The Royal Free Hospital

Open letter from Start Well clinical leadership

• AS a group of NHS doctors, nurses, and midwives, we have been working for the past two years on proposals to improve the way we deliver maternity and neonatal services in North Central London.

This work has led to the proposals in the NHS’s Start Well public consultation to improve access, experience and outcomes for pregnant women and people and their babies.

It is vitally important for local people that we get this right, so we want to hear as many views as possible before the consultation closes on March 17 2024.

We have been working to understand the needs of local people and the best way to provide care to maintain high standards. We have incredible staff, working to deliver the best possible care for families and children.

However, falling birth rates, increasing health complexity, along with ageing facilities, means that our services are not always able to deliver the care that people need, want and deserve.

We believe consolidating our maternity and neonatal services across four sites, reduced from the current five, will allow us to improve services for both users and staff.

This would mean that fewer babies who need specialist neonatal care would need to be transferred between hospitals than is currently the case, as all maternity hospitals would have a neonatal unit able to care for the sickest babies. Such units also better enable staff to maintain their skills to deliver specialist care.

We are asking people for their views on two options: closing the maternity and neonatal services at either the Royal Free Hospital or the Whittington Hospital site. While both options are implementable, on balance the option to retain maternity services at the Whittington is the preferred option.

Whichever option is selected, there is a commitment to investing in our maternity and neonatal hospital buildings and facilities, which currently do not always meet modern best practice. Some facilities are located over multiple floors in 19th-century buildings with no ensuite facilities in many rooms.

We will be investing approximately £40million into estates and facilities to provide the best possible environments for parents and babies, as well as our staff. These proposals represent a real terms investment in maternity, neonatal and paediatric services.

Spreading our specialist staff across five hospitals means they are stretched thinly, and we sometimes fall below best practice guidance on staffing levels.

This adds pressure to teams working hard to deliver care and can impact quality and choice. Too often, midwife-led care is forced to close temporarily to enable those members of staff to support the doctor-led units that look after higher-risk patients.

Given the national shortage of midwives and specialist doctors, vacancies are hard to fill, and we do not always have the appropriate level of senior staff to supervise new recruits.

We can provide better clinical care by bringing our services together onto fewer sites, where larger, more sustainable teams can maintain and grow their skills.

These proposals are driven by a desire to improve care for babies and pregnant women and people and will have a positive impact on quality, safety, experience and staff development.

We have already received feedback from staff, patients and local people and encourage everyone to take part in the consultation. You can fill in a consultation questionnaire on our website or by calling 0800 324 7005 before the consultation closes on Sunday March 17.

SIGNATORIES —
CLARE DOLLERY, Executive Medical Director & Acting Deputy CEO, Whittington Health NHS Trust
MIKE GREENBERG, Barnet Hospital Medical Director, Royal Free London NHS Foundation Trust
TIM HODGSON, Medical Director, Specialist Hospitals Board, UCLH NHS Foundation Trust
VICKY JONES, Executive Medical Director, North Middlesex University Hospital NHS Trust
SANJIV SHARMA, Executive Medical Director & Acting Deputy CEO, Great Ormond Street Hospital (GOSH) Foundation Trust
GEORGE ATTILAKOS, UCLH NHS Foundation Trust, Lead Obstetrician for North Central London
DAVID CONNOR, Director of Midwifery at Royal Free London NHS Foundation Trust, Co-Chair Local Midwifery & Neonatal System NCL
GILES KENDALL, UCLH NHS Foundation Trust, Clinical Lead Neonatology North Central London
CHRIS CALDWELL, Chief Nursing Officer, North Central London ICB
JO SAUVAGE, Chief Medical Officer, North Central London ICB
SIMON BARTON, Regional Director of Specialised Commissioning, NHS England
MARIE CUMMINS, Director of Nursing and Quality, NHS England