London North West Healthcare University NHS ... London North West Healthcare Our Early Adopters Journey

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  • January 2017 – October 2017

    November 2017 – October 2018

    November 2018 – onwards

    North West London Local Maternity System

    London North West Healthcare University NHS Trust

    University NHS Trust London North West Healthcare

    University NHS Trust

    University NHS Trust London North West Healthcare

    Our Early Adopters Journey A toolkit

    North West London received funding from NHS England to improve local maternity services and deliver the recommendations from the National Maternity Review, Better Births.

    • Evaluate and share learning with other sites across the UK

    • Continue to provide women and families with better continuity of care and improved postnatal care

    • Set up local maternity system – working collaboratively to plan improvements to maternity services

    • Engaged with women and staff on how we can improve maternity care

    • Launched website for parents and families to share their maternity experiences

    • Planned new ways of working to improve continuity of care

    • Created personalised postnatal care plans to be used in all trusts


    • All trusts to have a maternity app providing consistent information for mum’s on-the-go

    • New maternity teams offering better continuity of care in all sites across North West London

    • Implement better tools for communication between care providers and women

    • Introduce photo booklets, to help women get familiar with their named midwife and the team of midwives

    • Bespoke training for midwives and maternity support workers to enhance their skills and career development

    • New standardised postnatal discharge pack


    North West London was an ‘early adopter’ for NHS England’s Maternity Transformation Programme to fast track the implementation of recommendations in The National Maternity Review (2016). The North West London maternity team has developed this document to provide an overview of how change has been implemented within our maternity services, the challenges faced and to share lessons learnt. This toolkit contains practical advice and information, details of new ways of working, use of new technology and case studies.

    The infographic below details the journey of the early adopter’s programme in North West London.


    1. Who we are 1

    2. Gap analysis 2

    3. Our vision and aim 3

    4. Engaging stakeholders 4

    5. Mapping the existing pathways 5

    6. Working with maternity staff 6

    7. Working with service users 7

    8. Project plan 8

    9. Planning and delivering new models of care 9

    10. Finance and workforce planning 13

    11. Evaluation 18

    12. Case studies 20

    13. Maternity Transformation beyond ’Early Adopters’ 60

    14. References 62

    15. Appendices 63

    How to use this toolkit: In the orange Next steps box, we make suggestions for you to think about for your service. Where there is an asterisk * there is a tool in the Appendices to assist you


  • 1

    1. Who we are

    The North West London Local Maternity System (LMS) comprises four hospital trusts, six maternity units and eight clinical commissioning groups, supporting approximately 29,000 births a year. The LMS covers the same areas as the North West London Sustainability and Transformation Partnership (STP) footprint, now known as the North West London Health and Care Partnership.

    The LMS is made up of midwives, obstetricians, neonatologists, mental health specialists, GPs, health visitors, commissioners, representatives from NHS England, service users (Maternity Voices Partnership representatives) and the North West London maternity project management team. Representatives from other organisations are invited to attend periodically.

    In late 2016, North West London was chosen as one of seven Early Adopter sites to receive funding from NHS England to improve local maternity services and to test the recommendations from the National Maternity Review, “Better Births”. With this funding the LMS was encouraged to “go further, faster” and to share the learning with other LMS’s across the country.

    Queen Charlotte’s and Chelsea Hospital

    West Middlesex Hospital

    Hillingdon Hospital

    Northwick Park Hospital

    Chelsea and Westminster Hospital

    St Mary’s Hospital

    Giving birth in North West London

    Acute provider trust Hospital site (maternity unit)

    Chelsea and Westminster Hospital NHS Foundation Trust (CWHFT)

    Chelsea and Westminster Hospital

    West Middlesex Hospital

    Imperial College Healthcare NHS Trust (ICHT) Queen Charlotte’s and Chelsea Hospital

    St Mary’s Hospital

    London North West University Healthcare NHS Trust (LNWUHT) Northwick Park Hospital

    The Hillingdon Hospitals NHS Foundation Trust (THH) Hillingdon Hospital

    The NHS trusts providing maternity care in North West London are:

  • 13. Maternity Transformation beyond “Early Adopters”


    The Early Adopters project started with a gap analysis, looking at the care currently being provided and the recommendations made in the National Maternity Review. As North West London has a history of engaging with the women and families in our area, we were pleased to find that many of the recommendations had already been achieved.

    Key areas for improvement were identified:

    • Improve the consistency of information women receive

    • increase continuity and personalisation of care within a small team of midwives

    • each team of midwives to have an identified obstetrician

    • improve women’s access to perinatal mental health services

    • improve quality of to postnatal care

    • improve handover to community services after discharge from maternity services

    • move towards electronic maternity records

    • enhance maternity commissioning.

    Some of the above areas were identified as achievable within the Early Adopters two year project. Others were allocated to key areas of focus within the LMS Maternity Transformation Programme (see Chapter 13).

    2. Gap analysis

    Implementing Better Births

    A resource pack for Local Maternity Systems

    March 2017

    Five Year Forward View Publications Gateway Ref No. 06648

    BETTER BIRTHS Improving outcomes of maternity services in England

    A Five Year Forward View for maternity care


    Next steps: Undertake a gap analysis against Better Births to see where your LMS/maternity unit needs to improve (National Maternity Review 2016, Annex A, pages 100-111).

  • 3

    3. Vision and aim

    The North West London LMS vision is to lead the way in providing first class, safe maternity care that offers choice and individualised continuity, with the family at the heart of everything we do.

    Our vision will be achieved by:

    • Increasing continuity of carer

    • improving postnatal care

    • ensuring consistency of information.

    The aim is to improve the clinical outcomes and care experience for women and families using the maternity services in our area.

    Our aim will be achieved by:

    • Asking women for feedback on their experiences

    • asking staff for feedback on working in new models of care

    • assessing the health outcomes of women and babies through formal evaluation

    • evaluating the operational and financial impact.

    Definition of “continuity of carer”:

    Women will have a lead midwife that is known to them, to coordinate their care, with antenatal, intrapartum and postnatal continuity being provided by a team of no more than six to eight midwives.

    Next steps: • Set out your vision

    • state the aims for improvement

    • be clear about the definition of ‘continuity of carer’.

  • 4. Engaging stakeholders


    The LMS held a launch event at the Royal College of Obstetricians and Gynecologists in London in April 2017. Approximately 100 members of staff attended from across the sector. Presentations from Baroness Julia Cumberlege, Professor Jane Sandall (Kings College, London), Sandra Smith (NHS England), Jacque Gerrard (RCM Director for England) and Pippa Nightingale (Senior Responsible Officer, NW London Maternity Transformation):

    • Invited participants to give their views about maternity care in North West London

    • invited staff to give their views on the proposed work streams

    • shared initial thoughts on ways to improve maternity services (see below).

    Who are we trying to help?

    • Understand current models of how midwifery-led care is provided across North West London

    • Develop personalised models of care adaptable to all maternity pathways and needs

    • Continuity of carer • Reduction in adverse outcomes • Improve maternity care experience throughout the care

    journey • Better workforce design and experience

    • Logistics for service redesign, opportunities and constraints • Embedding new changes to workforce model and

    engagement • Financial impact, cost of redesign and benefits realisation • How new care model integrates into holistic maternity


    Users: • Describe your ideal pathway • Do you want