Frequently Asked Questions

• 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.

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.

The Start Well public consultation on proposed changes to maternity and neonatal services and children’s surgical services in North Central London has now closed.

The responses received will now be analysed by Opinion Research Services, an independent research agency, who will produce a report for the consulting bodies; North Central London Integrated Care Board, on behalf of the local integrated care system, and NHS England (London) Specialised Commissioning. This report, along with a wide range of other evidence and information will be used to develop a ‘decision making business case’ for consideration by the Integrated Care Board.

In the meantime, no decisions have been made on changes to maternity, neonatal or children’s surgical services in North Central London and services will continue to run as usual.

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.

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 consulted on both with an open mind.

• 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.

The ICB needed to consult on proposals for changes to services in order to obtain views on proposals, regardless of how many options there were 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 were therefore consulting with an open mind on both options.

The purpose of the consultation was to capture views and feedback on both options and to listen to alternative views and solutions that we might not have identified. The responses received will now be analysed by Opinion Research Services, an independent research agency, who will produce a report for the consulting bodies; North Central London Integrated Care Board, on behalf of the local integrated care system, and NHS England (London) Specialised Commissioning. This report, along with a wide range of other evidence and information will be used to develop a ‘decision making business case’ for consideration by the Integrated Care Board.

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.

Yes, you can still give birth at these locations. No decisions have been made on changes to maternity, neonatal or children’s surgical services in North Central London and services will continue to run as usual.

• 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.

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.

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.

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.

• 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.

Yes, you still give birth at Edgware Birth Centre. No decisions have been made on changes to maternity, neonatal or children’s surgical services in North Central London and services will continue to run as usual.

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.

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.

• 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.

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.

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.

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.

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.