Agenda item

Notice of items to be raised under this heading must be given in writing to the Deputy Director Democratic Services or their representative before the meeting in accordance with Standing Order 60.

In accordance with Standing Order 60, the Chair agreed to take two urgent items relating to additional beds in Northwick Park A&E and Northwick Park Maternity Services. He welcomed Pippa Nightingale, CEO of London North West University Healthcare NHS Trust, to provide an update.

A&E Winter Pressures and Additional Beds

Pippa Nightingale began her remarks by reminding the Committee that NWL hospitals were still currently in the winter period, with an outbreak of a new strain of norovirus in the community which was being seen across all hospitals and impacting patients and staff. As a result, the Trust was reminding people not to socialise in public when they were symptomatic. The Committee heard A&E departments had experienced significant pressure this winter, with Northwick Park seing a 9% increase in attendance to A&E, which had not been the intention with the Out of Hospital Strategies in place. She advised that these strategies did not seem to have been delivered effectively and therefore an increase in attendance to emergency departments had put a strain on the Northwick Park Hospital. She advised, however, that the Trust was fortunate to have two A&E departments through Northwick Park Hospital and Ealing, so had the ability to move ambulances between the two, which was not always ideal for local populations but meant there was a footprint to move patients where one site was busy.

Pippa Nightingale then moved on to highlight some of the positives, which were that the Trust had ran all three Urgent Care Centres themselves for the first year, and those centres were operating daily at 99% and achieving the target of seeing, treating and discharging patients within 4 hours, which was highlighted to be very good performance. As a result of that positive performance, more patients could be seen and the Trust could move patients between A&E and Urgent Care Centre pathways in a much more streamlined way than previously when there had been third party organisations running those services. The Trust had also opened additional winter beds this year to deal with the extra demand being experienced. As an estimate, around 130 conveyances of patients by ambulance was seen by Northwick Park daily, but the Hospital usually only needed to admit between 40-45% of those patients, so colleagues felt there was work to be done to remind people when it was the right time to use an ambulance and how to use other parts of the health system. That communications work would be done through Primary Care next year.

The Committee were informed that the Trust was fortunate to have been funded to build an additional 32-bed acute ward, which had opened in April 2024 and had helped demand. Pippa Nightingale expressed that it was a very good facility and had been full from the first day of opening. In addition, the Trust had been fortunate to open some mental health compliance rooms in response to the high numbers of patients in NWL hospitals with a mental health illness, likely because they were waiting for a mental health bed placement or because they had physical health needs as well. She highlighted that this was the first time the Trust had been able to build rooms where staff could safely provide care to them in the new acute medicine ward which had helped the situation.

She concluded her update by highlighting that if Northwick Park had not seen a 9% increase in A&E attendance then it would have the right bed balance, but because of the increase there were still patients being held in temporary escalation spaces with care being provided to them. As such, she advised that the hospital had been challenged but that the teams had done a good job managing demand, and whilst A&E performance was not where colleagues would want it to be, which was the case across London, it had performed better than the previous year.

Northwick Park Maternity Services Improvement Plan

Pippa Nightingale then provided an update on maternity services at Northwick Park. She explained that she had attended the scrutiny Committee in 2022 to talk about maternity services and had informed the Committee that she was not satisfied with the maternity services in the Trust she was running, of which she had recently became CEO. At that time, she had asked the Committee for their patience and trust that the hospital would improve services to the right place over time, as the issues were not immediately fixable, and so thanked the Committee for that support and patience, highlighting that the support the Trust had received locally from members and leaders had been exceptional.

She was pleased to inform the Committee that Northwick Park Hospital was now in what she felt was a very good place with maternity. Almost £6m had been invested in estates, including a brand new birth centre which was now open, and a bespoke triage service had been introduced where women and pregnant people were seen promptly when they attended the maternity service. The neonatal service had been renovated and a new bereavement suite had been opened. It was recognised, however, that buildings did not fix every problem, although they had helped make the service feel invested in. In tandem with estates improvements, the hospital had done a lot of work around culture, which Pippa Nightingale felt had been the reason the service in the past had received scrutiny, as the culture had never been addressed. She highlighted that improving culture within the service had been a challenge and had meant that staff had exited the service that she did not feel could work to the standards needed to improve the service to where it needed to get to. As a result, the first year of the improvement plan had focused heavily on managing very long, difficult and complex HR processes.

The Committee were advised that the service had then focused on recruitment, and Pippa Nightingale expressed she was pleased that Northwick Park Hospital now had one of the lowest vacancy rates in midwifery across London at 7%, compared to 2 years ago when it had been at a 48% vacancy rate. With a new and enthused workforce in both the midwifery and medical workforce, this had helped to change the culture, and the service was now on the embedding stage, supporting staff to get the experience they needed, a lot of whom were at the start of their careers.

Pippa Nightingale informed the Committee that, as a result of the improvements made, Northwick Park Hospital now had a stillbirth rate lower than the national average, which had previously been much higher than the national average, and it had been lower than average for over a year. The neonatal mortality rate was also lower than the national average. As such, Pippa Nightingale stated that Northwick Park Hospital now had some of the best and safest mortality ratings across the country. In the recently published Embrace report, which was the national mortality report for maternity, Northwick Park now had a 15% lower than national expected mortality rate for maternity. The service had also met the 10 CNST safety targets for the past 3 years. In addition, friends and family tests showed that 94% of women and pregnant people would recommend the service. Pippa Nightingale felt that these improved figures began to tell a positive story, but reassured members that the service was not complacent and was now ensuring those positive improvements were fully embedded and seen long term.

The Chair thanked Pippa Nightingale for her introduction and invited comments and questions from those present, with the following points raised:

The Committee highlighted that the next part of the improvement plan should be to communicate the improvements to users to instil confidence that the service was where it should be. As such, they asked what communications were planned or already in place to do that. Pippa Nightingale explained that the service had been appropriately cautious to celebrate the successes straight away, conscious that early communications could result in the birth rate suddenly increasing, and she wanted to be assured that the improvements were embedded, the achievements made had been stabilised and that the workforce was fully equipped before the hospital saw an increase in births. The new birth centre had also only recently opened 6 weeks previously. She added that the majority of promotion of the service came from women and families through word of mouth, and the best thing maternity services could do was deliver a good service that would then cascade through communities via word of mouth. Considering the steady improvements, she felt that the service could now start to think about promoting the improvements made through primary care and GPs, who had already done some of that work, as well as through social media channels. This would be done carefully to avoid flooding activity. She felt that women and pregnant people would naturally start to return to Northwick Park for their maternity care over time, and for the last 6 months the booking rates of women and pregnant people booking to give birth at Northwick Park at the start of their pregnancy had increased considerably.

The Committee asked if the Trust felt the need for a a confidence building exercise to be done with the community and asked how councillors could support that. Pippa Nightingale advised that she did think that was needed and the service was now at the point that she felt confident to do that. This would be done through the Trust’s Maternity and Neonatal Voice Partnership (MNVP) which had some strong voices and worked with service users and in children’s centres to promote the work being done. The Trust was also working with faith groups to communicate with residents. For example, the Trust was looking to partner with Neasden Temple to deliver some antenatal clinics. As such, she felt that working with established community partners was the way to instil that trust.

Noting that the Committee had previously heard about the culture issues within the service and the issues with retention, members asked whether those issues had now gone following the improvements made. Pippa Nightingale advised members that the Trust had recently had the staff survey results returned and they had been the best results the Trust had ever seen. Upon delving further into the figures to look at maternity, that was also very positive. As such, she felt confident that the culture had started to change as a result of dealing with some of the challenging staff who had caused some of those culture issues. She highlighted that sometimes there was a need to create a change in a workforce to create a new culture, and that had taken the first year of the improvement plan. As such, she felt that the challenging actions had now been done and were starting to show a difference in culture within that department.

The Committee queried whether CQC had returned to ratify the improvements made since their last visit. Pippa Nightingale confirmed that they had not yet returned.

The Chair thanked Pippa Nightingale for providing her updates and drew the item to close.