Save King George Hospital: January 2018

I attended the North East London Save Our NHS (NELSON) meeting last night to be given a great piece of work by a campaigner to set out the argument for maternity to return to King George Hospital. NELSON is a cross party group who have been great friends to the save King George A&E campaign supplying speakers at meetings and turning up at photo shoots too. Article follows:

The argument for re-opening comprehensive maternity services at King George Hospital.

Better Births

The National Maternity Review ‘Better Births’ (Feb 2016)ⁱ set out the FYFV for maternity services in England. It aimed to make maternity care safer, in line with the Health Secretary’s ambition to halve the number of stillbirths, neonatal deaths and serious brain injuries occurring during birth, but also to ensure care that was kinder, more personalised, and “wrapped care around each woman”.

Better Births’ recommendations included:

Genuine choice, with the ‘choice journey” beginning with services recognising women’s needs;
Choice discussions with midwife about options for care beginning at booking;
Organising services around women and their families (through, for example community hubs with a range of relevant services);
Continuity of carer, close to home where possible;
Choice of place of birth offered to all with unbiased information;
Transfer to post-natal care that is seamless and well supported;
Co-designing of services with local women.

New structures

In response to the Review, NHSE established a national Maternity Transformation Programme to be implemented by

a National Maternity Transformation Board (NMTB)
a London Maternity Transformation Board (LMTB), reporting to the NMTB, and
Local Maternity Systems (LMSs), bringing together commissioners, providers and service users and reporting, in London, to the LMTB.

North East London

NE London is covered by the East London Local Maternity System (ELLMS), reporting to the LMTB but also to the East London Health and Care Partnership (ELHCP) - or STP.

ELLMS has now developed a plan for the next 5 years to look at how their system will deliver NHSE’s ‘Better Birth’ recommendations. This plan involves significant ‘transformation’ from providers of maternity services.

Neither ELHCP nor ELLMS is a statutory body: they are not accountable for the delivery of maternity services. Instead accountability for commissioning remains with CCGs, and accountability for service provision remains with Trust Boards.

NHSE has produced a set of Key Lines of Enquiries for all LMSs to bear in mind while developing plans ahead of an assurance submission to NHSE in October 2017.

Better Care and Wellbeing in East London

The East London Health and Care Partnership’s document Better Care and Wellbeing in East London states that

With a shared goal to help people live healthy and independent lives, the Partnership’s mission is to protect vital services and provide better treatment and care built around the needs of local people, safely and conveniently, closer to home. (http://eastlondonhcp.nhs.uk/wp-content/uploads/2017/06/Better-Care-and-Wellbeing-in-East-London.pdf)

Plans of East London Local Maternity System (ELLMS)

Plans by the ELHCP and ELLMS for transforming the maternity services of East London were set out in a report to the Inner North East London Joint Health Overview and Scrutiny Committee in November 2017. This report confirmed that the aims of this transformation include:

To ensure more women have a personalised care plan
To expand choice, including choice in “the three places of birth” (hospital, midwifery led centre and home)
To ensure that women receive continuity of the person caring for them during pregnancy, birth and post-natally.
To ensure that more women will be enabled to give birth in midwifery led settings.

Current maternity services in East London

i) Provision

Maternity services are currently provided by the Royal London, Whipps Cross, Newham, BHRUT (Queens), and Homerton hospitals. Each has an obstetric labour ward and an alongside midwifery led unit. (King George’s provides clinics and antenatal care only.) In addition, the Barkentine Centre is a midwife-led birthing centre provided by BartsHealth NHS Trust.

A pilot is currently underway in Waltham Forest with a midwifery-led provider, Neighbourhood Midwives, in which low-risk women are offered continuity of care from the same midwife throughout pregnancy, labour and the post natal period. (Neighbourhood Midwives does not provide a birthing centre: birth takes place either at home or in one of the hospitals or midwife-led units described above.)ⁱⁱ

ii) Challenges

According to the ELHCP and the ELLMS, challenges facing maternity services in East London include:

A projected increase by 4.41% (about 1500 births) within the next 5 years, with greater pressure anticipated in the BHR footprint. ⁱⁱⁱ

High turnover of midwifery staff and workforce gaps in acute providers means challenges with clinical capacity or transformation.
Variations exist in patient ratio to GP with Redbridge and Waltham Forest falling in the lowest 20%
The age of women giving birth is higher than national average (NEL 32.16 years compared to national average of 30.4 years).
19.9% (2712) of women are presenting with multiple co-morbidities (which may rise as high as 23% by 2018)
A more than 2% rise in the last 2 years in the number of women reported as unable to speak or understand English (from 6.9% to 9.3%).
An expected increase in the prevalence of diabetes by 1.5% (1051 women) per year.
A further 1% (254 women) of women are expected to develop gestational diabetes during pregnancy.
Mental health conditions are rising by 1% (254 women) per year.
Achieving continuity of carer is highly dependent on funding

Argument

This assessment of the challenges facing providers of maternity services in East London corresponds with BartsHealth’s assessment, set out in Transforming Services Together. This states that maternity services are struggling with rising birth rates and a population whose health complexity is increasing, while staffing levels are below recognised standards.

Pressure on services in East London is indicated by the fact that between April to June 2017, the obstetric unit at Newham was closed on three occasions, and the obstetric unit at Whipps Cross was closed once during the same period.

We support the intention to increase midwifery-led units for straightforward pregnancies as evidence suggests that these units, if well-resourced, can provide more continuity of care, fewer unnecessary interventions and better experience of care. However, to ensure the safety of maternity care, these units must be backed up by fully reliable emergency contingency provision.

At the moment, with the loss of obstetric or midwifery-led provision at King George’s Hospital (other than clinics and antenatal care), there is a significant gap - a substantial area of East London that is not covered by local maternity services or emergency provision. Currently, women going into labour in the (Redbridge/Ilford??) area who are not having a home birth have to travel to Queen’s, Newham or Whipps Cross. Any community hub or midwife-led unit set up in (Redbridge/Ilford) would have no local facilities for emergency contingencies.

Moreover, Better Births promotes choice for women in terms of place of birth as well as recognition of their needs. Yet lack of provision in the (Redbridge/Ilford) area ignores local womens’ needs and denies them any real choice. Local services have not been co-designed with local women. Without urgently meeting current and future demand for local maternity services, there is a risk that women will experience unsafe, poor quality services that do not meet their needs or choices.

We therefore urge ….. to re-open comprehensive maternity services at King George’s.

APPENDIX

Total births in NEL Jan-June 2017

Provider	Jan	Feb	Mar	April	May	June
RLH	436	358	430	420	434	414
WX	428	334	371	388	443	387
Newham	537	479	507	524	533	517
BHRUT	666	611	679	657	701	718
Homerton	496	406	469	419	502	521
Neighbourhood midwives	4	7	8	7	7	8

Out of Obstetric Unit Births

Data suggests that low risk women are safer giving birth in midwife led settings and have a better experience of care
In 2016-17 approx 18% of births in NEL were in midwifery led settings with wide variation across providers from 13-25%
There is capacity to increase these figures even in the face of rising acuity

	BHRUT	HUH	NEWHAM	RLH	WX
Out of Obstetric Unit birth rate 2016/17	18.34%	17.45%	25.3%	13.1%	15.6%
Aspirations for Out of Obstetric Unit Births 2021	22%	25%	40%	30%	35%

NEL Obstetric Unit births

	April	May	June
RLH	79.5%	84.3%	80.7%
WX	84.5%	84.2%	86.8%
Newham	75.8%	74.3%	76.8%
BHRUT	79.9%	82.0%	79.1%
Homerton	80.7%	80.3%	81.8%

Neighbourhood midwives	29%	29%	38%

NEL Homebirths

	April	May	June
RLH	0.95%	1.15%	1.45%
WX	0.52%	0.45%	0.78%
Newham	0.38%	0.75%	0.97%
BHRUT	0.20%	0.70%	1.80%
Homerton	1.60%	2.60%	1.80%

Neighbourhood midwives	43%	71%	63%

i https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

ii Neighbourhood Midwives is a private, employee-owned company, selling itself on the basis that the NHS is overstretched and often cannot provide continuity of care. Its website provides a link to its NHS funded services pate, where it says it is working with the NHS to offer women in Newham the chance to take part in a pilot of midwifery continuity of care. (Privately provided care cost - depending on the package - between £592 - £742 per month. The Programme Director of Neighbourhood Midwives was on the Review team for Better Births, along with Sam Everington among others). Neighbourhood Midwives is piloting ways of cross-boundary working and developing a new model of transitional care, including care in the community that would currently be hospital based.

iii Transforming Services Together (http://www.transformingservices.org.uk), the BartsHealth NHS Trust’s initiative to improve the local health and social care economy in Newham, Tower Hamlets and Waltham Forest states that maternity services in these areas are struggling to a population with increasingly complex health needs, staffing levels below recognised standards, and an estate that does not meet the needs of users. Over the next ten years, it is predicted that there will be an extra 5,000 births per year across north-east London, in particular in Tower Hamlets and Newham.

The main speaker is Cllr Jas Athwal, the Leader of Redbridge Council.

The arguments for a mid-wife led maternity unit for our expanding population are at

http://savekinggeorgehospital.blogspot.co.uk/2017/11/the-case-for-maternity-led-midwife-unit.html

Local NHS managers published a paper about the future of maternity provision for NE London on the 9th November 2017 at the link above. King George is not one of the sites given in this NHS paper.

However, the recent PWC report commissioned by the NHS has the following quote about King George includes the following:

“The recent work undertaken in May and June 2017 provides
compelling evidence that a new model of emergency care across
NEL is evolving with significant emergency care demands.
This requires a new clinical model to be developed by BHRUT,
incorporating an integrated UCC specification. Subsequent to the
model being developed, there will then be a gateway review and
agreement with Barts Health on the revised model and the
updated potential impact on Whipps Cross and Newham hospitals.
A new staffing model could be developed as part of the new model
of care.” (my emphasis)

The NHS are working on a "new clinical model" this allows us to make the argument that part of this new clinical model should be a mid-wife maternity unit at King George Hospital.

Jane Milligan Chief Officer NHS Tower Hamlets CCG and Executive Lead for East London Health and Care Partnership (NEL) writes the below in a recent update on 29/11/17

"The model we finally adopt must provide excellent, safe patient care and meet the needs of local people now and well into the future."

Redbridge women should be given the choice to have their babies at King George. The full update is below:

29 November 2017
Dear partner/stakeholder,
I wanted to update you on the latest position regarding the A&E department at King George Hospital in Goodmayes.
As you will know, the decision to replace the A&E with an Urgent Care Centre (UCC) was taken in 2011 and much has changed since then. Our east London population is growing and ageing, demand for NHS services continues to increase, and we face ever-increasing challenges as a healthcare system.
Following on from the recommendations in a strategic review undertaken recently by PWC, we now need to consider more options for the way we deliver urgent and emergency care across our communities. This will allow us to look at how this care is provided locally, taking these challenges into account.
It is important we consider how we deliver these services across both King George and Queen’s hospitals to enable us to deliver care in the best way for patients. Exploring more options will enable us to do this.
This is now an opportunity for us to work with our clinicians, patients, partners and stakeholders to develop a plan to make it easier for people to access the right services, deliver care sustainably, and address the challenges such as an ageing population and increasing demand on A&E services.
The model we finally adopt must provide excellent, safe patient care and meet the needs of local people now and well into the future.
In the meantime, the existing A&E at King George hospital will continue to operate as now.
I will continue to keep you updated of further developments.
Kind Regards,
Jane Milligan
Chief Officer NHS Tower Hamlets CCG and Executive Lead for East London Health and Care Partnership (NEL
STP)
ENDS

It would be great if you could come along and contribute ideas to how we can drive the campaign forward.

Save King George Hospital

Thursday, January 18, 2018

Cllr Athwal launches campaign for world class maternity service for King George Hospital at public meeting

Wednesday, January 17, 2018

The argument for bringing back maternity to King George Hospital

Monday, January 15, 2018

Come to the public meeting calling for the return of Maternity to KGH: Wednesday 17th January 2018 6pm Redbridge Central Library