Agenda item

Report to follow.

Anna Stewart, Programme Director for the Start Well programme, introduced the report for the item on Start Well, which was a long-term change programme focusing on children & young people’s and maternity & neonatal services in a hospital context across North Central London. This covered hospital services at the North Middlesex, UCLH, Royal Free, Barnet, Chase Farm and Whittington Health as well as pathways with specialist providers such as Great Ormond Street. The project had started in November 2021 and the first phase had been looking at how services worked at the moment, how they compared to best practice and international standards, and identifying opportunities for improvement. This phase had now been completed with the Case for Change findings published.

Dr Emma Whicher, Medical Director for North Middlesex University Hospital and SRO (Senior Responsible Owner) for the Start Well programme, provided further detail to the Committee about the themes that had been identified. She said that there were good examples of outstanding care provided to children & young people and pregnant women but opportunities for improvement were found. These included:

• Health inequalities with variations in stillbirth rates between boroughs and the babies of black women twice as likely to be admitted to a neonatal unit after birth compared to those of white women.
• The sustainability of staffing was recognised as a challenge with agency staff being used to fill shifts in many instances. In neonatal services there was a need to match care capacity with demand and the provision of community support was variable between boroughs.
• With regards to children and young people’s services there had been an increase in the number of children presenting to A&E with minor/moderate health issues suggesting that these could be dealt with in alternative settings. Children and young people with long-term health conditions who lived in the most deprived areas were more likely to be admitted to hospital. Pathways for children waiting for treatment was variable between and within hospitals depending on the skills of the surgeons.

Chloe Morales Oyarce, Head of Communications and Engagement for NCL ICB, spoke about the engagement process outlining a 10-week period of consultation running from 4^th July to 9^th September which would seek views from staff, patients, stakeholders and the public about the Case for Change findings. The patient and public engagement process had been developed with partners including Councils and the voluntary and community sector. This would include online discussion events, interactive workshops, a questionnaire, drop-in events and specialist engagement with children and young people. A report would subsequently be published on the feedback received and this would be used to inform the next stages of the programme.

Angie Belanor, Head of Maternity & Neo-natal Commissioning for NCL ICB, reported that a piece of work was ongoing to improve midwifery workforce issues including by looking at ways of attracting staff and supporting staff health and wellbeing to improve retention and reduce sickness rates.

Anna Stewart and her colleagues then responded to questions from Committee Members:

• Asked by Cllr Connor about the questions that would be asked to residents, Anna Stewart explained that the engagement would be split into two areas. Firstly, there would be an opportunity to reflect on the findings from the Case for Change and then, secondly, asking about what mattered to the people using services. It was important to check and reflect that the work that had been done in the first phase matched with the staff and patient experience. This feedback would all be brought together in September to develop a view on what good models of care looked like. Specific factors may, for example, include individual hospital footprints and recruitment challenges.
• Cllr Cohen commented on the waiting times noting that, according to the report, 4,300 children and young people were currently waiting for treatment at NCL sites and that 330 had been waiting for over a year. Dr Emma Whicher explained that a backlog had built up during the Covid pandemic, particularly in dental and ENT procedures for children due to the strict requirements on infection control. Now that these requirements had been loosened, work was ongoing to reduce this backlog. There was a well-established process in acute hospitals of reviewing children on waiting lists for any risk of harm. Cllr Connor commented that the waiting list numbers were shocking and suggested that a breakdown of the types of cases should be provided. (ACTION)
• Cllr Hutton commented that those presenting at A&E were likely to be those least engaged with health services and that the local voluntary and community sector may have a role to play in improving engagement. Cllr Revah asked about typical waiting times at A&E. Anna Stewart said that this issue had been considered as part of the programme with workshops held over the summer. She added that there was found to be a link between A&E attendance and deprivation but further exploration and engagement on this issue, including understanding on what engages people to attend, was needed in the next stages of the programme.
• Asked by Cllr Revah about the definition of age ranges for children’s services and adults services, Anna Stewart said that different hospitals had different age cut-offs for transitions between services, ranging from 17 to 19. The Case for Change report acknowledged this issue and suggested that there was an opportunity for thinking more consistently on this across the NCL area.
• Cllr Revah and Cllr Anolue asked about support for new mothers to prevent isolation such as home visits, particularly in BAME communities. Cllr Milne expressed concerns about the statistic in the report that black women were twice as likely to be admitted to a neonatal unit after birth compared to those of white women. Angie Belanor said that across the country there was an emphasis on continuity of care models which improve outcomes and so it was important to ensure that this was offered in a structured way locally and that it was delivered in communities where outcomes were in particular need of improvement. Enhanced visiting was available for parents of babies that had been admitted to neo-natal units. This was also linked in with a national piece of equalities work which was looking at the experiences of staff and outcomes for patients from BAME backgrounds.
• Asked by Cllr Anolue what measures were in place to encourage recruitment into midwifery, Angie Belanor commented that national funding had recently been made available for improvements to maternity services including to support staff recruitment and retention and improve care. Support was also being provided through maternal medicine networks and a structured development programme for newly recruited staff.
• Cllr Bevan asked about measures to engage young people in the consultation process. Chloe Morales Oyarce explained that they had been using different measures with partners to do this including focus groups with children in care organised through a voluntary organisation, contact with condition-specific groups through NHS Trusts, and consultation with schools, children’s centres and voluntary & community groups.

Cllr Connor suggested that details on the number of people from BAME backgrounds who were engaged over the Start Well consultation should be made available along with when their views on these topics were. (ACTION)

The Committee proposed recommendations based on the discussion as follows:

• A breakdown of the types of cases of the 4,300 children & young people on the waiting list for treatment should be provided.
• On retention of the workforce, an understanding from staff of the key reasons that would cause them to consider leaving their job should be sought.
• An issue was raised about the acknowledgement in the report that the Royal Free did not have a high level of neonatal care provision and so the future of the unit was being considered. The concern expressed was that patients might not feel confident in giving birth at the Royal Free if there was no neonatal unit available should something go wrong so this issue should therefore be considered as part of the Start Well process. A similar concern was raised about the comment in the report that “the maternity and neonatal estate at the Whittington Hospital does not meet agreed modern standards”. (ACTION)

It was agreed that a further update on the Start Well process could brought to the JHOSC at a later date and that the timing of this would need to be agreed as part of the Panel’s work planning process. (ACTION)