Planned transition for maternity and inter-dependent services from - - PowerPoint PPT Presentation

Planned transition for maternity and inter-dependent services from Ealing Hospital

Ealing CCG Governing Body 20 May 2015

Agenda Item 1.0 Welcome and apologies

Agenda Item 2.0 Declarations of interest

Agenda Item 3.0 Minutes of previous meetings

Agenda Item 4.0 Introduction and summary

Summary Paper and Resolutions

Paper 4.0 Presenter – Clare Parker

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• In February 2013, the Joint Committee of Primary Care Trusts (JCPCT) met and took the decision

to consolidate the number of maternity units in North West London from 7 to 6

• In October 2013, the Secretary of State endorsed these plans, although no decision was made on

the timing of the transition of maternity services.

• In late 2013 Ealing Hospital raised concerns to the Medical Director of NHS England (London

region) regarding the issue of a reduction in deliveries for the Trust and the risk this posed to the quality of care

• In response to the concerns raised by Ealing Hospital, on 19th March 2014, Ealing CCG

Governing Body made a decision to invest in contingency plans for the transition of maternity and neonatal services from Ealing Hospital by 2015.

• Ealing CCG Governing Body met again to discuss the issue in October 2014 and agreed to plan

for the implementation and assurance of these changes

• The Governing Body considered the initial outputs of the first phase of assurance at its meeting in

March 2015 and agreed that further work was required

• Today’s meeting will consider the outputs of this assurance work and decide whether a date can be

set for the transition

Ealing Clinical Commissioning Group (CCG) Governing Body is meeting to decide whether to set a date for a transition of maternity activity from Ealing Hospital

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The Governing Body will consider a range of documents and hear from clinical leaders regarding this change

• During the course of this meeting, presentations will be given on:
• The case for change (maternity & paediatrics)
• An overview of the new North West London (NWL) model of care for maternity
• Feedback from a review undertaken by the London Clinical Senate
• The modelling of activity following the transition (maternity and paediatrics)
• Readiness for the proposed changes
• Outputs of the assurance processes undertaken by CCGs in North West London,

NHS England and the Trust Development Authority (TDA)

• An implementation plan for the changes which will be enacted should the CCG take

a decision today on timing

• An overview of the communications, engagement and equalities work planned
• The Governing Body will pause for questions between presentations to enable

Governing Body members to ask questions of presenters.

• The Governing Body will take questions from the public before it takes a decision on

whether to set a date for this change.

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(1) ACKNOWLEDGE that it has received Delegated Authority from the following statutory bodies [listed in accompanying Paper 4.0 Summary Paper & Resolutions] and is therefore vested with the authority to take decisions on timing with regard to the agreed maternity, paediatric and gynaecology service changes at Ealing Hospital on their behalf (2) With regard to maternity services currently delivered on the Ealing Hospital site (a) AGREE that, in line with the Secretary of State’s decision of 30th October 2013 to endorse the transition of the Maternity service, a date should now be set for completion of the implementation of this change. (b) AGREE that based on the information and recommendations presented to the Governing Body, the transition of the Maternity service should be completed on 1 July 2015. (3) With regard to gynaecological services on the Ealing Hospital Site AGREE that based on the information and recommendations presented to the Governing Body the transition of the defined range of emergency gynaecology services should be completed by 1 July 2015

The resolutions for the Ealing CCG Governing Body to consider are as follows (1/2):

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(4) With regard to paediatric services currently delivered on the Ealing Hospital Site (a) AGREE that, in line with the Secretary of State’s decision of 30th October 2013 to endorse the transition of the defined range of paediatric services at Ealing Hospital, a preferred date should now be set for the completion of the implementation of this change. (b) AGREE that based upon the information and recommendations presented to the Governing Body there should be a clear implementation plan and assurance process developed to enable the proposed transition of paediatric services to be completed on 30 June 2016. (5) The CCG Governing Body is also asked to: (a) AGREE to develop a joint Assurance process with NHS England and the Trust Development Authority to ensure that the transition of the paediatric services can proceed as planned and monitor and address any clinical or delivery risks in paediatric services across North West London. That the

• utputs of this process will be formally reviewed by the governing body in public no later than 31 March

2016

The resolutions for the Ealing CCG Governing Body to consider are as follows (2/2):

Questions

Item 5.0 Maternity: The clinical case for change, proposed model of care and anticipated benefits of the proposed change

Maternity Case for Change

Paper 5.0 Presenter – Dr Mike Anderson

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• The purpose of this section is to set out:
• The reasons why these changes are planned and the benefits they will

deliver for women in Ealing

• An overview of the planned future configuration of services
• The rationale for making these changes on 1st July 2015 and no later

Purpose

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The SaHF programme, led by local clinicians, proposed changes to services in NWL that would safeguard high quality care and services for the local population. This included: Consolidation of maternity and neonatal services from seven to six sites to provide comprehensive obstetric and midwife-led delivery care and neonatal care. This will better enable providers to achieve 24/7 consultant presence. The key trusts for these services would be Chelsea and Westminster, Hillingdon, London North West Healthcare Trust (LNWHT), Imperial and West Middlesex The Joint Committee of Primary Care Trusts’ decision was reviewed by the Independent Reconfiguration Panel (IRP)

• n 13 September 2013, which stated in its report to the Secretary of State:

“Commissioners and providers of acute hospital services across north west London must ensure that changes required to secure safety and quality for patients are made without delay.” “Maternity and paediatric inpatient services should be concentrated on the sites identified by Shaping a Healthier Future.” “The NHS’s implementation programme must demonstrate that, before each substantial change, the capacity required will be available and safe transition will be assured.” The Secretary of State accepted the recommendations of the IRP in his statement to Parliament in October 2013.

To improve services for women, the NHS agreed to consolidate maternity care onto fewer hospital sites

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The NHS in North West London wants women to access higher quality maternity services wherever they give birth

Figure 2: Improvement in consultant cover (hrs/week) on labour wards in NWL pre and post change

• All other Trusts in NWL have achieved

extended consultant presence in line with London Quality Standards (LQS). Therefore women accessing services at Ealing Hospital will become increasingly disadvantaged compared to women delivering at other units in NWL.

• The implication here is that the quality of

care received by women accessing maternity services at Ealing Hospital will not be as high as the quality of care received at other Trusts in NWL. Because of the cost–inefficiencies of a small unit with a falling number of deliveries Ealing has needed substantial financial subsidy which could be better invested for other services

Figure 1: Number of hours of consultant presence on labour ward 2012-2014 by each Trust in NW London

Hospital Consultant hours on labour ward

2013/14 2014/15 Post change

Chelsea & West.

98 110 115

Queen Charlotte’s

60 98 140

St Mary’s

60 98 98

Northwick Park

60 98 108

The Hillingdon

98 96 114

West Middlesex

98 144 164

Ealing

60 60

• Average (post change)

76 101 122

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1. Ealing Hospital is only able to achieve 60 hours of consultant presence on the labour ward, significantly lower than the 168 hours required to meet the London Quality Standards. 2. Delivery activity at Ealing Hospital is at its lowest with rapid decline in the last three years. This reduction in activity has continued to decline during 2014/15, which is causing increasing concern for the viability of the unit. 3. Issues have been identified with the quality of obstetrics and gynaecology training at Ealing Hospital. 4. It is likely to be increasingly difficult to attract and retain maternity staff at Ealing Hospital. 5. There will be a significant additional cost to Ealing CCG for maintaining the maternity services at Ealing Hospital beyond 2014/15. 6. There is an increasing risk that services will become unsafe, necessitating unplanned closure of the Ealing Hospital maternity service.

Ealing Hospital cannot grow sufficiently to meet the standards which could be offered at other Hospitals

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• This drop in activity is the most significant across all

Trusts in NWL from 12/13 to 13/14 (12% compared to average of 4% for all Trusts in NWL).

• This has resulted in Ealing CCG having to invest

significant unplanned supplementary funding (due to the reduced income) to ensure it continues to deliver a safe maternity service for the residents of Ealing (£2.6 m in 2013/14 and 2014/15).

• In addition, this drop in delivery activity could impact
• n the ability of trainees to acquire the necessary skills

and experience, thereby jeopardising their ability to fulfil curricular requirements, as identified by Health Education North West London (HE NWL).

• Bookings are falling and only 62% of these convert to

deliveries (See Fig. 4) , further accentuating the reduction of activity at the Hospital.

• This places additional stress on the service and

accentuates the growing risks around training, workforce retention and financial stability.

This is because the number of women choosing to give birth at Ealing Hospital is at its lowest level in over three years

• 15%
• 10%
• 5%

0% 5% 10% 15% Fig 4. Bookings at Ealing Hospital have fallen considerably since September 2014 Fig 3. Activity has fallen at Ealing Hospital by 12% over these three years

Actuals Forecast

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2,175*, 40% 2,036, 37% 470, 8% 340, 6% 209, 4% 155, 3% 108, 2%

Ealing Imperial Hillingdon West Mid Northwick Park Chel West Other

This reduction in activity is highlighted by the fact that 60% of Ealing women already choose to give birth at a different unit

This transition will build on a trend already underway across the geographical area

* Ealing hospital performed 2,390 deliveries in 2014/15. 215 of these were for practices in neighbouring CCGs that border Ealing. Ealing hospital delivered 2,175 babies for women registered with Ealing practices.

2014/15 birth activity for Ealing residents, by Trust

Imperial Hillingdon West Mid Northwick Park Chel West

Ealing CCG deliveries and recorded residence of mother (excluding Ealing Hospital)

Bubble size represents the number of deliveries recorded in each area

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• Ealing Hospital has generally been rated ‘less good’ than other NW London training locations for
• bstetrics and gynaecology for their overall experience and training.
• They would require significant investment in obstetric consultant numbers to support training needs,

and would need to ensure sufficient clinical experience to enable trainees to cover the requirements of the obstetric curriculum - this is not feasible for the current/future levels of activity.

• The low levels of neonatal activity at Ealing Hospital are already impacting on the training experience.

It is likely to be increasingly difficult to attract and retain maternity staff at Ealing Hospital

• There is evidence that staff working at Ealing Hospital are already making enquiries about vacancies

in receiving Trusts

• Any de-stabilisation of staff will present a real safety threat to Ealing Hospital
• Midwives and neonatal nurses are in short supply so even if funding could be found for additional

staff, there is a risk that there would not be sufficient staff available to recruit. This would necessitate an over-reliance on temporary / locum staff which is not desirable in terms of either quality of service

• r patient experience. As a result, the risk of unplanned change due to workforce shortages will

increase. From a purely training perspective, Ealing Hospital will require significant investment in

• bstetric consultant numbers to support training needs

There are compelling reasons for Ealing CCG to take a decision at its meeting today (1/2)

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• Ealing Hospital has already received £2.6m supplementary funding to ensure it continues to

deliver a safe maternity service for the residents of Ealing for 2014/15.

• The supplementary funding could be better used to fund or improve other services for Ealing

patients

• The introduction in 2015/16 of the Better Care Fund, transfer of funding to councils and the need

to use any additional investment funding to develop new out of hospital services, means that continued investment in the maternity service at these levels until 2017/18 is not sustainable.

There are compelling reasons for Ealing CCG to take a decision at its meeting today (2/2)

There are significant financial challenges facing the maternity service at Ealing Hospital

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• Collectively, the challenges outlined mean that while doing nothing is still an option, it is one that

presents significant and increasing risk to the public. The transition needs to be implemented in a planned manner.

• Providing additional funding is the only feasible solution to keep services running and this will not

address all of the clinical safety issues.

• The current view of the SaHF Clinical Board and Implementation Programme Board is

therefore that the optimal solution should be to complete the implementation of the transition

• f maternity services from Ealing Hospital on 1st July 2015.
• This will:
• Create certainty and clarity for women and staff
• Enable Ealing residents to access better quality care.

There is an increasing risk that services will become unsafe, necessitating unplanned closure of the Ealing Hospital maternity service

Questions

Maternity and Neonatal Model

• f Care

Paper 5.1 Presenter – Pippa Nightingale

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• We need to improve the way maternity and newborn care is delivered across North West London

by:

• investing in more midwifery led care in the community.
• improving access to specialised services in major hospitals,
• ensuring there are more consultants and midwives present on labour ward during birth
• Only 40% of the women in Ealing who gave birth in 2014/15 chose to have their baby at Ealing
• Hospital. The other 60% went to the other six maternity units in NW London.

– The lack of joined up care across NWL meant that the 60% of women who gave birth

• utside Ealing had to see a different team of midwives during their antenatal care and their

postnatal care.

• For those who chose to give birth in Ealing Hospital the labour ward is not able to provide the

same level of consultant cover as other NWL Trusts. All hospitals are striving to provide consultant cover on labour wards 24 hours a day,7 days a week (ie 168 hours a week). With the exception of Ealing Hospital, all of the other Trusts in NW London offer at least 98 hours per week and are investing to increase this

• Ealing maternity is only able to meet the minimum safe standards of 60 hours of consultant

presence on labour ward per week.

Why we need to change maternity services in NW London

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Strong local services

• All hospitals will be expanding their midwifery led community model into the Ealing

borough to ensure consistent antenatal and postnatal care is provided in community settings close to home. Most women will see the same team of midwives for all their maternity care.

• This will be expanded into children’s centres in Ealing and other boroughs in NW London to

be co-located with health visitors and other children’s services. Supported by specialist maternity units

• Birthing units and labour ward activity will be concentrated across six sites in upgraded

facilities, with expectant mothers able to choose between midwife-led or obstetric-led units.

• All of the Trusts in NW London are investing in hiring more consultants to work on labour

ward and more midwives to provide more individualised care to women during pregnancy, birth and after birth.

• Neonatal services will expand across NW London. This will provide for a greater number of

cots across NW London.

• At Hillingdon and West Middlesex Hospital, separate consultant rotas for paediatrics and

neonatal services will be implemented providing dedicated cover for neonatal services – these already exist at the 4 other sites.

What we are doing to improve maternity and newborn care in NW London

1000

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Model of care for maternity services in NW London – summary

• f pathway

Choice from six maternity providers, supported via advice from GPs, providers and a maternity booking service in NW London Early access to maternity services by 12+6 weeks Access to translation, interpreting and advocacy services based on an assessment of need Access to advice and support on lifestyle, breastfeeding, diet, diagnostics etc Choice of setting with more care close to home (children’s centres, health centre's, GP surgeries, community hubs) Shared care between GP/Midwives/Obstetrician as appropriate Triage, treat and transfer protocols to avoid unnecessary admissions Access to 24/7 Day Assessment, early pregnancy and emergency gynaecology services for women should problems occur Choice of birth setting – home, midwifery led or

• bstetric led

1:1 Midwifery care in established labour Increase in midwife to birth ratios in line with Birth-rate Plus recommendations (target 1 Midwife to 30 births) Increase consultant

• bstetric presence on the

delivery ward (target for 168hrs presence) Choice of setting - care either in home or close to home in community settings A model of Transitional Care for babies Clear handover protocols and communication with identified healthcare professional for the transition to parenthood Enhanced children's safeguarding through development of provider: borough protocols

Early pregnancy Antenatal Delivery Postnatal

Choice Access Continuity of care

Neonatal

All babies needing

• n-going neonatal care

have rapid access to the appropriate level of care as close to home as possible. Key elements include:

• A specialist neonatal

transport service

• Established care

pathways that allow mothers and babies to access rapidly a unit

• ffering the appropriate

level of neonatal care

• Adequate assessment
• f need and provision
• f appropriate

capacity

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The proposed model of care promotes access, choice and continuity of care for Ealing women

• Can choose their delivery unit from six maternity

providers in NW London

• Can choose the location for their antenatal and

postnatal care - either at Ealing Hospital, one of the children's centres, health centre’s, their local GP clinic for GP appointments or their maternity services provider site in NW London

• Will need to travel to their maternity services provider

site for their scanning appointments

• Requiring specialist antenatal care may need to travel

to their maternity services provider or will receive care locally at the Ealing hospital site

• Will still be able to access the Early Pregnancy

Assessment Unit at Ealing Hospital Trust

• Will be able to stay with their babies if they require

transitional care

• Will extend their current community boundaries to ensure that midwifery led

maternity care can be provided locally

• Will offer women a choice of where to receive their antenatal and postnatal

care depending on ongoing assessment of their clinical/social risk and needs.

• Will work out of the Ealing Hospital site and Ealing Children's

Centres/health centres to deliver:

• Antenatal care (including booking appointment & phlebotomy)
• Postnatal care
• Parent education classes
• Breastfeeding clinics
• Will offer scanning services at their hospital site
• Will continue effective local services where appropriate e.g. diabetes clinic
• London North West Healthcare Trust will offer consultant led antenatal

clinics and scanning from the Ealing Hospital site.

• Hillingdon Hospital will offer consultant led antenatal clinics and scanning

for women on an intensive pathway from the Ealing Hospital site.

Women Receiving Trusts

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• The majority of women who live in Ealing borough choose not to deliver at Ealing Hospital (~60% in 2013/14).

These women receive fragmented maternity care, with different parts of the maternity pathway delivered by different

• providers. For example:

– Both Hillingdon and Imperial offer ante-natal and delivery services to Ealing women, but post-natal treatment for these women is always delivered by Ealing Hospital. – For women choosing other sites, such as West Middlesex or Northwick Park their antenatal care and delivery care is delivered at the maternity services provider site and there is no option for care delivered locally

• These women will now be able to access all midwifery led antenatal and postnatal care in community settings.
• Women in Ealing who currently choose another NW London maternity provider, may not get into their chosen units

due to preferential treatment for women from their host CCG boroughs (this is currently the case for Ealing women choosing Queen Charlotte’s hospital). With the new model, there will be common acceptance criteria for all women in NWL.

• The Maternity Booking Service in NW London will give sector wide Management Information, enabling joint decisions

across the system on demand, capacity and service improvement.

• Women in NWL will now have access to more information about their choices of maternity unit in NWL, via the

development of a NWL maternity leaflet and other supporting travel and communications materials.

• NW London is hiring more consultants to work on labour ward and more midwives to provide care across the

maternity pathway than ever before, leading to improved standards in care for women across NW London.

Conclusion

Questions

London Clinical Senate Review (February 2015 Report)

Paper 5.2 Presenter – Dr Mark Spencer

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Overview of London Clinical Senate report (February 2015)

NHS England (London) commissioned the London Clinical Senate to carry out an external review of:

• 1. Whether there has been any substantive change to the case for change since the

acceptance of the proposals in 2013.

• 2. Whether the clinical models for maternity and paediatric services are still appropriate.
• 3. To review and comment on the proposed timing of these changes, including

identification of risks and benefits in terms of clinical quality and safety. The London Clinical Senate summarised their findings in a report to NHS England (London) in February 2015.

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Outcomes from London Clinical Senate report (1)

• The Review Team found no material issues that alter the strategic case for change

presented in 2013. At an operational level the Review Team found that the drivers for change have accelerated since the case for change was accepted.

• Overall the Review Team considered the clinical models remain appropriate:
• The model for maternity services will improve quality and choice.
• The model for neonatal services aligns with national definitions, though the Review

Team requested more clarity on arrangements for transitional and outreach care, which has been provided

• The Review Team supports the recent proposal to maintain an emergency

gynaecology service on the Ealing Hospital site.

• The key elements of the clinical model for paediatrics were also considered to be
• appropriate. There was a lack of detail on aspects of the model that will remain at

Ealing Hospital, which has since been clarified.

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Outcomes from London Clinical Senate report (2)

• With regard to the timing of the transition, the Review Team advises very strongly that

maternity services at Ealing Hospital should move in line with the date now proposed i.e. by June 2015 and would be extremely concerned if this date slipped.

• Staff retention is also likely to become a growing problem if further delays occur.

Retaining the service at Ealing Hospital beyond this timescale will significantly increase the risk of unplanned closure of the unit. This will impact on continuity of care for women and increase risk across the system as other hospitals will need to respond in an unplanned way.

• With regards to paediatric services at Ealing Hospital “the Review Team agreed with the

proposal to retain paediatric inpatient and A&E services delivered at Ealing Hospital following the transition of maternity and neonatal services. To do otherwise would significantly increase risk across the system. However, the Review Team would be concerned if, because of a lack of appropriate planning and agreement to provide additional capacity within the receiving hospitals, the eventual transition is delayed beyond June 2016 and would suggest that opportunities be sought to enable this timeline to be accelerated where possible.”

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The Review Team advised that NHS England (London) seek the following assurances:

Recommendations from London Clinical Senate report for transition

• f maternity and neonatal services

Recommendation SaHF programme response

Further detail is required about the provision of an emergency gynaecology service at Ealing Hospital in terms of workforce and criteria for access. Updated model for emergency gynaecology has been agreed with LNWHT, and approved through the SaHF Clinical Board. This model is included in the papers for this Ealing CCG Governing Body meeting. This model includes the provision for conducting emergency surgery at Ealing Hospital site, with availability of consultant gynaecologist and required facilities. Receiving hospitals across North West London have sufficient overall capacity and have put actions in place to mitigate risks to an acceptable level. Hillingdon, Imperial and West Middlesex Hospitals have completed or are due to complete estates work to provide additional capacity required. This will be verified through site visits. For neonatal services, satisfactory arrangements are in place for transitional and outreach neonatal services, supported by the North West London Neonatal Operational Delivery Network. All units in North West London are investing in improving neonatal transitional care. This is supported by the North West London Neonatal Operational Delivery Network. The outreach model for supporting neonatal care will be continued at Ealing Hospital. External peer review of all affected services within the hospitals providing the additional maternity, neonatal and gynaecology capacity is strongly recommended before, during and up to 18 months after transition. The Review Team in particular noted challenges in providing services at Hillingdon Hospitals NHS Foundation Trust and Imperial College Healthcare NHS Trust, suggesting these should be a priority. The programme has undergone peer review from out of sector clinicians (i.e. London Clinical Senate review) The SaHF programme has held lessons learned sessions with midwives and consultants involved in the closure of the Barnet and Chase Farm maternity unit to learn the lessons from this experience. The SaHF programme is planning to undertake a detailed review of maternity services in NWL following the transition (phase 4 of the long term transformation plan), which will include external peer review.

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Setting a clear date for the subsequent transition of paediatric services is necessary to assure the quality of the service until June 2016. NHS England (London) should seek assurance that this will be supported by:

Recommendations from London Clinical Senate report for transition

• f paediatrics services

Recommendation SaHF programme response

A robust plan for the paediatric workforce with a more innovative model than currently suggested. Agreed that a comprehensive paediatrics workforce strategy will be developed involving sustained formal and informal engagement with staff. In addition SaHF is working with HE NWL to establish a pan-NWL pool of trust middle-grade paediatric staff to address existing sector wide vacancies and reduce reliance on trainees. The development of clear business cases for the expansion of paediatric services in receiving hospitals, and the services that will remain at Ealing Hospital. Business cases have been developed for the paediatrics estate work required at receiving hospital sites. A business case for a Rapid Access Clinic at Ealing Hospital has been approved by Ealing CCG and is in the process of being implemented. The development of new paediatric services, such as the Rapid Access Clinic, at Ealing Hospital goes ahead as planned. A business case for a Rapid Access Clinic at Ealing Hospital has been approved by Ealing CCG and is in the process of being implemented. This Rapid Access Clinic will be

• perational for at least 9 months before the planned transition date for paediatric services

A similar external peer review process as described for maternity services is strongly recommended. A draft review process has been developed and the SaHF programme will work closely with NHS E, TDA and the London Clinical Senate to agree and implement the review process. A clearly articulated communications strategy. A robust communications and engagement plan is under development to ensure that all affected groups are aware of the proposed changes and have the opportunity to contribute to the implementation planning process. There will be a particular focus on hard to reach groups, groups who typically make disproportionate use of Ealing paediatric services and condition-specific groups who may be particularly impacted by the changes.

Questions

Agenda Item 6.0 Forecast maternity activity to receiving hospitals

Presenter – Dr Mark Spencer

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• The Ealing Allocation Model estimates how Ealing Hospital’s deliveries will split between the

receiving sites across NWL by trying to understand the impact of different drivers of women’s choice

• f unit.
• Birth rates across NWL have declined each year since 2011/12, with this trend continuing in 2014/15.

The predicted outturn for 2014/15 is 29,297 births (270 births below 2013/14 and 2,303 below 2011/12).

Maternity capacity and activity modelling pack

• The number of beds since 2011/12 has increased slightly and in 2015/16, trusts are planning on

having exactly the same total number of beds as 2013/14 at 423 beds

• North West London managed in 2011/12 to deliver a higher number of births than we are

estimating for any scenario for 2015/16 with fewer beds than the planned bed base in 2015/16.

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Scenarios used for stress testing the model

Two scenarios of the number of deliveries at NWL sites are used to stress test the model.

• Scenario 1 – 29,297 births (the same number of births as predicted outturn for 2014/15). This is

based on the Office for National Statistics (ONS) prediction of no growth

• Scenario 2 – 30,565 births (predicted outturn for 2014/15 + 4.3%). This includes an allowance of

3,000 births for Ealing Hospital, which is 15% above the forecast outturn for 2014/15 plus the planning assumptions used by trusts.

• Stress testing each scenario, the NWL system has sufficient bed capacity using all allocations of

Ealing’s deliveries – Scenario 1 – there is a surplus of 24-27 beds across NWL compared to the bed model recommendations (equivalent of 1,890 – 2,120 births) – Scenario 2 – there is a surplus of 3-11 beds across NWL compared to the bed model recommendations (equivalent of 270 – 870 births)

• Both of these scenarios are for a lower number of births than in 2011/12, when there were less

beds in NWL

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Conclusions (1 / 2)

Headroom and women’s choice

• Most trusts are able to take more births than they are planning for 2015/16.
• Under Scenario 1, with most distributions of Ealing’s births including those with strongest

weighting, all trusts have sufficient capacity to serve the women who choose them.

• Under Scenario 2, there are permutations in which trusts potentially do not have the capacity to

serve the women who choose them as their first choice. These women, however, can be accommodated at other sites in NWL as their second choice provider.

• In the allocations with the strongest weightings, at least 99% of NWL women receive their first

choice of unit. In the worst case allocation under Scenario 2, 2.4% of NWL women do not receive their first choice, driven by a shortage at West Middlesex. Maternity Booking Service

• Maternity is a planned service and the Maternity Booking Service has been introduced to track

deliveries and bookings across NWL, enable the system to manage excess demand for any particular site in NWL and enable specific sites and the wider system to respond early to changes in demand.

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Conclusions (2 / 2)

Contingency planning at Chelsea & Westminster and Hillingdon

• Chelsea & Westminster has 6-7 fewer beds than the bed model recommends.

– The main contributor to having fewer beds than the model recommends is having 6 fewer transitional care beds than the bed model recommends. – Chelsea & Westminster operates a different transitional care model to other trusts. Transitional care is provided in the Special Care Baby Unit (SCBU) supported by nursery nurses and there is current SCBU capacity.

• Under Scenario 2, Hillingdon’s planned number of beds was 3-5 beds fewer than the number the

bed model recommends. – Hillingdon has the physical space for 4 additional antenatal beds on its antenatal ward or

• verflow ward if required

– There is also an additional labour ward room that can be used flexibly with Midwifery Led Unit (MLU) and its bereavement, recovery and High Dependency Unit (HDU) beds are flexible. – A surplus of Day Assessment Unit (DAU) beds allows the trust to flex antenatal beds and Hillingdon is able to transfer women in maternity HDU to its main hospital HDU ward as a contingency – Hillingdon has added 2 additional beds to reduce the potential shortfall

Questions

Presenters – Dr Abbas Khakoo and Dr John Hutchins

Agenda Items 7.0 and 8.0

Assessment of the impact of the timing of the maternity transition on paediatric services at Ealing Hospital and forecast paediatric activity to receiving hospitals

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Consolidating paediatric in-patient services at 5 Major Hospitals will improve care for patients

SaHF plans for paediatric service reconfiguration were endorsed by the Secretary of State, Independent Reconfiguration Panel and London Clinical Senate.

• The rationale for reconfiguring the way in which paediatric in-patient care is delivered in North West London

(NW London) was set out in detail in the SaHF Decision Making Business Case

• The main drivers of this case for change can be summarised as:
• There is a shortages of paediatric trained nurses
• The national strategy is to move paediatric training doctors out of London, which exacerbates the

current shortage

• These factors together make sustaining the current number of paediatric units unmanageable
• Together with a need to implement 7 day services this means that high quality paediatric care can only

be provided across a smaller number of units Consolidating paediatric services at fewer sites will enable Trusts to improve levels of consultant cover. Consistent presence of senior clinicians will: 1. Enable NWL to provide consistent 7 day services 2. Reduce paediatric emergency admissions and shorten length of stay 3. Reduce mortality rates 4. Increase patient satisfaction 5. Expose trainees to a wider range of complex cases while supported by consultants 6. Provide platform for Out of Hospital services

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From Inpatient care to Out of Hospital care – Ealing children will be first in line to receive the benefits

• Out of Hospital care keeps children in

their home

• Care is delivered in the home and Day

Unit

• Improved child and family –friendly

approach

• Comparable clinical outcomes to in-

patient care

• Infrastructure to support earlier discharge if

admission is required The reconfiguration will allow the hospitals serving Ealing children to:

• Experience a consistent presence of

senior clinicians

• Enable NWL to provide consistent 7 day

services

• Improve clinical outcomes for in-patient

episodes

• Reduce requirement for emergency

admissions

• Increase patient satisfaction

Out of Hospital benefits for Ealing children In-hospital benefits for Ealing children

47

Paediatric in-patient services will ultimately close at Ealing Hospital; however Urgent Care Centre (UCC), Out-patient and day-care services will be retained on-site

Retained services New /enhanced services Closed services Proposed Ealing Hospital paediatric model of care

Consultant-led paediatric Rapid Access Clinic (RAC):

• 7 day, GP referral-only service.
• Aim is to reduce A&E attendance

by providing GPs with an alternative to referring to A&E.

• Timed same-day/ next-day

appointments with paediatric specialists offered to patients.

• Enhanced Day Unit range of

services

• Enhanced Community Children’s

Nursing service

• Enhanced medical trainees

experience (stabilises workforce)

• Paediatric urgent care provided

by the Urgent Care Centre (UCC);

• ALL existing general and

specialist paediatric Outpatient services (i.e. clinics on site plus community delivery of diabetes, asthma);

• Non-emergency, low-acuity day-

care services such as day-cases,

• rthopaedics, Liaison Child and

Adolescent Mental Health Services (CAMHS), Ear Nose and Threat (ENT) clinic, physio

• A&E resuscitation – to stabilise

children attending UCC before transfer

• Paediatric in-patient services

*At first, the RAC will not accept referrals from the UCC, however, this will be reviewed after 3 months.

BUT from now until 30 June 2016 (i.e. for 13 months) - no reduction in Ealing Paediatric services

48

A new consultant-led Rapid Access Clinic (RAC) will improve care for Ealing children and reduce A&E attendance

• Aim is to reduce paediatric A&E attendance at

Ealing Hospital by 1,900 pa.

• 7 day, GP referral-only service.
• Timed same-day/ next day appointments.
• Service not intended to manage urgent or

emergency cases and will not accept referrals from the UCC (at least initially).

• Co-located with the current Ealing Day Care

Unit and run in parallel

• Staffed by one (1) consultant, one (1) nurse and
• ne (1) training post
• Open from 11am – 7pm on week days and a

minimum of three hours per day on weekends – will pick up referrals from morning and evening GP surgeries

The RAC will be implemented at Ealing Hospital during summer 2015, initially as a one-year pilot.

1900, 24% 2400, 31% 1700, 22% 1800, 23%

<16 GP Referrals to A&E - Discharged from A&E without ongoing treatment <16 A&E activity referred from UCC* <16 GP Referrals to A&E - Admitted or Other Disposition Other <16 A&E activity (e.g. LAS conveyances direct to A&E)

Chart to show the proportion of current annual <16 yrs A&E activity at Ealing Hospital that would be suitable for care at the RAC

*At first, the RAC will not accept referrals from the UCC, however, this will be reviewed after 3 months.

Phase 1 RAC cohort Proportion in- scope for RAC during phase 2*

49

Why paediatric in-patient services closure at Ealing Hospital on June 30 2016?

• Experience of neonatal care is an important element of the paediatric training

rota.

• In the long-term, paediatric training at Ealing Hospital is not viable in the absence
• f neonatal services.
• Transition can only be achieved safely if appropriate capacity is in place at

receiving Trusts.

• Extensive capital builds underway at receiving sites – new capacity will be

available by 30th June 2016 (and earlier in most cases).

• Paediatric activity peaks annually March-May.
• SaHF Paediatric Project Delivery Board advise that transition should be timed to

avoid peak activity and winter pressure – i.e. between June and September.

• The level of consultant cover at Ealing Hospital is substantially below London

Quality Standard requirements - (5.7 Whole Time Equivalents WTEs) vs 10 WTE).

• Risk that prolonged uncertainty over the future of the service would destabilise

the workforce.

Neonatal inter- dependency Receiving Trust capacity Avoiding peak activity Workforce

Factors influencing timing of the paediatric transition

But – final date is dependent on completion of assurance processes including patient journey remodelling

“There is a compelling reason to transition the inpatient paediatric service as soon as feasible” “At an operational level [we] found that the drivers for change have accelerated since the case for change was accepted.” London Clinical Senate; February 2015

50

16 in-patient beds will be re-provided across NWL – this figure includes significant contingency of 127% of current activity

Ealing Paediatric in-patient activity flow – Highest case

WMUH Hillingdon

• St. Mary’s

Ealing

Northwick Park

400

500 500 1,100 300 ChelWest

2,800 spells pa. – 127% of current Ealing in- patient activity (2013/14 baseline)

West Middlesex Northwick Park Hillingdon Imperial ChelWest

Maximum number of additional beds required

16

6 3 3 2 2

1.8 day average LoS*

51

All 5 receiving Trusts have confirmed that they will be able to absorb paediatric activity from Ealing by June 2016

Ealing Hospital currently has 16 inpatient beds (12 Standard paediatric in-patient beds and 4 Paediatric Assessment Unit (PAU) beds) and manages 7,800 paediatric cases in A&E per annum (pa) The Paediatric Project Delivery Board (PDB) recommends that all 16 beds and 100% of <16 A&E activity are re-provided across the system; plus an additional 27% system-wide over-capacity to ensure resilience. Trusts have confirmed formally that they are in a position to provide this additional capacity by June 2016, subject to appropriate support from commissioners.

Hospital site Capacity recommended by Paediatric PDB Capacity proposed by Trust Capacity in place Hillingdon Hospital In-patient: 3 in-patient beds

• 4 in-patient beds

January 2016 A&E: 1,800 attendance pa.

• 4 PAU beds co-located with

A&E Northwick Park Hospital In-patient: 3 in-patient beds

• 3 in-patient beds

November 2015 A&E: 1,700 attendances pa.

• N/A no capital investment

required WMUH In-patient: 6 in-patient beds

• 4 PAU cubicles co-located

with A&E

• 4 in-patient beds

November 2015 A&E: 3,900 attendances pa.

• 6 Emergency Department

(ED) cubicles (inc. 1 HDU cubicle) Chelwest In-patient: 2 in-patient beds

• Able to absorb activity without

expansion June 2016 A&E: 1,100 attendances pa.

• Able to absorb activity without

expansion

• St. Mary’s

In-patient: 2 in-patient beds

• 2 in-patient beds

June 2016 A&E: 1,400 attendances pa.

• Expansion of existing A&E

52

Plans are in place to ensure that paediatric services are sustainable in Ealing for 13 months after neonatology closes

“We are confident that a safe paediatric service can be maintained at Ealing Hospital as a transitional measure in the absence of maternity and neonatal services” Dr Abbas Khakoo, Chair, SaHF Paediatric Project Delivery Board The key elements of ensuring paediatric services are sustainable at Ealing Hospital for up to 13 months are: 1. Ensuring that the paediatric workforce at Ealing Hospital is stable - working in partnership with Health Education North West London (HENWL) who commission training programmes. There are currently no concerns about the stability of the nursing workforce. 2. Ensuring that the patient journeys of the future are safe and allow delivery of best quality care – neonates requiring longer term follow–up will have this in Ealing Hospital. 3. Ensuring that additional capacity is created at receiving sites as rapidly as possible. Specifically, that Trust capital investment business cases are progressed at pace to ensure that physical capacity is in place to receive Ealing paediatric patients as soon as possible. 4. “Blue light” cases will continue to come to Ealing Hospital during this period.

53

We will undertake significant further work to prepare the system prior to implementation (on 30th June 2016)

Over the next twelve months, efforts will be focussed in the following areas: 1. Implementation and evaluation of the Rapid Access Clinic at Ealing Hospital 2. Clinical pathway re-design and testing 3. Workforce planning (including formal consultation) 4. Capital building work at receiving sites 5. Communications and engagement with patients (including hard to reach groups) and clinicians (including GPs, ED clinicians and condition-specific specialist services such as sickle-cell anaemia) 6. Work with Ealing UCC provider to clarify UCC specification such that it is able to manage as many children on-site as possible, 7. Ealing CCG, NHSE and TDA assurance 8. Safe and high quality care of “blue light” critical care (both London Ambulance Service (LAS) and walk-in cases)

Checkpoints are built into the process to provide commissioners with opportunities to review progress and assure themselves that implementation is on-track.

Questions

Presenter – Dr Mark Spencer

Agenda Item 9.0

Gynaecology: The requirement to change, proposed model of care and anticipated benefits of the proposed change

56

Maternity services are transitioning from Ealing Hospital

• In February 2013, the Joint Committee of Primary Care Trusts agreed that Maternity and Paediatrics

services should transition from Ealing Hospital to six receiving sites across North West London

• Gynaecology services are interdependent upon the maternity services at Ealing Hospital site
• The key interdependencies are staffing and activity from pregnancy related conditions
• During and after the maternity transition, it is essential to provide emergency gynaecology services at

Ealing Hospital site to support the Emergency Department – providing continuity of care to the women from the area

• Ealing Hospital will continue to provide elective out-patient & in-patient services on-site as before

LNWHT have experience of delivering acute gynaecological services at distant sites

• Central Middlesex Hospital (CMH) with support from Northwick Park (NWP) gynaecology department

has dealt with urgent gynaecology attendances in a safe and clinically sustainable manner for a number of years since it closed its maternity unit

Context

57

Option Number Option Benefit Risk 1 (preferred

• ption)*

Continue to take all London Ambulance Service (LAS) patients to Ealing site – initially manage all patients at Ealing

• No change for patients
• No need to change LAS pathways
• Ease of implementation
• Replicates model already safely used

at CMH

• Need to ensure out of hours consultant will be

available if required

• Need to manage clinical risk if consultant

required Out of Hours 2 LAS conveyances – split pathway for in hours and

• ut of hours to Ealing

Hospital site

• Secure 221 ED attendances at Ealing
• Minimise the burden on potential

receiving sites

• Difficult to implement for LAS
• Perception of two tier care at Ealing Hospital

site

• Difficult to manage the communications
• Potential loss of up to 688 ED attendances

3 All LAS conveyances diverted to alternative receiving sites

• Easy to implement
• Minimise the risk of out of hours

emergency surgery

• Loss of up to 909 ED attendances including

general surgery

• Difficult to manage the communications to the

community

• Pressure on receiving Trusts

Three options were considered for the patients presenting out of hours:

*Following discussions between LNWHT, Ealing CCG, London Ambulance Service and the Chair of the SaHF Clinical Board, it was agreed that Option 1 would provide the most clinically safe and sustainable model for North West London.

58

• Enhanced gynaecology emergency clinic (GEU) in the core hours during the week – an increase of

20 hours during the week

• Introduction of the GEU services on the weekends – now available for 8 additional hours on the

weekends

• Single point of review – early pregnancy unit (EPU) and gynaecology emergency clinic unified to a

single Gynaecology Emergency Unit (GEU)

• Dedicated middle grade cover for emergency gynaecology patients (in hours and out of hours) –

24/7 cover

• Consultant cover for gynaecology emergencies: in hours – on site and out of hours from Northwick

Park Hospital site

• Patients who require urgent surgical intervention – out of hours, will be transferred to Northwick Park

site or a hospital of their choice

Key features of the future model of care

59

There will be minimal impact on women presenting with gynaecology emergencies at Ealing Hospital

• Only two women per day present with gynaecology complaints at the Ealing ED
• In a 12 month period, only 9 women required emergency gynaecology surgery out of

hours

• Less than one woman per month may require transfer for emergency gynaecology

surgery out of Ealing Hospital

60

1. Improved access to care - extended core hours of the service (additional 28 hours per week) 2. Improved quality of care –

• Dedicated experienced middle grade gynaecology doctor 24/7
• Dedicated sonography for extended hours

3. Focussed gynaecology training at the Ealing Hospital site 4. Continued support to the emergency department at Ealing Hospital – reduced pressure since patients are seen in the GEU 5. Avoidance of additional pressure on adjacent emergency and maternity units

The model of care delivers a number of benefits

Questions

Meeting interval

Agenda Item 10.0 Operational readiness of NWL providers

Letters of Readiness from Trust Chief Executives

Paper 10.1

Presenters – Clare Parker and Dame Jacqueline Docherty

65

• This section summarises the letters of support confirming operational readiness from all NWL providers.
• The Ealing CCG Governing Body (GB) meeting on 18 March 2015 confirmed that further work needed to be undertaken on operational

readiness before a decision on the timing of the maternity and interrelated services transition could be taken.

• Each of the NWL providers were asked to provide an update on their progress against a range of domains in advance of the Ealing CCG

Governing Body meeting on 20 May 2015.

• The providers have discussed and agreed their progress and confirmed their operational readiness with their boards against the

following areas:

Background and context

Domain Progress made since last meeting 1 – Maternity workforce All maternity workforce recruitment plans are in place Orientation and induction of maternity staff transferring from Ealing Hospital is underway 2 – Estates The required maternity physical capacity is in or will be in place 3 – New maternity model of care A plan is in place to implement the new NWL maternity model of care 4 – Internal staff communications Appropriate internal communications plans are in place and on track 5 – Trust Project Support Project support requirements to deliver all operational plans have been confirmed and are in place.

66

• Ealing CCG has received the following letters of support confirming that each of the NWL providers are operationally ready and fully

support the proposed transition of maternity and interrelated services from Ealing Hospital.

• All providers note that should Ealing CCG GB not be in a position to take a decision to set a date for this transition an urgent summit of

all providers will be required to define a rapid solution to make maternity services safe across NWL in light of the previous delays to the decision making process.

Letters of support confirming operational readiness

Provider Date letter received Signed on behalf of the Trust Board by London North West Healthcare NHS Trust 13 May 2015 Dame Jacqueline Docherty DBE, Chief Executive The Hillingdon Hospitals NHS Foundation Trust 11 May 2015 Shane DeGaris, Chief Executive Chelsea and Westminster Hospital NHS Foundation Trust 11 May 2015 Elizabeth McManus, Chief Executive West Middlesex University NHS Trust 12 May 2015 Jacqueline Totterdell, Chief Executive Imperial College Healthcare NHS Trust 11 May 2015 Tracey Batten, Chief Executive London Ambulance Service NHS Trust 12 May 2015 Jason Killens, Operations Director

67

• LNWHT is responsible for services on both the Ealing Hospital and Northwick Park Hospital sites, and is therefore

both a ‘sending’ and ‘receiving’ site for the transition of maternity services

• LNWHT has confirmed operational readiness against the key domains set out below:
• Maternity workforce
• Estates
• New maternity model of care
• Internal staff communications
• Trust project support
• Sending site readiness
• Should Ealing CCG Governing Body not be in a position to take a decision to set a date for this transition, LNWHT

has requested an urgent summit to define a rapid solution to make these services safe in light of the previous delays to this decision making process.

• LNWHT has highlighted that it is at a point where there is serious potential for the service at Ealing Hospital and the

future transfer to unravel, particularly as Ealing bookings are now down to 130 expectant mothers for June 2015.

• LNWHT believes that to not agree a date in the immediate future will translate into an unacceptable and real patient

safety risk at the Ealing site.

Operational readiness of London North West Healthcare NHS Trust

Operational readiness of Health Education North West London

Paper 10.2 Presenters – Clare Parker

69

• HENWL is the Local Education and Training Board (LETB) for North West London.
• Senior leaders in the organisation have reviewed the plans for clinical training following any transition of maternity

and interdependent services.

• The proposed reconfiguration will have an impact on the way in which HENWL provides training for Obstetrics and

Gynaecology (O&G) and GP postgraduate medical trainees and student midwifery training.

• There are two types of learners that will be materially affected by the transfer of the maternity service:
• Midwifery students (43 at Ealing Hospital)
• Medical trainees (occupying 16 training posts at Ealing Hospital, of which 9 are O&G posts, 4 are GP O&G

placements and 3 are Foundation O&G posts)

• HENWL has funded packages of support to aid the transition of students who will be affected, and ensure that their

educational experience is protected and enhanced.

• During the 12 months following the transition, trainees will be surveyed on a monthly basis to ensure their training

requirements are being met and any concerns fed back to contribute to both training and service development.

• HENWL fully supports a decision on the optimal timing for the transition of maternity activity from Ealing Hospital

as soon as practicable and preferably by July 2015, to avoid the risk of de-stabilising the service at Ealing.

Health Education North West London is assured of the plans for the training and education of clinical staff

Questions

Presenter – Dr Raj Chandok

Agenda Item 11.0 TAG Travel Analysis and Travel Recommendations

72

• This section summaries the content of Paper 11.0 (TAG Travel Analysis and Travel

Recommendations) which outlines the work that the SaHF Travel Advisory Group (TAG) has undertaken to understand the impact on travel and transport issues arising from the Ealing Hospital service transitions

• This presentation summarises:
• The purpose and remit of the SaHF Travel Advisory Group
• The membership of the TAG
• The scope of the TAG working groups
• The TAG recommendations for the maternity transition at Ealing Hospital

Purpose and scope

73

Purpose and remit of the SaHF Travel Advisory Group

• The purpose of the Travel Advisory Group (TAG) is to work with stakeholders to identify and

mitigate any travel and access issues (wherever possible) arising during programme implementation of SaHF.

• The aims and objectives of the TAG are:
• Where required, to advise on the management of the travel implications and opportunities for

improvement.

• Bring together key stakeholders who can advise on actions needed to improve experience of

travel to health services in North West London.

• Link to other groups and organisations that can support this area of work.
• Assure itself that travel implications of SaHF implementation have been identified and that
• pportunities for improvements and appropriate mitigations of any issues have been

considered.

74

Membership of the SaHF Travel Advisory Group

• The TAG is chaired by Raj Chandok (Vice Chair, Ealing CCG) and the membership has included

representation from the following bodies and organisations:

• Transport for London (TfL)
• London Ambulance Service (LAS)
• Patient & Public Representative Group (PPRG) representatives / Healthwatch / Patient Groups
• Acute Trusts
• Local Authorities / Transport Planners
• SaHF programme team
• West Trans Sub Regional Transport Partnership
• Equalities Group representative(s)

75

TAG Working Groups

• For the Ealing Hospital maternity transition TAG has established a range of working groups to

undertake detailed work to review patient travel services, work with trusts and undertake an analysis of the travel data to date and applying this to the changes.

• The objectives of these groups are to ensure that due regard has been given to impact on

travel/transport issues and mitigations are in place where necessary.

Working Group Scope

• 1. Patient Transport Services (PTS)

Working Group. Review Patient Transport Services and Patient Experiences across NW London with the aim of producing NWL wide PTS Standards and an improved patient experience.

• 2. Travel Planning Working Group.

Review and support trusts with their travel plans . Provide advice and recommendations to TAG in relation to acute trusts to support service

• transitions. Liaison with TfL and WestTrans to produce bespoke travel

resources.

• 3. Maternity Transition Working Group

To focus specifically on Ealing Hospital service transitions – travel analysis and proposed recommendations.

76

Summary of the recommendations from TAG travel analysis

• There are no material travel implications as a result of the gynaecology changes and additional

analysis will be undertaken prior to the implementation of the paediatric changes.

• The Travel Advisory Group through the Maternity Transition Working Group and TAG meetings has

given due regard to the impact on travel and transport issues arising from the maternity transition and proposed the recommendations and mitigations detailed on the following slide.

• The SaHF Programme response to each of the specific TAG recommendations is covered under the

Communications, Engagement and Equalities agenda item

77

Maternity transition recommendations (1/5)

Ref TAG Recommendations for Maternity Transition SaHF Programme Response 1

A robust SaHF communications plan is implemented to include travel information to the new receiving trusts to help women make an informed decision about which receiving trust they choose.

• Agreed. The programme has, in conjunction with the Trust, CCG and lay

partners, developed a robust plan for communications and engagement. This includes communications materials which have taken on board advice from TAG and include a significant amount of travel material:

• NWL booklet – one page of travel information per site. Includes

nearest stations, bus routes and parking charges on the advice of the TAG

• Car map provided by TAG (subject to feedback from user testing)
• Bus map from Ealing provided by TAG
• Travel script for midwives/

2

Each receiving trust to provide a prospectus on where the full care pathway will be provided (including community locations). This will be supported with travel information to the locations to enable women to make an informed choice (women on the intensive pathway will be informed about which receiving trusts are providing care at the Ealing Hospital site).

• Agreed. The NW London wide booklet has been designed to provide

information on the services available at each hospital to assist patient choice. In line with advice from TAG, 6 additional pages were included to provide detailed travel information for each hospital site. The booklet makes clear that for many women, most antenatal and postnatal care can be provided in the community at a location nearer to their home than their hospital. Detail on community services will be through local engagement and interaction with the healthcare professional. Work is currently being undertaken develop further Ealing specific material around the location of community services and an update will be given at the Governing Body meeting.

78

Maternity transition recommendations (2/5)

Ref TAG Recommendations for Maternity Transition SaHF Programme Response 3

Upon first contact with a healthcare professional (Practice Nurse /GP) – choice of alternative receiving trusts and travel information to be made available and travel implications to be discussed and understood Agreed. An advisory script for midwives is being prepared to include information which can be provided to women who are unsure about their travel plans. Information in the script includes assisting with developing a personalised travel plan through TFL journey planner, referrals to PTS / healthcare cost scheme and Trust taxi booking

4a Upon first contact with a midwife, travel information to be

provided and travel implications to be discussed.

4b

For the most vulnerable patients if there are significant travel implications affecting appointment attendance , midwife to arrange appropriate travel arrangements. These can include the use of the Hospital Taxi Scheme and / or Patient Transport Services (PTS) as appropriate.

5

If travel costs are an issue, all healthcare professionals to signpost women to the Healthcare Travel Costs Scheme, if eligible.

79

Maternity transition recommendations (3/5)

Ref TAG Recommendations for Maternity Transition SaHF Programme Response 6

Healthwatch Ealing will support the maternity transition initially by supporting women to make informed choices through the signposting of travel information resources. (Healthwatch Ealing capacity to provide this in a sustained manner is to be understood). Agreed. We welcome the support from Healthwatch Ealing in this. The programme will provide Healthwatch Ealing with a range of materials both in hard copy and electronically. This will include the booklet, the Easy-read guide, maps and translated material. NW London wide material will also be made available to the other Healthwatch organisations across the boroughs.

7

TAG will write to each receiving trust asking them to confirm that their trust travel plans reflect the changes in requirements for access to maternity units arising from the Ealing Hospital transition. These should include adequate car parking provision reflecting increased demand, and provision of public transport information appropriate to the wider catchment area. (Action for TAG)

8

TAG recommends that each receiving hospital trust have an on-line (TfL) journey planner link on their website. (Action for TAG)

80

Maternity transition recommendations (4/5)

Ref TAG Recommendations for Maternity Transition SaHF Programme Response 9

TAG through collaborative working with TfL will produce a bespoke Ealing Public Transport Map from seven key Ealing locations to each of the receiving hospital trusts. Agreed. This is a useful map in a recognised format. We are testing this in independent focus groups and intend to distribute this to key locations, as well as in letters to women currently booked in at Ealing Hospital.

10

TAG through collaborative working with WestTrans will produce a bespoke Road Map from Ealing to each of the receiving hospital trusts. Initial feedback has raised concerns about the usefulness of the

• map. Whilst showing the relative location which would assist

choice, it is hard to see any detail and would be unlikely to pass accessibility tests. We do however acknowledge that TAG are keen this is used and we are testing this in independent focus groups along with the other proposed communication and engagement materials.

11

TAG recommend that localised travel guides are developed for specific Ealing postcodes such as UB1;UB2;UB5;UB6 if there is an identified need for further travel information.* Agree with TAG that particular areas require additional focus. However, we feel that our activity can go further and be more personalised and postcode specific. We are therefore developing an advisory script for midwives which would include advice on providing a personalised, printed journey planner to any women concerned about their travel arrangements.

* Note: Recommendation 11 - (2 members feel this recommendation should be actioned immediately).

81

Maternity transition recommendations (5/5)

Ref TAG Recommendations for Maternity Transition SaHF Programme Response 12

Ensure that the latest hospital based maternity booking information for Ealing residents is regularly updated and used to inform and finesse communications activities including travel advice Agreed. We will work closely with the operations team through the Operations Executive, with GPs through the CCG, with midwives through the Trust and with the wider public through our engagement to ensure we are hearing feedback on any issues, concerns, useful additions to our communications etc. Any feedback will be considered as early as possible to ensure effective changes to our approach can be made.

13

The SaHF evaluation of Ealing Hospital Services post transition, should include travel support and women’s travel experiences Agreed. We will work with TAG and the wider programme to ensure this occurs.

82

Overview of the next steps

• The TAG will continue to meet and advise the SaHF Implementation Programme Board as
• required. The summary of the next steps are:
• The programme continues to work with the TAG to respond to the recommendations and

mitigations set out in this paper

• TAG will undertake additional analysis prior to the implementation of the paediatric changes.

Questions

Presenter – Sarah Bellman

Agenda Item 12.0 PPRG Statement and Recommendations

Questions

Agenda Item 13.0 Assurance undertaken in support of this decision

Reflections from NWL A&E service transitions and implications for maternity transition

Paper 13.0 Presenter – Clare Parker

88

Purpose and scope

• The purpose of this section is to:
• Document the reflections and insights gained during and after the joint transition of the Central

Middlesex and Hammersmith emergency services on 10 September 2014.

• Set out how the programme is acting on these reflections as it moves forward to the next

stages of implementation; including other service transitions.

• It draws upon a number of sources, including a reflections workshop held on 25 November 2014 with

representatives in attendance from North West London commissioners, providers and NHS England

• It includes both those aspects that worked well during the A&E changes and the learnings about

what we can strengthen in the process.

89

• Value of challenge sessions

and site visits

• Set up system monitoring and

data collection early

Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services

• Established CCG led provider

assurance process

• Established independent review of
• perational readiness, NHSE

assurance and implementation assurance framework

• System monitoring and

performance baseline established Reflections from A&E Changes Responses for Maternity Changes

Assurance & Monitoring

90

Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services

• Data analysis and modelling

requires full time dedicated resource

• Benefit of external audit to critically

challenge modelling work

• Modelling should reflect patient

flows and consider peaks and troughs in activity

• Conducted extensive modelling of

patient flows, which has been clinically led and undergone rigorous external scrutiny

• Capacity modelling performed at

trust level, with sufficient ‘flex’ to deal with unexpected increase in activity Reflections from A&E Changes

Modelling

Responses for Maternity Changes

91

• Full engagement of clinicians in

implementation planning and delivery

• Early identification of workforce

needs to enable sufficient time to address requirements

Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services

• Provider collaboration through the

maternity Project Delivery Board to agree a consistent pan NWL model

• f care
• Identified workforce needs early and

completed staff consultation to provide clarity on staff transfers Reflections from A&E Changes

Clinical Models of Care

Responses for Maternity Changes

92

Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services

• Allow time to embed and test new

clinical pathways before transition

• Generic specifications or service

models may require local tailoring

• Effectiveness of table top

modelling exercises using real life scenarios

• New model of care for maternity

and neonatal care implemented across NWL trusts (all providers running alongside midwifery led units and establishing transitional care on their postnatal wards to relieve pressure from the neonatal unit)

• New pathways for community

model of care will be implemented prior to final transition

• Undertaken table top modelling

exercises

Clinical Pathways

Reflections from A&E Changes Responses for Maternity Changes

93

• Senior management oversight of
• perational performance pre and

post transition to quickly address emerging issues

• Proactive and reactive risk

management, with regular communications and updates on key risks

Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services

• Established clear governance and

reporting structures

• Representatives on maternity

Project Delivery Board are nominated Trust delivery leads

• Established clear performance

baseline before the service changes

• Established Operational Delivery

Checkpoint meetings, including Trust Chief Operating Officers, to manage operational delivery and risk Reflections from A&E Changes

Governance

Responses for Maternity Changes

94

Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services

• Communicate existing system

challenges and benefits delivered

• Provide clarity in terminology
• Make messages in public information

campaigns clear and simple

• Test communication materials with

lay partners to ensure messages are clear and will be understood by public

• All communications materials have

been developed in partnership with lay members to ensure messaging is simple and clear to public

• Clinicians (GPs, consultants,

midwives) will be used as key communication channel to keep local women up to date on changes to maternity services

Reflections from A&E Changes

Comms & Engagement

Responses for Maternity Changes

95

• Value of challenge and feedback

from lay members in informing equalities and access work

• Continue engagement with local

communities and groups after service transitions

• Community led engagement

projects can be used to disseminate key messages to local communities

Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services

• Invested time and resource into

engagement with local communities / groups around changes

• Engagement work will be enhanced

following decision on timing in preparation for implementation Reflections from A&E Changes

Equalities & Travel

Responses for Maternity Changes

Questions

Outputs of NHS England Stage One Assurance Process

Paper 13.1 Presenter – Clare Parker

98

• The NHS England assurance process for the transition of maternity and interdependent

services from Ealing Hospital consists of three phases:

• Stage 1: areas for assurance before a decision is made by Ealing CCG Governing

Body on the timing of the transition

• Stage 2: areas for assurance prior to the transition of services
• Stage 3: areas for assurance in the year following transition of maternity services

NHS England assurance process for the transition of maternity and interdependent services from Ealing Hospital

99

NHS England and NHS TDA have confirmed they are fully assured against the Stage 1 assurance requirements

• In a Stage 1 assurance letter to the Ealing CCG Chair, NHS England and NHS TDA confirmed that

they are fully assured against the following Stage 1 (pre-decision) assurance requirements:

• Confirmation that number of midwives, consultants, neonatal nurses and sonographers, as set out

in the SaHF workforce plan in February 2015, will be in place at each receiving site by the time of transition

• Director of Operations and Trust Liaison posts filled
• Estates work at Queen’s Charlotte will be completed in advance of transition
• Testing of maternity booking system for monitoring booking at Trusts
• Details of gynaecology emergency model at Ealing Hospital

100

NHS England and NHS TDA have confirmed the Stage 2 (pre-transition) assurance requirements

• In the Stage 1 assurance letter to the Ealing CCG Chair, NHS E and TDA also confirmed the following Stage 2 (pre-transition)

assurance requirements:

• Between the date of the decision to close and the date of closure that the Trust Heads of Midwifery provide a weekly update of

staff in post, vacancies and planned recruitment to provide assurance that plans remain on track

• Trusts continue to observe the pattern in unplanned births at home and plan mitigating actions to manage any associated risk
• NHS TDA/ NHS England site visits to receiving Trusts
• Completion of planned site visit to Queen Charlotte’s Hospital to confirm facilities readiness
• Testing of maternity booking system to support women’s choice is tested by women who are booked in at Ealing Hospital and may

need to transition provider to ensure all women’s care has been transferred to the receiving provider

• Confirmation required that LAS have the capacity to manage emergency paediatric, gynaecology and maternity transfers
• Agreed financing of transition & capital costs
• IT systems fully functional in community centres
• Confirmation that all women booked at Ealing Hospital have been contacted, alternative booking made and transferring care plan

has been signed by all three parties

• Confirmation of time period that midwives will be present in Ealing A&E post inpatient maternity closure
• Continued emphasis on communications with stakeholders (GPs, community groups, LAS, others)
• Post implementation programme management arrangements for monitoring actuals against plan
• Confirmation of emergency surge arrangements for maternity

Questions

Outputs of CCG Led Assurance Process

Paper 13.2 Presenter – Clare Parker

103

• Following the decision by the NWL CCGs to delegate decision making authority to Ealing CCG

Governing Body for the timing of the transition of Ealing maternity services, provider focused assurance reviews were arranged to provide continued assurance to NWL CCGs

• The provider focused assurance reviews were led by the lead commissioner and comprised of:
• An assurance review session at a private meeting of the CCG Governing Body
• A clinical site visit led by CCG Governing Body members
• All of the provider assurance review sessions were completed and the following assurance products

were developed:

• Provider readiness pack presented to the private CCG Governing Body meeting
• Notes from the provider readiness session (used to inform the key lines of enquiry for the clinical

site visits)

• Site visit report
• In addition, the Ealing CCG chair and Managing Director attended clinical site visits at all sending and

receiving sites on 16th and 23rd January to:

• Discuss transition plans with trust maternity and paediatrics clinicians
• Review preparations for transition of maternity services

Update on the CCG assurance process for the transition of maternity and interrelated services from Ealing Hospital

104

Themes that have emerged from the CCG assurance process and SaHF programme response (1/2)

• Through the CCG led provider assurance review sessions and clinical site visits a number of key assurance themes

have emerged that have been incorporated into the Trust and SaHF programme implementation plans

• These themes are listed below, together with the programme response to addressing these themes:

Assurance themes SaHF programme response

Plans for ensuring workforce readiness including recruitment plans

• A significant element of the workforce challenges facing Trusts will be facilitated by

transfer of midwifery and neonatal staff from Ealing

• The SaHF programme has worked with Trusts since the outcome of the Ealing staff

consultation process to identify gaps in workforce and develop robust and practical recruitment plans, as well as contingency plans Plans for providing the required physical capacity to handle additional maternity and neonatal activity from Ealing

• Since not all of the building works were complete at the time of these CCG led clinical

site visits the SaHF programme has been working closely with trusts to monitor the progress of the works

• The newly expanded unit at West Middlesex is now ready. The estates work at Queen

Charlottes is on course to be completed by the end of May 2015 and the Hillingdon Hospital estates work is on course to be completed by 19th June. Plans for providing community maternity care within the new geographic boundaries

• All NWL Trusts are committed to the provision of midwifery led care in the community.

The receiving trusts plan to expand their community provision as part of the transition and use existing community facilities in Ealing to deliver their care.

• SaHF is coordinating this workstream to ensure that all of the operational and

logistical arrangements for use of these community sites are ready in preparation for the closure.

105

Themes that have emerged from the CCG assurance process and SaHF programme response (2/2) Assurance themes SaHF programme response

Plans for handling the complex maternity cases from Ealing

• All of the Trusts are committed to providing routine midwifery led antenatal and

postnatal care in the community, particularly in Ealing.

• Northwick Park and Hillingdon Hospital will offer obstetric consultant clinics from the

Ealing Hospital site for local women and continue any community specialist clinics e.g. the diabetes clinic in Southall as appropriate.

• An evaluation of the success of this outreach model will be undertaken within three to

six months of transition with a view to expansion of this model with other Trusts in NWL. Clinical governance and quality metrics to ensure quality of service is maintained during and after transition

• All of the Trusts maintain individual Trust maternity quality dashboards.
• As part of the transition process, the SaHF programme has worked with relevant

clinical leads to develop and implement dashboards to monitor the transition of Maternity, Paediatrics and Emergency Gynaecology services from Ealing Hospital. Plans to meet the London Quality Standards for consultant hours on labour wards

• The SaHF proposals for reconfiguration of maternity and neonatal services in NWL

are aimed as an enabler for Trusts in helping them improve their performance against the London Quality Standards for Maternity.

• Trusts are not expected to achieve the standard as part of the transition, but use the

reconfiguration as a platform for continuing on a trajectory towards meeting 168hrs consultant presence by 2017/18.

• As part of the transition, all of the Trusts in NWL will be able to invest in more

consultant hours on their labour ward, raising the average in NWL from 101 hours per week in 2014 to 126 hours per week in 2015

Questions

Verbal update from Shaping a healthier future Implementation Programme Board on 19 May

Presenter – Clare Parker

Verbal update from Shaping a healthier future Clinical Board on 18 May

Presenter – Dr Mark Spencer

Questions

Agenda Item 14.0 Implementation planning and

• perational readiness for the proposed

transition of maternity and interrelated services from Ealing Hospital

Presenter – Pippa Nightingale

111

Improving maternity services in NWL is part of a long term transformation plan

Phase 1: Operational planning Phase 3: Transition of services Phase 4: Review Phase 5: Ongoing performance improvement

• Workforce planning and

recruitment on track

• Physical capacity and

infrastructure at receiving sites and community sites ready for use

• Models of care and

pathways scenario planning and testing

• Systems monitoring in

place

• Communications and

engagement tested and ready for launch

• Maternity Booking

Service (MBS)

• perational
• Transfer of all Ealing midwifery and

neonatal community and inpatient staff to new units

• Receiving units recruitment plans on track
• Receiving units physical inpatient &

community capacity in use

• Communications to all women and GPs

informing them of new arrangements

• Ealing no longer accept referrals or

bookings (GPs no longer refer to Ealing)

• Receiving sites accepting all new Ealing

referrals and bookings

• Receiving sites operating new community

model of care

• Receiving sites operating inpatient model of

care (including deliveries)

• Closure of Ealing maternity and neonatal

unit

• Comprehensive review of the

community model and development of proposed enhanced community model (if necessary)

• End to end review and stress

testing of maternity and neonatal pathways

• Review of MBS and development
• f enhanced MBS (if necessary)
• Development of sector wide

service spec and roles for Safeguarding and perinatal mental health

• Development of transitional care

education package for NW London

• enhanced community model (if

necessary)

• changes to end to end pathways (if

necessary)

• enhanced MBS (if necessary)
• Ongoing engagement with local

communities on the changes

1 3 4 5

NW London hospital providers are currently in the operational readiness phase and are ready to proceed to the phase 3 of implementation – transition of maternity and neonatal services from Ealing hospital to receiving hospitals in NW London

Hospitals in NW London are ready to move to transition of services

Phase 2: Operational readiness

• Workforce strategy and

planning

• Physical capacity and

infrastructure planning and scoping

• Models of care and

pathway development planning

• Systems monitoring

development

• Communications and

engagement strategy and planning

2

Year 1 Year 2 Years 3-5

112

Governance for the transition

Maternity Operational Delivery Checkpoint Meeting (fortnightly) Shaping a Healthier Future Implementation Programme Board Shaping a Healthier Future Programme Executive

Imperial College Healthcare NHS Trust London North West Healthcare NHS Trust West Middlesex University Hospitals NHS Trust The Hillingdon Hospitals NHS Foundation Trust Chelsea and Westminster Hospital NHS Foundation Trust

Trust Implementation Teams

Imperial College Healthcare NHS Trust Board London North West Healthcare NHS Trust Board West Middlesex University Hospitals NHS Trust Board The Hillingdon Hospitals NHS Foundation Trust Board Chelsea and Westminster Hospital NHS Foundation Trust Board

Trust Boards

Chaired by SaHF Operations Director, attended by Trust Chief Operating Officers, Heads of Midwifery, NHS England (London), NHS TDA (London), London Ambulance Service, HE NWL

Maternity Project Delivery Board (fortnightly)

Each team is led by Trust Chief Operating Officers, supported by dedicated project manager and Head of Midwifery, and reports into respective Trust Board

113

Communication

• There is ongoing communication with local women to ensure that they are being made aware of the

planned changes and that patient choice and continuity of care will be maintained through the transition.

• Women booked to deliver at Ealing Hospital have been contacted to determine their alternative

maternity provider of choice in NW London if a decision on transition date is made.

• There will be one to one calls between Ealing Hospital and women booked at Ealing Hospital to

discuss their handover of care to another trust in NW London.

• Communications and engagement activities around the planned changes, including marketing of the

new services across all sites, will be ready for launch upon a decision on the timing for transition.

Clinical pathways

• All clinical pathways and guidelines and associated operational policies across Trusts are on track to

be finalised in preparation for the transition of services.

• Enhanced community midwifery provision in children’s centres and health centres has been agreed

to ensure women in Ealing are able to access high quality, routine maternity care close to home.

All NW London Trusts have advanced operational plans for the planned service changes to maternity and neonatal care

114

Workforce

• The staff consultation process for maternity and neonatal staff at Ealing Hospital is complete and staff have been

advised of which receiving trust they will transfer to upon formal transition of the service (subject to Ealing CCG Governing Body’s decision on the timing of transition)

• A package of staff support measures for Ealing midwifery and neonatal staff has been agreed in recognition of the

impact on these staff arising from the delays in making a decision about the timing of the transfer of maternity and neonatal services and their employment from Ealing Hospital.

• The maternity staff at Ealing Hospital have commenced their orientation and induction at their new hospital and
• verall feedback has been very positive.
• A detailed workforce plan is in place across all Trusts with recruitment activity monitored and reported across the
• programme. Trusts have been supported by the SaHF programme to recruit at risk ahead of a decision to ensure

recruitment plans are proceeding in preparation for a decision.

• The distribution of junior medical trainees (Obstetrics and Gynaecology) and midwifery students has been agreed

with Health Education North West London.

• All units will improve their overall midwifery to birth ratio following transition of staff, as a sector NW London will

achieve an average midwife to birth ratio of 1:30 following transition (from 1:32 pre transition).

• All units will improve their consultant presence on labour ward following the closure at Ealing, as a sector NW

London will achieve an average of 123 hours of consultant presence on labour ward (from 101 hours pre-transition)

• All trusts also have contingency plans in place to ensure appropriate staffing.

All NW London Trusts have advanced operational plans for the planned service changes to maternity and neonatal care

115

Physical capacity

• Receiving trusts in NW London have reviewed the caseload of women indicating a preference to

transfer to their unit once Ealing closes and confirmed that they have the sufficient capacity to handle this transfer of activity (subject to Ealing CCG Governing Body’s decision on the timing of transition)

• The capital development schemes for the expanded units across NW London are on schedule to

deliver the physical capacity required for maternity services across NW London: – West Middlesex has completed a modular extension to the maternity and neonatal unit to provide capacity for an additional 600 births and 3 Special Care cots – Hillingdon is refurbishing the existing maternity unit to take an additional 800 births per year, the work will be completed by 19th June 2015. However, Hillingdon currently has sufficient capacity to handle the maternity activity that would transition from Ealing Hospital. – Imperial College Healthcare will complete the expansion of its maternity and neonatal capacity across both the Queen Charlotte’s and St Mary’s sites by end May 2015 to manage up to 1000 additional births and 6 special care cots – Chelsea and Westminster and Northwick Park do not require any changes to their maternity and neonatal infrastructure to support the transition

All NW London Trusts have advanced operational plans for the planned service changes to maternity and neonatal care

116

If Ealing CCG GB make a decision for a 1st July closure date, the following key dates will apply for the service transition phase

21st -22nd May

• Letter sent to all women booked at Ealing confirming decision and next steps

for them (include NW London maternity leaflet & travel map)

• Letter sent to all GPs in NW London notifying them of decision, to no longer

refer to Ealing hospital and informing them of new community boundaries (include NW London maternity leaflet, patient stories & travel map)

• Ealing hospital no longer accept new bookings – will be diverted to MBS
• Letter sent to Ealing midwifery and neonatal staff notifying them of decision

and dates for their transfer to their new Trust in NW London 25th May onwards

• Ealing Multi Disciplinary Team (MDT) contact all women booked to

communicate transfer process and next steps

• Ealing MDT begin to transfer women to chosen receiving unit in order of EDD

and intensity pathway

• Letter sent to Ealing midwifery and neonatal staff from their new hospital,

welcoming them to their new Trust and providing key staff transfer dates and contact points 8th -12th June

• Community midwifery staff (antenatal) from Ealing transferred to receiving

Trusts

• Receiving trusts start doing new bookings from Ealing women and antenatal

follow up appointments 15th -19th June

• Community midwifery staff (postnatal) from Ealing transferred to receiving

Trusts

• Receiving Trusts start doing new postnatal appointments (Ealing will complete

postnatal care if already started)

• Receiving Trusts working out of children’s centres/health centres according to

newly agreed community boundaries 22nd June

• Majority of inpatient midwifery staff from Ealing transferred to receiving

trust (small group of those transferring to Northwick Park remain on Ealing site until final closure day)

• Obs & Gynae medical trainees from Ealing rotate to Hillingdon and West

Middlesex 24th – 26th June 2015

• Last induction at Ealing hospital and Maternity unit closes to all new

admissions (24th June)

• Last elective C-section at Ealing hospital (25th June)
• Ealing divert spontaneous deliveries & babies to other providers

from 24th June onwards 29th June - 1st July 2015

• All babies discharged from Ealing neonatal unit (29th June)
• All mothers discharged from Ealing maternity unit (1st July)
• Final closure of labour ward, birth centre and neonatal unit at Ealing

(1st July)

• Last group of staff to transfer will be neonatal nurses, medical team,

the reduced number of staff on labour ward, birth centre and postnatal staff 2nd July onwards

• Maternity transitional team stay on Ealing site for 24 hours post

closure

• All women requiring transfer will be relocated back to their receiving

trust if it safe to do so

• Ealing hospital open for service with all other receiving units for

antenatal outpatient appointments. `

117

Background

• A set of metrics has been agreed to enable the system to monitor the effectiveness of the transition.
• The purpose of the dashboards is primarily to monitor capacity and demand to quickly identify issues

in the system, and support the creation of mitigating actions to ensure safe operations of our services across NWL.

• A secondary purpose is to monitor key performance and quality metrics to be able to monitor any

changes post transfer and develop mitigating actions required, to facilitate this.

• Maternity bookings and deliveries (activity) will be monitored on a weekly basis and quality metrics

for Maternity, Paediatrics and Emergency Gynaecology services will be monitored on a monthly basis (due to data availability).

Transition and Quality Dashboards

Weekly Dashboard (Maternity Only) Appointments Referrals Bookings Deliveries Monthly Dashboard Demand Capacity (i.e. Workforce) Quality Systems Resilience

118

Quality Baseline

• Key maternity quality metrics (where data is currently available) have been baselined to provide a

view of the pre – transition position. Specifically, – Emergency C-section and Elective C-section deliveries have remaining steady across NWL accounting for c.15% and c.12% of deliveries respectively. – Births born before arrival in NWL have averaged at approx. 13 births per month. – 12+6 weeks booking rate in NWL is decreasing, currently at 90% (meeting target) – Post partum haemorrhage remains low and decreasing over the year, currently at c. 1% across NWL. The dashboard will review activity against these and other baseline data to enable us to track improvements or deterioration in the quality of maternity care.

Transition and Quality Dashboards

Questions

Agenda Item 15.0 Communications, Engagement and Equalities

Presenter – Sarah Bellman

121

• The Shaping a healthier future programme has fulfilled all statutory equalities duties that

accompany any major change to NHS services, and has further sought to exceed its

• bligations
• The Programme has sought to demonstrate ‘due regard’ through a number of areas:

– Pre-consultation equalities related strategic review (Mott MacDonald – May 2012) – Formal consultation and associated gap analysis (July – October 2012; Gap analysis - August 2012) – Post-consultation sub-group analysis – Equalities action plan developed in 2013 – Bespoke equalities analyses and plans for provider Outline Business Cases

• Acute Hospitals receiving maternity (and related) activity from Ealing Hospital site have

used the outputs of the above work in their planning

• Similarly, the Communications and Engagement workstream has used these outputs to

develop the community work and materials needed to support a transition

Equalities analysis

122

• The Shaping a healthier future Programme has received recommendations from the

Patient and Public Representative Group (PPRG) and also the Travel Advisory Group (TAG).

• These recommendations have been considered by the Programme and paper 15.2
• utlines our response to the recommendations
• In most instances we have accepted and incorporated these recommendations into our

work plan.

• Where possible we have gone beyond the recommendation to ensure we are providing

the most effective communications and engagement possible.

Responses to lay partner recommendations

123

• Extensive work has been undertaken to develop the communications and engagement activity in

coordination with Ealing CCG, London North West Healthcare Trust and the lay partner groups in NW London.

Communications and engagement strategy

OBJECTIVES

• Raise awareness of changes and how they will

improve maternity services in NW London

• Help women make informed choices about

maternity units

• Provide reassurance about the changes
• Provide information on maternity units in NW

London

• Hear feedback and answer questions
• Ensure women and their families have access to

information

• Ensure regular and consistent information to

women

• Ensure healthcare professionals are informed and

equipped with information to assist women AUDIENCES

• Women currently requiring maternity services
• Potential users of maternity, neonatal and gynae

services

• GPs and CCGs
• Community, voluntary and hard to reach groups
• Workforce – Ealing Hospital (midwives, special baby

unit, gynae and paeds staff), Health Visitors and Social Workers

• Political stakeholders
• NHS stakeholders
• Media

124

Public information materials

Questions

Agenda Item 16.0 Resolutions for agreement (discussion)

Presenter – Ben Westmancott

127

(1) ACKNOWLEDGE that it has received Delegated Authority from the following statutory bodies [listed in accompanying Paper 4.0 Summary Paper & Resolutions] and is therefore vested with the authority to take decisions on timing with regard to the agreed maternity, paediatric and gynaecology service changes at Ealing Hospital on their behalf (2) With regard to maternity services currently delivered on the Ealing Hospital site (a) AGREE that, in line with the Secretary of State’s decision of 30th October 2013 to endorse the transition of the Maternity service, a date should now be set for completion of the implementation of this change. (b) AGREE that based on the information and recommendations presented to the Governing Body, the transition of the Maternity service should be completed on 1 July 2015. (3) With regard to gynaecological services on the Ealing Hospital Site AGREE that based on the information and recommendations presented to the Governing Body the transition of the defined range of emergency gynaecology services should be completed by 1 July 2015

The resolutions for the Ealing CCG Governing Body to consider are as follows (1/2):

128

(4) With regard to paediatric services currently delivered on the Ealing Hospital Site (a) AGREE that, in line with the Secretary of State’s decision of 30th October 2013 to endorse the transition of the defined range of paediatric services at Ealing Hospital, a preferred date should now be set for the completion of the implementation of this change. (b) AGREE that based upon the information and recommendations presented to the Governing Body there should be a clear implementation plan and assurance process developed to enable the proposed transition of paediatric services to be completed on 30 June 2016. (5) The CCG Governing Body is also asked to: (a) AGREE to develop a joint Assurance process with NHS England and the Trust Development Authority to ensure that the transition of the paediatric services can proceed as planned and monitor and address any clinical or delivery risks in paediatric services across North West London. That the

• utputs of this process will be formally reviewed by the governing body in public no later than 31 March

2016

The resolutions for the Ealing CCG Governing Body to consider are as follows (2/2):

Meeting suspended to allow questions from the public

Agenda Item 17.0 Questions from the public

Presenter – Dr Mohini Parmar

Agenda Item 18.0 Resolutions for agreement (decision)

Presenter – Dr Mohini Parmar

Agenda Item 19.0 Confirmation of next steps

Presenter – Dr Mohini Parmar