Frequently Asked Questions

Maternal medicine services are for women with complex medical conditions that either develop during pregnancy or they have prior to becoming pregnant.

We have given careful consideration to the impact of the recommendations on these services following and in light of feedback received during consultation. We have:

• Convened a clinical working group to consider the feedback we have received, working with the Maternal Medicine Network, who already support pathways across all North Central London (NCL) units
• Considered each pathway and specialty in turn to understand the impact
• Confirmed with our clinical reference group the feasibility of implementation taking into account everything we have heard

As is currently the case, women and pregnant people with the most complex or serious conditions will be seen at UCLH which is both the maternal medicine and fetal medicine centre and can look after the most sick and premature babies. Given that many patients with complex health conditions need to deliver early this will continue to be the most appropriate site for them to have their baby.

Through careful planning and working with the maternal medicine network through implementation, we will ensure that pregnant women and people access the right medical and obstetric care they need. Our approach to this is set out in the decision-making business case.

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.