Review of North Central London’s Start Well maternity and neonatal care reconfiguration proposals against the Mayor’s first four tests

As part of a role in collaborating with the NHS and other health partners on behalf of all Londoners, the Mayor of London developed six tests to apply to major health care transformation and reconfiguration programmes in the capital. The tests are designed to help challenge the NHS to ensure that major changes are in the best interests of all Londoners, with the six tests covering: inequalities; health care capacity; financial sustainability; integration with other care services including social care; clinical engagement; and patient and public involvement.

The Nuffield Trust has been involved in supporting development and evolution of these tests. In December 2023, the Mayor commissioned the Nuffield Trust to undertake a review of proposals by North Central London Integrated Care Board to consolidate maternity and neonatal care services within its geographic area. This report sets out our assessment of these proposals against the first four of the Mayor’s tests, and is made in respect of materials published as part of the public consultation on the proposals, including the pre-consultation business case. An updated assessment of the proposals will be made once the decision-making business case has been published, which is expected later in 2024. At that point we will also assess the proposals against the Mayor’s last two tests.

Many of the issues faced by maternity and neonatal care services are interrelated, so the tests should be read together. However, there are a number of issues that we highlight in this report as particular concerns that the Mayor may wish to seek further information and reassurance on.

These are:

• The lack of local, disaggregated data on maternal and neonatal health and health care inequalities. This gap is not unique to NCL, but the Mayor may want more information on how NCL and its neighbouring health systems propose to address it.
• The lack of clear and quantified commitments around addressing health care inequalities for maternity and neonatal care services in NCL. NCL have been clear the ICS has strong commitments in this area and that improvement ambitions are embedded throughout wider strategies. However, it would be useful if these could be made clear as part of the current proposals, particularly where they relate or intertwine with the acute pathway for these services, which is the focus of current proposals. Making these commitments clearer and measurable may also help alleviate local concerns about the impact of the proposals, as stakeholders will know these are ambitions for which NCL is prepared to be held to account.
• The robustness of population need modelling. This is a complex area and we recommend further sensitivity checks on the analysis that has been carried out so far.