Briefing and discussion on changes to maternity services in Outer North East London. Officers from NHS North East London and the City will be in attendance.
Minutes:
The NHS NELC officers explained that evidence showed that midwife led births produced a better overall maternity service. If the midwife led units were co-located with a maternity department, this would allow full medical cover for midwife deliveries.
It was accepted that the appropriate capacity was needed to deal with the demand for maternity services. Births in North East London had risen by 3.5% per year for the last ten years although this varied between boroughs with a lower rate of increase in Havering but a higher rate in Newham.
Recent developments included new maternity units at Newham and the Royal London, the midwife-led unit at Whipps Cross, the Barking Birthing Centre and the midwife-led unit at Queen’s which was currently under construction. Catchment areas and the hospital where a woman would give birth were normally agreed by the antenatal service. Most women using the antenatal service in Barking would now give birth at Newham. This and the other proposed changes would also reduce travel times for most women. Officers emphasised that patient choice remained in the new system.
Members were doubtful that Newham Hospital would have the capacity to cope with the proposed extra births, even with a new unit. It was emphasised that Newham would not be using its full capacity until its full workforce had been recruited. Two external reviews had been carried on maternity in Newham which had led to a reduction in the number of births to be taken from Barking & Dagenham until recruitment had been completed. Currently Newham would only be taking an extra 400 births rather than the 800 originally proposed.
The maternity department at King George Hospital would be closing although a date had yet to be confirmed. A working group was investigating with providers the number of births to be taken at each of the maternity units in North East London. The boundaries of hospital catchment areas could be adjusted if necessary. Officers agreed to circulate a recent paper to the NHS NELC Board considering projected birth rates etc.
The NHS NELC officers were not convinced that Queen’s Hospital would see as many as 9,000 births per year in reality. Population numbers were constantly changing and the effect of the recession may be to lower the birth rate.
It had been announced that, contrary to the Health for NEL proposals, parts of Waltham Forest would now be served by maternity at Homerton Hospital. This was due to it being expected that the new Whipps Cross maternity unit would be nearer to completion by now than it was and also due to the Barts Health merger where the Panel had stated that there should be more competition between Barts Health and the Homerton.
A total of 2,500 births per year at the Queen’s midwife led unit was considered to be sustainable as long as it was located on the same site as the main labour ward. At Whipps Cross, 16-20% of births were now in the co-located midwife led unit. The unit at Newham was also of a similar size. The appropriate training for this kind of unit was given to all midwives at Queen’s. The midwife led units were also externally assessed.
In the short term, the number of birth bookings each hospital could take would be capped. If for example Queen’s Hospital was fully booked on a certain date, a referral would be rejected. This system was used at Guys & St. Thomas’. The issue of caps and numbers of bookings per GP practice would be kept under review. It was not felt likely that there would be a demand for a birthing unit at King George although a third unit for Outer North East London would be considered in the longer term. The Barkantyne unit had taken several years to build up its reputation and associated demand levels.
It was confirmed that there was no cap on the number of Essex referrals to be taken at Whipps Cross and no changes were proposed to the Essex wards served by Whips Cross maternity. Officers accepted that there were some concerns over the births capacity at Whipps Cross although the midwife led unit was helping with this. The aim was to keep the total number of births at Whipps Cross to slightly in excess of 6,000 and some areas were therefore moving from the Whipps Cross to Homerton catchment areas. The NHS NELC officers stated that Waltham Forest GPs favoured more referrals being given to the Homerton and that some Waltham Forest mothers preferred this.
The maternity services liaison committee had been involved in the changes and information sessions were also being held in Children’s Centres in Barking & Dagenham, Redbridge and Waltham Forest. Workforce issues had been considered across the whole staffing mix – both midwifery and obstetrics.
Members remained concerned about the impact on women in Redbridge from the loss of service at King George, the cap at Queen’s and the transfer of some Redbridge wards to Whipps Cross. Officers agreed to supply details of expected birth capacities for each of Queen’s, Whipps Cross, the Barking Birth Centre and home births. The health officers added that the maternity plans had remained consistent and had not changed significantly in the last 18 months.
The Committee agreed to scrutinise the area of maternity again in 6-12 months.