be the place where staff choose to work and want to stay, with opportunities for training and ongoing career development.

Staff working in these services continue to be hugely valued and vital to the delivery of safe, quality care now and in the future.

Is this all about saving money?

No, not at all.  We want our services to be the best they can be. We have developed proposals to improve the quality and safety of care and address inequities and inequalities in access, experience and outcomes.

This programme of work is focused on improving quality of care and improving outcomes for our local population. During the options appraisal process we considered the affordability and value for money for each option, however this was not a deciding factor on the options for consultation. Our proposals involve prioritising significant additional investment, around £40 million in either option for maternity and neonatal services and around £4 million is needed for our proposals around children’s surgery to improve and expand the current estate and facilities.

What does this mean for my care now?

No decisions have yet been made and no changes will be made in the immediate future. The proposed changes are subject to consultation and further decision-making. If a decision is taken to make changes then implementation will be some years away. All hospitals in North Central London will continue to run as usual and are focused on maintaining quality services that meet the needs of babies, children, pregnant women and people and their families.