This is because the number of women choosing to give birth at Ealing Hospital is at its lowest level in over three years 15% • This drop in activity is the most significant across all 10% Trusts in NWL from 12/13 to 13/14 (12% compared to 5% average of 4% for all Trusts in NWL). 0% -5% • This has resulted in Ealing CCG having to invest -10% significant unplanned supplementary funding (due to -15% 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 Fig 3. Activity has fallen at Ealing Hospital by 12% over these three years on the ability of trainees to acquire the necessary skills and experience, thereby jeopardising their ability to Actuals Forecast 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. Fig 4. Bookings at Ealing Hospital have fallen considerably since September 2014 18
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 2014/15 birth activity for Ealing already underway across the residents, by Trust geographical area 155, 3% 108, 2% 209, 4% 340, 6% Ealing Imperial Ealing CCG deliveries and recorded residence of Hillingdon 470, 8% 2,175*, 40% West Mid mother (excluding Ealing Hospital) Northwick Park 2,036, 37% Bubble size represents the number of deliveries recorded in each area Chel West Other Imperial Hillingdon * Ealing hospital performed 2,390 deliveries in 2014/15. 215 of these were for practices in West Mid neighbouring CCGs that border Ealing. Ealing hospital delivered 2,175 babies for women registered with Northwick Park Ealing practices. Chel West 19
There are compelling reasons for Ealing CCG to take a decision at its meeting today (1/2) From a purely training perspective, Ealing Hospital will require significant investment in obstetric consultant numbers to support training needs • Ealing Hospital has generally been rated ‘less good’ than other NW London training locations for obstetrics 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 or patient experience. As a result, the risk of unplanned change due to workforce shortages will increase. 20
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 • 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. 21
There is an increasing risk that services will become unsafe, necessitating unplanned closure of the Ealing Hospital maternity service • 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 of maternity services from Ealing Hospital on 1 st July 2015. • This will: • Create certainty and clarity for women and staff • Enable Ealing residents to access better quality care. 22
Questions
Maternity and Neonatal Model of Care Paper 5.1 Presenter – Pippa Nightingale
Why we need to change maternity services in NW London • 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 outside 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. 25
What we are doing to improve maternity and newborn care in NW London 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 1000 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. 26
Model of care for maternity services in NW London – summary of pathway Choice Access Continuity of care Early pregnancy Antenatal Delivery Postnatal Neonatal Choice from six maternity Choice of setting - care Choice of setting with All babies needing Choice of birth setting – providers , supported via either in home or close on-going neonatal care more care close to home home, midwifery led or advice from GPs, providers to home in community have rapid access to the (children’s centres, health obstetric led and a maternity booking settings appropriate level of care centre's, GP surgeries, 1:1 Midwifery care in service in NW London as close to community hubs) A model of Transitional established labour home as possible . Key Early access to maternity Care for babies Shared care between Increase in midwife to elements include: services by 12+6 weeks GP/Midwives/Obstetrician Clear handover • A specialist neonatal birth ratios in line with as appropriate Access to translation, protocols and transport service Birth-rate Plus interpreting and advocacy communication with Triage, treat and transfer • Established care recommendations (target 1 services based on an identified healthcare protocols to avoid Midwife to 30 births) pathways that allow assessment of need professional for the unnecessary admissions mothers and babies to Increase consultant transition to parenthood access rapidly a unit Access to advice and Access to 24/7 Day obstetric presence on the offering the appropriate support on lifestyle, Enhanced children's Assessment, early delivery ward (target for level of neonatal care breastfeeding, diet, safeguarding through pregnancy and 168hrs presence) • Adequate assessment diagnostics etc development of provider: emergency gynaecology of need and provision borough protocols services for women should of appropriate problems occur capacity 27
The proposed model of care promotes access, choice and continuity of care for Ealing women Women Receiving Trusts • Will extend their current community boundaries to ensure that midwifery led • Can choose their delivery unit from six maternity maternity care can be provided locally providers in NW London • Will offer women a choice of where to receive their antenatal and postnatal • Can choose the location for their antenatal and care depending on ongoing assessment of their clinical/social risk and postnatal care - either at Ealing Hospital, one of the needs. children's centres, health centre’s, their local GP clinic for GP appointments or their maternity services • Will work out of the Ealing Hospital site and Ealing Children's provider site in NW London Centres/health centres to deliver: • Will need to travel to their maternity services provider • Antenatal care (including booking appointment & phlebotomy) site for their scanning appointments • Postnatal care • Requiring specialist antenatal care may need to travel • Parent education classes to their maternity services provider or will receive care locally at the Ealing hospital site • Breastfeeding clinics • Will still be able to access the Early Pregnancy • Will offer scanning services at their hospital site Assessment Unit at Ealing Hospital Trust • Will continue effective local services where appropriate e.g. diabetes clinic • Will be able to stay with their babies if they require • London North West Healthcare Trust will offer consultant led antenatal transitional care 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. 28
Conclusion • 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. 29
Questions
London Clinical Senate Review (February 2015 Report) Paper 5.2 Presenter – Dr Mark Spencer
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. 32
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. 33
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. ” 34
Recommendations from London Clinical Senate report for transition of maternity and neonatal services The Review Team advised that NHS England (London) seek the following assurances: Recommendation SaHF programme response Further detail is required about the provision of an Updated model for emergency gynaecology has been agreed with LNWHT, emergency gynaecology service at Ealing Hospital in and approved through the SaHF Clinical Board. This model is included in terms of workforce and criteria for access. 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 Hillingdon, Imperial and West Middlesex Hospitals have completed or are sufficient overall capacity and have put actions in place to due to complete estates work to provide additional capacity required. This mitigate risks to an acceptable level. will be verified through site visits. For neonatal services, satisfactory arrangements are in All units in North West London are investing in improving neonatal place for transitional and outreach neonatal services, transitional care. This is supported by the North West London Neonatal supported by the North West London Neonatal Operational Delivery Network. The outreach model for supporting neonatal Operational Delivery Network. care will be continued at Ealing Hospital. External peer review of all affected services within the The programme has undergone peer review from out of sector clinicians hospitals providing the additional maternity, neonatal and (i.e. London Clinical Senate review) gynaecology capacity is strongly recommended before, during and up to 18 months after transition. The Review The SaHF programme has held lessons learned sessions with midwives Team in particular noted challenges in providing services and consultants involved in the closure of the Barnet and Chase Farm at Hillingdon Hospitals NHS Foundation Trust and maternity unit to learn the lessons from this experience. Imperial College Healthcare NHS Trust, suggesting these should be a priority. 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. 35
Recommendations from London Clinical Senate report for transition of paediatrics services 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: Recommendation SaHF programme response A robust plan for the paediatric workforce Agreed that a comprehensive paediatrics workforce strategy will be developed involving with a more innovative model than sustained formal and informal engagement with staff. In addition SaHF is working with HE currently suggested. 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 Business cases have been developed for the paediatrics estate work required at receiving for the expansion of paediatric services in hospital sites. A business case for a Rapid Access Clinic at Ealing Hospital has been receiving hospitals, and the services that approved by Ealing CCG and is in the process of being implemented. will remain at Ealing Hospital. The development of new paediatric A business case for a Rapid Access Clinic at Ealing Hospital has been approved by Ealing services, such as the Rapid Access Clinic, CCG and is in the process of being implemented. This Rapid Access Clinic will be at Ealing Hospital goes ahead as planned. operational for at least 9 months before the planned transition date for paediatric services A similar external peer review process as A draft review process has been developed and the SaHF programme will work closely described for maternity services is strongly with NHS E, TDA and the London Clinical Senate to agree and implement the review recommended. process. A clearly articulated communications A robust communications and engagement plan is under development to ensure that all strategy. 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. 36
Questions
Agenda Item 6.0 Forecast maternity activity to receiving hospitals Presenter – Dr Mark Spencer
Maternity capacity and activity modelling pack • 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 of 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). • 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. 39
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 40
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. 41
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 overflow 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 42
Questions
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 Presenters – Dr Abbas Khakoo and Dr John Hutchins
Consolidating paediatric in-patient services at 5 Major Hospitals will improve care for patients • 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 SaHF plans for paediatric service reconfiguration were endorsed by the Secretary of State, Independent Reconfiguration Panel and London Clinical Senate. 45
From Inpatient care to Out of Hospital care – Ealing children will be first in line to receive the benefits Out of Hospital benefits for Ealing children In-hospital benefits for Ealing children • Out of Hospital care keeps children in The reconfiguration will allow the hospitals their home serving Ealing children to: • Care is delivered in the home and Day • Experience a consistent presence of Unit senior clinicians • Improved child and family –friendly • Enable NWL to provide consistent 7 day approach services • Comparable clinical outcomes to in- • Improve clinical outcomes for in-patient patient care episodes • Infrastructure to support earlier discharge if • Reduce requirement for emergency admission is required admissions • Increase patient satisfaction 46
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 Proposed Ealing Hospital paediatric model of care New /enhanced services Retained services Closed services • Paediatric urgent care provided Consultant-led paediatric Rapid • Paediatric in-patient services by the Urgent Care Centre (UCC); Access Clinic (RAC): • ALL existing general and • 7 day, GP referral-only service. specialist paediatric Outpatient • Aim is to reduce A&E attendance services (i.e. clinics on site plus by providing GPs with an community delivery of diabetes, alternative to referring to A&E. asthma); • Timed same-day/ next-day • Non-emergency, low-acuity day- appointments with paediatric care services such as day-cases, specialists offered to patients. orthopaedics, Liaison Child and • Enhanced Day Unit range of Adolescent Mental Health Services services (CAMHS), Ear Nose and Threat (ENT) clinic, physio • Enhanced Community Children’s Nursing service • A&E resuscitation – to stabilise children attending UCC before • Enhanced medical trainees transfer experience (stabilises workforce) BUT from now until 30 June 2016 (i.e. for 13 months) - no reduction in Ealing Paediatric services *At first, the RAC will not accept referrals from the UCC, 47 however, this will be reviewed after 3 months.
A new consultant-led Rapid Access Clinic (RAC) will improve care for Ealing children and reduce A&E attendance Chart to show the proportion of current annual <16 yrs A&E • Aim is to reduce paediatric A&E attendance at activity at Ealing Hospital that would be suitable for care at Ealing Hospital by 1,900 pa. the RAC • 7 day, GP referral-only service. Phase 1 RAC cohort • Timed same-day/ next day appointments. 1800, 23% 1900, 24% • 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 1700, 22% • Staffed by one (1) consultant , one (1) nurse and 2400, 31% Proportion in- scope for RAC one (1) training post during phase 2* • Open from 11am – 7pm on week days and a <16 GP Referrals to A&E - Discharged from A&E without ongoing treatment minimum of three hours per day on weekends <16 A&E activity referred from UCC* – will pick up referrals from morning and evening <16 GP Referrals to A&E - Admitted or Other Disposition GP surgeries Other <16 A&E activity (e.g. LAS conveyances direct to A&E) The RAC will be implemented at Ealing Hospital during summer 2015, initially as a one-year pilot. 48 *At first, the RAC will not accept referrals from the UCC, however, this will be reviewed after 3 months.
Why paediatric in-patient services closure at Ealing Hospital on June 30 2016? “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 Factors influencing timing of the paediatric transition • Experience of neonatal care is an important element of the paediatric training Neonatal inter- rota. dependency • In the long-term, paediatric training at Ealing Hospital is not viable in the absence of neonatal services. • The level of consultant cover at Ealing Hospital is substantially below London Quality Standard requirements - (5.7 Whole Time Equivalents WTEs) vs 10 Workforce WTE). • Risk that prolonged uncertainty over the future of the service would destabilise the workforce. • Paediatric activity peaks annually March-May. Avoiding peak activity • SaHF Paediatric Project Delivery Board advise that transition should be timed to avoid peak activity and winter pressure – i.e. between June and September. • Transition can only be achieved safely if appropriate capacity is in place at receiving Trusts. Receiving Trust capacity • Extensive capital builds underway at receiving sites – new capacity will be available by 30 th June 2016 (and earlier in most cases). But – final date is dependent on completion of assurance processes including patient journey remodelling 49
16 in-patient beds will be re-provided across NWL – this figure includes significant contingency of 127% of current activity Maximum number of additional beds required Ealing Paediatric in-patient activity flow – Highest case West 6 Middlesex Northwick 500 Park Northwick 3 Park average LoS* 400 1.8 day 500 Hillingdon Hillingdon 3 Ealing St. Mary’s Imperial 300 2 ChelWest 1,100 WMUH ChelWest 2 2,800 spells pa. – 127% of current Ealing in- patient activity (2013/14 baseline) 16 50
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. Capacity recommended by Hospital site Capacity proposed by Trust Capacity in place Paediatric PDB In-patient: 3 in-patient beds • 4 in-patient beds January 2016 Hillingdon Hospital A&E: 1,800 attendance pa. • 4 PAU beds co-located with A&E In-patient: 3 in-patient beds • 3 in-patient beds November 2015 Northwick Park A&E: 1,700 attendances pa. • N/A no capital investment Hospital required In-patient: 6 in-patient beds • 4 PAU cubicles co-located November 2015 with A&E • 4 in-patient beds WMUH A&E: 3,900 attendances pa. • 6 Emergency Department (ED) cubicles (inc. 1 HDU cubicle) In-patient: 2 in-patient beds • Able to absorb activity without June 2016 expansion Chelwest A&E: 1,100 attendances pa. • Able to absorb activity without expansion In-patient: 2 in-patient beds • 2 in-patient beds June 2016 St. Mary’s A&E: 1,400 attendances pa. • Expansion of existing A&E 51
Plans are in place to ensure that paediatric services are sustainable in Ealing for 13 months after neonatology closes 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. “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 52
We will undertake significant further work to prepare the system prior to implementation (on 30 th 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. 53
Questions
Agenda Item 9.0 Gynaecology: The requirement to change, proposed model of care and anticipated benefits of the proposed change Presenter – Dr Mark Spencer
Context 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 56
Three options were considered for the patients presenting out of hours: Option Number Option Benefit Risk 1 (preferred Continue to take all London • No change for patients • Need to ensure out of hours consultant will be option)* Ambulance Service (LAS) • No need to change LAS pathways available if required patients to Ealing site – • Ease of implementation • Need to manage clinical risk if consultant initially manage all patients • Replicates model already safely used required Out of Hours at Ealing at CMH 2 LAS conveyances – split • Secure 221 ED attendances at Ealing • Difficult to implement for LAS pathway for in hours and • Minimise the burden on potential • Perception of two tier care at Ealing Hospital out of hours to Ealing receiving sites site Hospital site • Difficult to manage the communications • Potential loss of up to 688 ED attendances 3 All LAS conveyances • Easy to implement • Loss of up to 909 ED attendances including diverted to alternative • Minimise the risk of out of hours general surgery receiving sites emergency surgery • Difficult to manage the communications to the community • Pressure on receiving Trusts *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. 57
Key features of the future model of care • 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 58
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 59
The model of care delivers a number of benefits 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 60
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
Background and context • 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: 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. 65
Letters of support confirming operational readiness • 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. Provider Date letter received Signed on behalf of the Trust Board by London North West Healthcare 13 May 2015 Dame Jacqueline Docherty DBE, Chief NHS Trust Executive The Hillingdon Hospitals NHS 11 May 2015 Shane DeGaris, Chief Executive Foundation Trust Chelsea and Westminster 11 May 2015 Elizabeth McManus, Chief Executive Hospital NHS Foundation Trust West Middlesex University NHS 12 May 2015 Jacqueline Totterdell, Chief Executive Trust Imperial College Healthcare 11 May 2015 Tracey Batten, Chief Executive NHS Trust London Ambulance Service 12 May 2015 Jason Killens, Operations Director NHS Trust 66
Operational readiness of London North West Healthcare NHS Trust • 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. 67
Operational readiness of Health Education North West London Paper 10.2 Presenters – Clare Parker
Health Education North West London is assured of the plans for the training and education of clinical staff • 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. 69
Questions
Agenda Item 11.0 TAG Travel Analysis and Travel Recommendations Presenter – Dr Raj Chandok
Purpose and scope • 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 72
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 opportunities for improvements and appropriate mitigations of any issues have been considered. 73
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) 74
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 Review Patient Transport Services and Patient Experiences across NW 1. Patient Transport Services (PTS) London with the aim of producing NWL wide PTS Standards and an Working Group. improved patient experience. Review and support trusts with their travel plans . Provide advice and recommendations to TAG in relation to acute trusts to support service 2. Travel Planning Working Group. transitions. Liaison with TfL and WestTrans to produce bespoke travel resources. To focus specifically on Ealing Hospital service transitions – travel 3. Maternity Transition Working Group analysis and proposed recommendations. 75
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 76
Maternity transition recommendations (1/5) Ref TAG Recommendations for Maternity SaHF Programme Response Transition 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 A robust SaHF communications plan is implemented to include advice from TAG and include a significant amount of travel material: travel information to the new receiving trusts to help women • NWL booklet – one page of travel information per site. Includes 1 nearest stations, bus routes and parking charges on the advice of make an informed decision about which receiving trust they choose. the TAG • Car map provided by TAG (subject to feedback from user testing) • Bus map from Ealing provided by TAG • Travel script for midwives/ 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. Each receiving trust to provide a prospectus on where the full care pathway will be provided (including community locations). The booklet makes clear that for many women, most antenatal and This will be supported with travel information to the locations to 2 postnatal care can be provided in the community at a location nearer to enable women to make an informed choice (women on the their home than their hospital. intensive pathway will be informed about which receiving trusts are providing care at the Ealing Hospital site). 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. 77
Maternity transition recommendations (2/5) Ref TAG Recommendations for Maternity SaHF Programme Response Transition Upon first contact with a healthcare professional (Practice Nurse /GP) – choice of alternative receiving trusts and 3 travel information to be made available and travel implications to be discussed and understood Agreed. 4a Upon first contact with a midwife, travel information to be provided and travel implications to be discussed. An advisory script for midwives is being prepared to include information which can be provided to women who are unsure about their travel plans. For the most vulnerable patients if there are significant travel implications affecting appointment attendance , Information in the script includes assisting with developing 4b midwife to arrange appropriate travel arrangements. a personalised travel plan through TFL journey planner, These can include the use of the Hospital Taxi Scheme referrals to PTS / healthcare cost scheme and Trust taxi and / or Patient Transport Services (PTS) as appropriate. booking If travel costs are an issue, all healthcare professionals to 5 signpost women to the Healthcare Travel Costs Scheme, if eligible. 78
Maternity transition recommendations (3/5) Ref TAG Recommendations for Maternity SaHF Programme Response Transition Agreed. We welcome the support from Healthwatch Ealing in this. Healthwatch Ealing will support the maternity transition The programme will provide Healthwatch Ealing with a initially by supporting women to make informed choices range of materials both in hard copy and electronically. 6 through the signposting of travel information resources. This will include the booklet, the Easy-read guide, maps (Healthwatch Ealing capacity to provide this in a and translated material. sustained manner is to be understood). NW London wide material will also be made available to the other Healthwatch organisations across the boroughs. 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 (Action for TAG) 7 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. TAG recommends that each receiving hospital trust have 8 (Action for TAG) an on-line (TfL) journey planner link on their website. 79
Maternity transition recommendations (4/5) Ref TAG Recommendations for Maternity SaHF Programme Response Transition Agreed. TAG through collaborative working with TfL will produce a bespoke This is a useful map in a recognised format. We are testing this in 9 Ealing Public Transport Map from seven key Ealing locations to independent focus groups and intend to distribute this to key each of the receiving hospital trusts. locations, as well as in letters to women currently booked in at Ealing Hospital. Initial feedback has raised concerns about the usefulness of the map. Whilst showing the relative location which would assist TAG through collaborative working with WestTrans will produce a choice, it is hard to see any detail and would be unlikely to pass 10 bespoke Road Map from Ealing to each of the receiving hospital accessibility tests. We do however acknowledge that TAG are keen trusts. this is used and we are testing this in independent focus groups along with the other proposed communication and engagement materials. Agree with TAG that particular areas require additional focus. However, we feel that our activity can go further and be more TAG recommend that localised travel guides are developed for personalised and postcode specific. We are therefore developing 11 specific Ealing postcodes such as UB1;UB2;UB5;UB6 if there is an an advisory script for midwives which would include advice on identified need for further travel information.* 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). 80
Maternity transition recommendations (5/5) Ref TAG Recommendations for Maternity SaHF Programme Response Transition Agreed. We will work closely with the operations team through the Ensure that the latest hospital based maternity booking Operations Executive, with GPs through the CCG, with information for Ealing residents is regularly updated and midwives through the Trust and with the wider public 12 used to inform and finesse communications activities through our engagement to ensure we are hearing including travel advice 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. Agreed. The SaHF evaluation of Ealing Hospital Services post 13 transition, should include travel support and women’s We will work with TAG and the wider programme to travel experiences ensure this occurs. 81
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. 82
Questions
Agenda Item 12.0 PPRG Statement and Recommendations Presenter – Sarah Bellman
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
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. 88
Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services Reflections from A&E Changes Responses for Maternity Changes • Established CCG led provider assurance process • Value of challenge sessions • Established independent review of and site visits Assurance & operational readiness, NHSE Monitoring assurance and implementation assurance framework • Set up system monitoring and data collection early • System monitoring and performance baseline established 89
Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services Reflections from A&E Changes Responses for Maternity Changes • Data analysis and modelling • Conducted extensive modelling of requires full time dedicated resource patient flows, which has been clinically led and undergone • Benefit of external audit to critically rigorous external scrutiny Modelling challenge modelling work • Capacity modelling performed at • Modelling should reflect patient trust level, with sufficient ‘flex’ to flows and consider peaks and deal with unexpected increase in troughs in activity activity 90
Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services Responses for Maternity Changes Reflections from A&E Changes • Full engagement of clinicians in • Provider collaboration through the implementation planning and maternity Project Delivery Board to delivery agree a consistent pan NWL model of care Clinical • Early identification of workforce Models of • Identified workforce needs early and needs to enable sufficient time to Care completed staff consultation to address requirements provide clarity on staff transfers 91
Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services Reflections from A&E Changes Responses for Maternity Changes • Allow time to embed and test new • New model of care for maternity clinical pathways before transition and neonatal care implemented across NWL trusts (all providers • Generic specifications or service running alongside midwifery led models may require local tailoring units and establishing transitional Clinical care on their postnatal wards to Pathways • Effectiveness of table top relieve pressure from the neonatal modelling exercises using real life unit) scenarios • New pathways for community model of care will be implemented prior to final transition • Undertaken table top modelling exercises 92
Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services Reflections from A&E Changes Responses for Maternity Changes • Senior management oversight of • Established clear governance and operational performance pre and reporting structures post transition to quickly address emerging issues • Representatives on maternity Governance Project Delivery Board are nominated Trust delivery leads • Proactive and reactive risk management, with regular • Established clear performance communications and updates on baseline before the service key risks changes • Established Operational Delivery Checkpoint meetings, including Trust Chief Operating Officers, to manage operational delivery and risk 93
Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services Reflections from A&E Changes Responses for Maternity Changes • Communicate existing system • All communications materials have been developed in partnership with challenges and benefits delivered lay members to ensure messaging is simple and clear to public • Provide clarity in terminology Comms & • Clinicians (GPs, consultants, • Make messages in public information Engagement midwives) will be used as key campaigns clear and simple communication channel to keep local women up to date on changes to • Test communication materials with maternity services lay partners to ensure messages are clear and will be understood by public 94
Summary of key reflections from Hammersmith and Central Middlesex A&E closures and responses for transition of maternity services Reflections from A&E Changes Responses for Maternity Changes • Value of challenge and feedback • Invested time and resource into from lay members in informing engagement with local communities equalities and access work / groups around changes Equalities & • Continue engagement with local • Engagement work will be enhanced Travel communities and groups after following decision on timing in service transitions preparation for implementation • Community led engagement projects can be used to disseminate key messages to local communities 95
Questions
Outputs of NHS England Stage One Assurance Process Paper 13.1 Presenter – Clare Parker
NHS England assurance process for the transition of maternity and interdependent services from Ealing Hospital • 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 98
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 99
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 100
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