NHS London closures: Royal Free Hospital or Whittington Hospital maternity and neonatal services could shut

Maternity and neonatal services at two hospitals are being considered for closure by the NHS in north London.

North Central London ICB (integrated care board) is looking at options involving closing maternity and neonatal services at the Royal Free Hospital in Hampstead or the Whittington Hospital in Archway.

Currently, maternity and neonatal services are provided at UCLH, Barnet Hospital, North Mid, Whittington health and the Royal Free Hospital, serving people in Barnet, Camden, Enfield, Haringey and Islington.

The change would see services offered at four locations rather than five in the area, under an initiative labelled the 'Start Well' programme by the ICB, which "aims to improve the quality and safety of care for pregnant women and people, reduce inequalities in outcomes and give every child the best start in life".

The closure of the Royal Free's services is named as the "preferred option". For children’s surgical services, the ICB is consulting on developing a centre of expertise for emergency and inpatient surgery at Great Ormond Street Hospital, as well as a centre of expertise for day case surgery at University College London Hospitals.

There are separate recommendations to consult on a proposed option to close the birth suites at Edgware Birth Centre, but keeping ante and post-natal services open.

If the ICB board approves the recommendations, a 14-week public consultation will be launched on December 11.

Jo Sauvage, chief medical officer for North Central London ICB, said: “While NHS front-line staff work incredibly hard to deliver good quality maternity, neonatal and paediatric surgical care, services aren’t currently set up in the best way to meet the changing needs of local people. Fewer babies are being born in North Central London and more complex care is often needed during pregnancy and birth, and we need to adapt our services to that. Our goal is to align services with the changing needs of the community and continually evolving best practice."

The ICB says medical staff "have led the design of the proposed options over the past two years, with input from parents, patients and families to arrive at these proposals". They have been jointly developed with NHS England Specialised Commissioning.

Dr Sauvage said: “We firmly believe every baby and child should have the best start in life. Good foundations in pregnancy and birth have a big influence on life chances and support reducing inequalities. So it is important that pregnant women and people have a positive birth experience and we ensure that everyone has access to the same high quality services no matter where they live or choose to have their baby.”

Maternity and neonatal services

It is proposed to bring together neonatal and maternity services in north central London onto four sites rather than the current five. Each would comprise:

• A home birth service
• A level 2 or 3 neonatal unit (able to support very unwell babies and babies born early)
• A consultant obstetrician-led labour ward
• An alongside midwife-led birth unit (a birthing unit led by midwives for low-risk births, but co-located with an obstetrician-led unit)

Two options are proposed for consultation:

• A - Services delivered at UCLH, Barnet Hospital, North Mid and Whittington health, with the closure of the service at the Royal Free Hospital.
• B - Services delivered at UCLH, Barnet Hospital, North Mid and the Royal Free Hospital with the closure of the services at Whittington Health.

The former is listed as the preferred option for the following stated reasons:

• It would be significantly easier to implement option A than option B from a workforce perspective because Whittington Hospital already has a local neonatal unit (level 2) while the Royal Free Hospital currently has a special care unit (level 1) neonatal unit. Therefore in option A there would be a smoother transition to the new model of care with minimal need for staffing changes.
• Option A would result in projected patient flows of 850 deliveries per year to hospitals in North West London (NWL) which NWL ICB has confirmed could be delivered within existing capacity. In option B patient flow to North East London (NEL) would be more difficult to manage.
• In both proposed options all maternity and neonatal services would close at one hospital site and there would be a focus across all hospitals to deliver best practice clinical quality standards and our new model of care.
• Either proposed option would require significant additional investment, of around £40 million to improve, expand and modernise the estate and facilities in the hospitals that would continue to deliver maternity and neonatal care.

Edgware Birth Centre

There are separate recommendations to consult on a proposed option to close the birth suites at Edgware Birth Centre. Ante and post-natal services would remain open. The ICB says the site is not well used for births, with 45 of the 20,000 births in its area happening there in 2021/22. The number has declined since 2017.

The ICB says only around 30% of pregnant people across North Central London would be clinically appropriate to give birth there, and that it does not have enough specialist staff to support the unit as well as other alongside midwifery-led units, sometimes leading to short-term closures of the service.

Children’s Surgery

The ICB is consulting on developing a centre of expertise for emergency and inpatient surgery at Great Ormond Street Hospital and a centre of expertise for day case surgery at University College London Hospitals.

Some surgery for babies and very young children, and some surgery for older children that is more complex or less commonly done, would no longer be carried out at some local hospitals.