Charles Wright: Hard choices loom over London maternity services

Charles Wright: Hard choices loom over London maternity services

London’s falling birth rate, already prompting school cutbacks, mergers and even closures, is now resulting in controversial plans coming forward north of the river to shut down maternity services too, at either the Royal Free (pictured) or Whittington hospitals.

The proposals from the North Central London integrated care board, responsible for planning health services and allocating NHS funding in Barnet, Enfield, Haringey, Islington and Camden, are now out for consultation – pitching MPs against each other in support of their respective local services and prompting warnings from maternity staff that the changes could put more mothers’ lives at risk.

Fewer children being born in the city — overall births were down by 17 per cent in the decade to 2021 — is the key issue. Across the board’s five boroughs, around 20,000 babies were born in 2021/22, a thousand less than in 2018. Twenty-one per cent of the boroughs’ 1.8 million population are currently under 18. By 2041, that will be 10 per cent lower.

This has left the boroughs with a mismatch between demand and supply of the right care in the right place, the board argues. Effectively, there are enough births for four units but not for the current five: Barnet general hospital, North Middlesex hospital and University College hospital along with the Royal Free and the Whittington.

“The needs of local people are changing, and our services need to adapt to the number of babies being born falling, and [to] care needed during pregnancy and after birth becoming more complex,” the board’s consultation document says. “We need to make sure there is sufficient neonatal care in the right places.”

Falling demand is compounded by significant staff shortages, the board adds. The current sites are short of 86 midwives, and nurse vacancies mean units “cannot always open all their cot spaces”, forcing babies to be moved out of the area. There’s also a need for more dietetics, physiotherapists, occupational therapists and speech and language therapists across all sites.

“We cannot recruit enough staff to fill these jobs across five hospitals,” is the board’s stark conclusion. Going to four units would make recruitment easier, while also improving staff skills, it argues. “Evidence shows that key to delivering good outcomes and maintaining staff skills and competencies are neonatal units that see enough babies.”

The Royal Free neonatal unit, by contrast, with admissions down year on year since 2018, “does not treat enough babies for staff to maintain their specialist skills and competencies,” the board says – with “safety measures” to reduce risk currently costing more than £750,000 a year, “not a good use of resources”.

Concerns about the quality of provision are further highlighted by the fact that while Barnet hospital and UCH services are rated “good” by the Care Quality Commission, the North Middlesex maternity unit is currently rated “inadequate” and the Whittington and the Royal Free as “requiring improvement”. Buildings across the area are showing their age as well.

Shutting the Royal Free unit is the board’s “preferred” option, because fewer staff would have to relocate. North west London’s St Mary’s and Northwick Park hospitals have the capacity to accommodate the projected 850 births a year in that part of the capital. This compares with potentially needing Hackney’s Homerton hospital to deliver an additional 350 babies a year were the Whittington service to close, adding to demand which, in its case, is actually rising.

That preference has seen battle lines drawn, with consultants and midwives at the Royal Free warning just last week of the risks to mothers if a unit linked to a “wealth of specialist units, resources and clinics” is closed. Local Labour MP Tulip Siddiq, whose children were born at the hospital, is in the fight too, arguing that poor transport links to other north London hospitals mean it is “heavily relied upon” by her constituents.

Siddiq’s petition against closing the Royal Free unit is up against that of her Labour neighbour, Hornsey & Wood Green MP Catherine West, in support of the Whittington. Its maternity unit, West argues, is an “adored, essential part of our community”.

The politicians, along with their Labour colleague Anne Clarke, London Assembly member for Barnet & Camden, are putting wider arguments too, targeting government policy and the rising cost of living.

“The NHS is under so much strain thanks to 13 years of failed austerity, but we can’t place the burden of increased costs and pressures on women by making them travel further for maternity care,” said Clarke, while Siddiq highlighted “underinvestment” and north London’s high rents “forcing many poorly-paid health workers to move out”.

The solution, she said, “cannot be to shut down vital local services. We must instead address these problems at their source, including tackling the recruitment and retention crisis in our National Health Service and bringing down rents and the cost of living, particularly in London”.

Clarke makes a further point, echoing concerns from London Councils about school place provision, concerning if and when raising a family in the city becomes more popular. “Birth rates can rise again if couples feel in a better financial position to have children, and those who wish to can delay for only so long,” she said. “It is easy to cut services, but will be very difficult indeed to reopen services if demand requires it.”

With opposition to the proposals mounting, there are no easy decisions for the care board, which has already ruled out a “no change” option. And with warnings from the Centre for London think tank and others that inner London is heading towards becoming a “child-free area” looking to be borne out by the statistics, it won’t be alone in facing hard choices.

Consultation on the North Central London proposals runs until 17 March. Full details here. X/Twitter: Charles Wright and OnLondon. Support and its writers for just £5 a month or £50 a year and get things for your money too. Details HERE.

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