Agenda item

In February 2013 the North West London joint committee of Primary Care Trusts approved implementation of the Shaping a Healthier Future Programme.  The reconfiguration commenced with the closures of the A&E units at Central Middlesex Hospital and Hammersmith and Fulham Hospital on 10 September 2014.  The next stage of implementation is the planned changes to maternity services at Ealing Hospital.  This report from Brent Clinical Commissioning Group sets out the anticipated impact that the changes to maternity, neonatal, paediatric and gynaecology services at Ealing Hospital will have on Brent Residents.

Dr Susan LaBrooy (Medical Director, SaHF) introduced a report detailing the process by which approval was granted for the consolidation of inpatient paediatric services and maternity and neonatal services in North West London, and outlining the anticipated impact of these changes on Brent residents. Encompassed within these changes was the cessation of the interdependent maternity and paediatric services at Ealing Hospital. It was explained that the decision to consolidate these services had been clinically driven and had been approved by the Secretary of State in 2013. The maternity service at Ealing Hospital had been declining and the hospital was only able to achieve 60 hours of consultant presence on the labour ward; this did not provide enough activity to allow medical professionals to remain validated as practitioners and was therefore unsustainable without significant further investment.

Dr Susan LaBrooy further explained that in 2013/14 only 1 per cent of Brent women chose to use maternity services at Ealing Hospital. The majority of Brent women chose to North West London Hospitals (43 per cent) or Imperial College Healthcare (41 percent), both of which had sufficient capacity to accommodate the additional numbers of births following the closure of the service at Ealing Hospital. Modelling conducted regarding usage of maternity services following the proposed closure at Ealing Hospital had identified that West Middlesex and Hillingdon Hospitals would receive the greatest increase in use of their maternity services. Further modelling was underway with data being collected from expectant and new mothers via GPs and Children’s Centres. This data would inform the decision of the Ealing Clinical Commissioning Group as to when the transfer of services would take place, as would evidence from site visits conducted by NHS England and the NHS Trust Development Authority to assess the assurance provided. Members were further advised that a North West London maternity booking service had been commissioned which would allow women to choose their preferred hospital and would ensure that priority was given to local women. This booking service would provide valuable monitoring information for maternity services.

During members’ discussion, the committee sought confirmation that NPH would be able to cope with additional pressure on their maternity services, given the findings of the recent Care Quality Commission (CQC) inspection and the high birth rate in Ealing. Further information was sought regarding the capacity of Imperial College Healthcare to accommodate additional deliveries. A query was raised regarding the number of consultant hours on the maternity ward at NPH and how this compared to the recommended figure.  The committee questioned what contingency plans were in place if it was found that the proposals were not feasible or appropriate. It was questioned whether similar modelling had been undertaken regarding the anticipated dispersal of service pressures for A&E units following the closure of the unit at Central Middlesex Hospital (CMH).

In response to the queries raised, Dr Susan Labrooy advised that the Borough of Ealing had a large birth rate but maternity services were accessed by women at a variety of different hospitals. It was not anticipated that NPH would experience a significant increase of women using its maternity services as a result of the proposed closure at Ealing Hospital, particularly in light of the declining numbers of Ealing women choosing to use NPH in recent years. However, NPH was able to accommodate an increase in use of its maternity services without any changes to infrastructure. Similarly, and to a greater extent, St Mary’s Hospital and Queen Charlotte’s and Chelsea Hospital could also increase the capacity of their Maternity Services without any changes to their infrastructure. Indeed, even if all of the assumptions drawn from the modelling were incorrect, there still remained capacity in every affected hospital to accommodate greater usage of their maternity services than was expected. Dr Susan LaBrooy added that modelling work was being undertaken for A&E usage but emphasised that hospitals were currently facing an unexplained increase in attendances at A&E which was occurring on a national scale.

Commenting on the CQC findings, Dr Susan LaBrooy advised that though areas for improvement had been identified, at no time had the CQC raised concerns regarding the safety of maternity services at NPH. Simon Crawford (Deputy Chief Executive, LNWHT) advised that the delivery suite at NPH maintained 106 consultant hours. The Royal College of Obstetricians recommended that this figure should stand at 168 consultant hours and a workforce strategy for maternity services was in place. Most London healthcare trusts were now delivering over 100 consultant hours and were working towards increasing it to the recommended figure. Dr Susan LaBrooy advised that the assurance process being undertaken would highlight the balance of risk between proceeding with the proposals and maintaining the current configuration of services. Professor Ursula Gallagher further explained that the maternity booking service would act as a contingency to help alleviate pressures across maternity services in North West London by allowing these to be managed.

A subsequent request was made for information to be provided in writing to Councillor Daly regarding the workforce planning work that had been undertaken with regard to maternity services.

The Chair emphasised that the committee remained concerned about whether sufficient consideration had been given to potential future pressures on maternity and paediatric services in North West London and would therefore require a further update at a future meeting of the committee.

RESOLVED:

That the committee be provided with an update on the implementation of the proposed changes to maternity, neonatal, paediatric and gynaecology services at Ealing Hospital at a future meeting.