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We are a partnership of NHS, councils, and voluntary sector organisations, working together to improve health and care in Barnet, Camden, Enfield, Haringey, and Islington.  

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NCL Start Well programme update

The Start Well programme has now been underway for more than a year and is continuing to ensure we are delivering the best care to meet the needs of local children, young people, pregnant women and people, and babies.

Read about the work of the Start Well programme so far on our website

Options appraisal for maternity, neonates, and paediatric surgical services

The Start Well programme recently began an options appraisal process for maternity, neonates, and paediatric surgical services. This process will allow us to consider the advantages and disadvantages of different options for delivering these services compared to the current arrangements. The aim is to identify preferred options in a structured and robust way.

The options appraisal and an NHS England assurance process are expected to run until late spring/early summer. The options appraisal is being overseen by the Start Well programme board, which has representation from all NCL acute Trusts. A clinical reference group and patient and public engagement group are shaping how the options are evaluated and informing decision making.

Depending on the outputs of the options appraisal, and before any decisions as to service change are taken, the ICB may undertake further engagement and/or a formal public consultation.  

The Integrated Impact Assessment

Alongside the options appraisal we are carrying out an Integrated Impact Assessment (IIA). This will ensure Start Well is helping to reduce inequalities in service provision and outcomes and that we fulfil our legal obligations concerning equality and diversity, sustainable development, and health and wellbeing issues.

The IIA outputs will tell us about the potential impacts of options being considered on different population groups and consider ways these can be avoided or reduced.

A steering group – with patient representation and experts from a range of specialisms including public health, patient and public involvement, quality, and business intelligence – is guiding the process and ensuring a rigorous approach.

Areas that do not require service change

The Start Well programme has identified some opportunities where we can improve services without the need for large-scale service change and many areas are already being progressed through existing NCL programmes of work. 

Feedback from Start Well highlighted that improving quality of communication across maternity, neonatal, and children and young people services is really important to patients and the public. Improvements, led by the Local Maternity and Neonatal System, are already underway in maternity services and include: 

  • introducing the personalised care and support plan digitally and in hard copyacross NCL which clearly outlines choices around maternity care throughout the pathway
  • developing trauma informed carethrough working with women who have lived experience of inequality and disadvantage
  • evaluating quality of, and access to, interpretation services.

There are also areas of existing good practice around communication with children and young people, and we are exploring how learning can be shared including:  

  • ‘Language that Cares’ – work in Haringey to support those in contact with children in care to use language that is age appropriate and caring
  • Great Ormond Street ‘About Me First’ – training for clinical teams to further develop knowledge, skills and confidence in communicating with children and young people and support shared decision making.

More information about Start Well is available on our website. If you have any questions, please email