Paper 15.5

Strategy & Transformation: Maternity engagement report

20th March 2015 – 29th March 2015

1 Introduction In 2013 as part of the “Shaping a Healthier Future” programme it was decided to improve maternity services in North West . This included consolidating maternity services onto six hospital sites and closing the maternity unit at hospital. Ealing CCG met on 18th March 2015 to discuss the timing of the closure of Ealing Hospital Maternity Unit, and agreed that further work needed to be undertaken before deciding a closure date. A phase of community engagement was necessary to:

a) Update people on the progress of Ealing Hospital Maternity Unit b) Dispel any misconceptions c) Listen to any concerns and feed this back into the team developing the plans d) Identify key topics to feed into materials and the next phase of engagement

Engagement activities commenced on 20th March after Ealing CCG’s meeting and concluded on 29th March ahead of the pre-election period.

Engagement took place in Ealing, Harrow, and which are the primary locations for women choosing to give birth at Ealing hospital.

For this phase of engagement, activities were primarily focussed on children’s centres. These were identified as best placed to facilitate access to those most likely to be affected by the changes to maternity services.

This paper summarises the engagement activity undertaken, the key themes emerging from the feedback and recommendations for future engagement and communications activities. 2 Summary of activity

3 Key Themes 3.1 Maternity service experience

Those engaged shared their experiences of maternity services to date.

There were mixed reviews of the care received at Ealing Maternity Unit. Whilst some Mothers had a good experience, the team heard from other mothers that their experience was poor. This often linked to conversations about care at other units and a general desire to see some services improve. This was countered by some parents who had had very positive experiences and praised the staff at Ealing maternity unit.

Many Mothers had chosen to give birth at Queen Charlotte’s because of its reputation. However, it was reported that some Mother’s experienced a busy unit and had long waiting times.

Many people in Harrow had chosen to give birth at Northwick Park due to previous bad experiences at Ealing hospital. Five Mothers at the Vaughan Children’s Centre had delivered their first baby at Ealing Hospital. However, after 4 of these Mothers had a negative experience at Ealing Hospital they moved to Northwick Park Hospital to have their other babies.

Some Mothers also reported high turn away rates at West and Hillingdon when Mothers present for delivery. In addition to this, some people spoken to also reported poor after care at Hillingdon hospital. 3.2 Capacity

A Primary concern of Mothers in the neighbouring boroughs of Hillingdon, Harrow and Hounslow was about the impact on capacity of the maternity units at the remaining hospital sites.

In Harrow, those engaged repeatedly reported their fear of how the closure of Ealing maternity unit would impact Northwick Park hospital and Queen Charlotte’s. There was concern about capacity at these hospitals to cater for increased births in the future. The experience at these hospitals was that the maternity wards were already very busy and that midwives looked over worked.

In addition to this, those engaged in Hillingdon and Hounslow both expressed similar concerns about the impact of Ealing maternity unit closing on Hillingdon and West Middlesex hospital. Engagement activities highlighted that Mothers would like to know what ‘increasing capacity’ in the other hospitals actually means.

‘The reasons make sense but how will the other hospitals cope? They are already extremely busy, the morale of the mid wives seems very low which results in really poor post birth care.’ Mother - Rayners Lane Children Centre, 3.3 Case for change

A number of women expressed that they would like to unit to stay as it was local. However, after conversation, the majority understood the reasons for the change. This included assurance from the team that a significant amount of antenatal and postnatal care would still be available in the borough.

3.4 Travel

Travel came up in around 1/3 of engagement meetings after participants were asked if there were any concerns about having to go elsewhere. Concern around travel was more prevalent within . Engagement in the other boroughs – Harrow, Hillingdon and Hounslow – revealed that travel wasn’t a primary concern.

Many in Southall particularly expressed concern as they do not have access to a private vehicle. As a result, mothers that we spoke to said that they were anxious and concerned about what they would do about transport in the future. Concerns from some around what to do if they need to travel at night – mainly those who don’t have a car. Some raised concerns about having to get a taxi and the resulting increased cost.

Difficulties travelling to another hospital was reported most acutely by the Tamil Community in Southall. Concerns were raised that Southall Mothers may look to ambulances to provide transport to hospital after the closure of Ealing Maternity Unit. For those with access to a private car, travel seemed less of a concern although traffic around Southall raised as a minor concern.

Some people said they didn’t know what buses went where. Questions were also around number of appointments that would require further travel.

‘What will we do?! If I have to go to hospital in the night, I will need to leave my husband at home with the children and take a taxi by myself for 20-30 minutes to get to another hospital. I can’t call an ambulance - my friends tell me that they won’t come unless you are about to die.’ Mother - Southall Tamil Women’s Group, Ealing

‘Many of our families don’t own a car so travel to surrounding hospitals will be an issue. Also many of our families are on food bank vouchers so any rise in the use of public transport to get to hospitals may become unaffordable.’ Staff member - Greenfields Children’s Centre, Ealing

‘I am very concerned about giving birth before reaching the hospital.’ Mother – Grover Children’s Centre, Ealing 3.5 Hospital Preferences

A number of the Mothers engaged in Ealing said they would prefer to give birth in Ealing Hospital – particularly when travel has been identified as an issue. However others stated that their first choice would not be Ealing hospital despite being closest to their homes.

Some women also expressed that they hadn’t previously felt they had a choice about where they were booked into for the birth.

Many of those engaged in Harrow reported that their preference was Northwick Park Hospital. Though some stated that Ealing or Queen Charlotte’s would be their first choice – the number was fewer.

Many of the Mother’s in Hillingdon would choose Hillingdon as their first choice. In a group of 60 people at Charville Children’s Centre, Belmore Children’s Centre and Belmore Nursery, only 7 had given birth at Ealing Hospital.

Those engaged wanted to know what the likelihood of being able to their first choice hospital was with the closure of Ealing maternity unit. There were also questions about whether other hospitals would have their notes.

‘We prefer Queen Charlottes, even though we live in Southall’. Mother, Southall

‘We don't have enough information on the other Hospitals to be able to choose which one we would go to.’ Mother – Ealing 3.6 Community Services

Many of the Mothers engaged were encouraged that pre and post natal services were remaining local. Concerns were expressed in some areas that the community services were insufficiently resourced and this lead to long waiting times. With the closure of Ealing maternity unit, people raised questions about whether this situation would be affected.

‘Community provision at Jubilee Children’s Centre has been reduced. There are two week waits for appointments with midwives and when you go, you have to wait up to two hours to see her!’ Parent – Grove Children’s Centre, Ealing 3.7 Importance of engagement

Many of the people engaged discussed with the team how important it was to be kept informed. This proactive phase of engagement was well received and it was a good opportunity to share some of the more positive changes that will be taking place – for example, employing more staff.

Advice was generally that translating the full booklet would not be useful but a separate EasyRead version which could be translated into Tamil and Punjabi would be well received. Leaders also advised caution in providing ‘information overload’ with too much information in one go.

‘I am not having any more children but thank you for the information. I understand the changes and it makes sense. I will pass the info on to friends and family who will be directly affected.’ Mother - Grove Children Centre, Ealing

‘Thank you for explaining this to me. It helps me to understand what is really happening instead of just what the headlines might say.’ Mother - Hill View Children Centre, Harrow

‘It’s great to hear that you are employing more staff!’ Mother - Roxbourne Children Centre, Harrow

‘I feel reassured about the changes and understand the reasons for the closure. More local community ante natal clinics is great news!’ Mother - Rayners Lane Children Centre, Harrow

4 Recommendations for communications and engagement 4.1 Materials and messaging

 Continue plans for simple booklet detailing the information a patient would want to know on each hospital so they feel able to make an informed choice o This booklet should provide support in choosing where to give birth and cover topics including: . Where can I give birth? . How do I book? . What is the public transport access?  Languages – The booklet should be in simple, plain English as advised by community leaders.  EasyRead leaflet - An alternative leaflet should be produce to highlight the key messages and should be made available in EasyRead, Tamil and Punjabi.  Travel information – Develop a suggested advice sheet for midwives when having initial conversations with patients around their travel arrangements for birth and prenatal care.  Services – Information should include when you will need to travel and what is available close to home

4.2 Next stage engagement

 Development of FAQs for next level of engagement detailing what will be different at each site answering the following questions:

o What does increased capacity mean? o What can we expect in terms of our care? o Will you increase the number of midwives and consultants at each hospital and if so, by how much? o How will you ensure the language capabilities of midwives from Ealing Hospital are distributed appropriately across the sites?

 Key Locations - Flyers and posters should be distributed as recommended below because these locations have the highest footfall of:

o Maternity units o Children Centres o Faith institutions

 Certain groups require interpreters - the engagement team to work with groups in advance to ensure that interpreters are available  Follow up meetings– the engagement team to follow up with groups where requested and agreed in the meetings from this phase of engagement

5 APPENDICES

5.1 Meetings attended

The schedule of engagement activity is detailed below:

EALING

Organisation Date S&T Rep. No. engaged Page No.

Abbas Mirza & Faraz Grove Children Centre 19/3/15 35 Yousufzai 35 Greenfields Children Centre 20/3/15 Abbas Mirza

20 Havelock Children Centre 20/3/15 Abbas Mirza

Laurel Gardens Children 10 23/3/15 Abbas Mirza Centre 16 Islip Manor Children Centre 23/3/15 Abbas Mirza

Dormer Wells Children Abbas Mirza Abbas 21 24/3/15 Centre Mirza Jubilee Gardens Children 6 24/3/15 Abbas Mirza Centre 10 Hathaway Children Centre 24/3/15 Faraz Yousufzai

Southall Park Children 10 25/3/15 Abbas Mirza Centre Visitation Pre School, 14 25/3/15 Abbas Mirza 15 Windmill Children Centre 25/3/15 Abbas Mirza

17 Woodend Children Centre 25/3/15 Abbas Mirza

Tamil Womens Group 12 26/3/15 Faraz Yousufzai Children Centre 186

HARROW

Organisation Date S&T Rep. No. engaged Page No. Rayners Lane Children 23/3/15 11 Centre Faraz Yousufzai Vaughan Children Centre 23/3/15 16 Faraz Yousufzai

Earlsmead Children Centre 25/3/15 17 Abbas Mirza

Hill View Children Centre 25/3/15 15 Faraz Yousufzai

Roxbourne Children Centre 26/3/15 8 Faraz Yousufzai

Rayners Lane Children 26/3/15 9 Centre Faraz Yousufzai Grange Children Centre 27/3/15 8 Faraz Yousufzai

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HILLINGDON

Organisation Date S&T Rep. No. engaged Page No.

Harefield Children Centre 23/3/15 Faraz Yousufzai 11

Belmore Children Centre 25/3/15 Faraz Yousufzai 15

Charville Children Centre 25/3/15 Abbas Mirza 15

Belmore Nursery 25/3/15 Faraz Yousufzai 30

Bara Hall Children Centre 25/3/15 Faraz Yousufzai 40

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HOUNSLOW

Organisation Date S&T Rep. No. engaged Page No.

Abbas Mirza & Faraz MLC and NCT 20/03/15 9 Yousufzai

Gurdwara Singh Sabah 22/3/15 Abbas Mirza 40

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Organisation Name VCS groups Ealing

Ealing CVS Afghan Council UK

Ealing Healthwatch Iraqi community Association Ealing Community Network

Travellers Achievement Service

Acton Community Forum

Ealing Equalities Council

Ealing Domestic Violence Service Ealing Womens Aid

Ealing Refugee and Advice Forum

GNP Federation

Southall Community Alliance

Ealing and Hammersmith College

Sofale family learning regeneration project Southall Black Sisters

Ealing Womens Forum

Ealing community Midwifery Service

West London Citizens Ealing Parent Partnership Service Contact a Family Ealing

Tamil Community Center

Ealing NCT Ealing Maternity Liason Committee

Netmums Ealing Mumsnet Ealing Armenian Advice centre

Pre- schools and Children Centres in Ealing

Ealing Pre-school Learing Alliance Acton Park Children's Centre John Perryn Childrens Center Maples Children Center South Acton Children center West Tywford Childrens Center Greenfields Children center Havelock Childrens center Children center Grove Childrens center Southall Park Childrens center Windmill Park Childrens center Academy Gardens Childrens Horsenden Childrens center Islip Manor Childrens Center Limetrees Childrens center Northolt park Childrens center Wood End Childrens center Windmill Childrens center Copley Close Childrens center Grange primary School Childrens Center Childrens center Hathaway Childrens center Jubilee Childrens Center North Primary Childrens Center Ealing Hospital Childrens center Log Cabin Childrens Center Faith Groups Abu Bakr Mosque Acton Mosque Ahmadiyya Muslim Association Bhagwan Valmik Mandir Central Jamia Masjid Dashmesh Sat Sang Sabha Gurdwara Nanaksar Guru Granth Gurdwara Jamia Masjid Aisha and Islamic Centre Ealing Our Lady Mother of the Church (Polish Church) Shri Kanaga Thurkai Amman (Hindu) Temple Sri Guru Singh Sabha Gurdwara Ramgarhia Sabha St Anselm's Roman Catholic Church Ukranian Orthodox Church Darussalam Masjid & Cultural Centre Greenford Mosque Polish Mission (St Bernards) Sri Kanaga Thurkkai Amman Temple

Ealing Council Ward Forums in March (attendance to be agreed) Ward Forum Ward Forum North Greenford Ward Forum Northolt West End Ward Forum South Acton Ward Forum

No meetings in council calender planned for June yet due to Elections Audience Type of engagement planned

Through VCS network and online newsletter 500 groups affiliated to VCS (commission) Afghan community in Ealing Information and facts sheets Through healthwatch network and online Healthwatch local network newsletter (Commission) Iraqi community in Ealing Information and fact sheets ECN Network Through ECN network will need to take advice due to literacy Travellers Community in Ealing issues Residents and Local groups in South Ealing Through ACF Network BME groups and communities in Ealing Face to Face

Local Ealing Women Will need to take advice due to audience Local Ealing Women Letters and Fact Sheets Face to Face followed up with relevant Refugee women and Families in Ealing information in different languages Residents of Greenford, Northolt and Face to Face Meeting with local groups in Southall Residents and Groups in Southall (Commission) Facts sheets and information in different Female Students at College languages Facts sheets and information in different Somali mothers and families languages Women in Southall Meeting with local groups in Southall Groups and individuals representing womens issues Face to Face Information to be provided in different Service users of the service languages Local groups and residents from including Ealing face to face and the possible use of website Parents that use service Information and fact sheets Families that use service Information and fact Sheets Facts sheets and information in different Local Tamil community languages Both have well used Twitter and Facebook pages, they also produce a regular newletter for members called "Babble" we will need to Ealing mothers and Families supply copy Ealing mothers and Families Fact sheets and Information Copy for website and possibly advertising on Ealing Mothers and Families site Ealing Mothers and Families Copy for website Armenian families in Ealing Fact sheets and Information

120 affiliated pre-schools within Ealing Commission Acton Families Fact sheets and Posters Acton Familes Fact sheets and Posters Acton Families Fact sheets and Posters Acton Families Fact sheets and Posters Ealing Families Fact sheets and Posters Southall Families Fact sheets and Posters Southall Families Fact sheets and Posters Southall Families Fact sheets and Posters Southall Families Fact sheets and Posters Southall Families Fact sheets and Posters Southall Families Fact sheets and Posters Northolt Families Fact sheets and Posters Greenford Families Fact sheets and Posters Northolt Families Fact sheets and Posters Northolt Families Fact sheets and Posters Northolt Families Fact sheets and Posters Greenford Families Fact sheets and Posters Greenford Families Fact sheets and Posters Hanwell families Fact sheets and Posters Ealing Families Fact sheets and Posters Hanwell Families Fact sheets and Posters Ealing families Fact sheets and Posters Ealing Families Fact sheets and Posters Ealing Families Fact sheets and Posters Ealing Families Fact sheets and Posters Ealing Families Fact sheets and Posters

Faith Communities Face to Face Faith Communities Fact sheets and Posters Faith Communities Fact sheets and Posters Faith Communities Face to Face Faith Communities Face to Face Faith Communities Face to Face Faith Communities Face to Face Faith Communities Face to Face Faith Communities Fact sheets and Posters Faith Communities Fact sheets and Posters Faith Communities Fact sheets and Posters Faith Communities Face to Face Faith Communities Fact sheets and Posters Faith Communities Face to Face Faith Communities Fact sheets and Posters Faith Communities Fact sheets and Posters Faith Communities Fact sheets and Posters Faith Communities Face to Face Faith Communities Fact sheets and Posters

East Acton Residents Face to Face North Ealing Residents Face To Face Greenford Residents Face to Face Northolt Residents Face To face South Acton Residents Face To face Tender to provide hard to reach engagement for the transition of maternity services from Ealing Hospital

Background

The Shaping a healthier future (SaHF) programme concerns the health services provided in North West London.

The SaHF programme has worked extensively with clinicians, members of the public, patients and other stakeholders since November 2011 on proposals to transform the health system in NW London.

On 19 February 2013, the Joint Committee of Primary Care Trusts (JCPCT), representing the PCTs in NW London, agreed with the recommendations put forward by the SaHF programme in a Decision Making Business Case (DMBC). This will entail significant changes in the delivery of healthcare in NW London, including the consolidation of maternity services in North West London across six receiving site hospitals in North West London.

Progress so far

You will be joining the project at the point required to engage more widely with families and women on the changes to maternity services before the transition of maternity services from Ealing Hospital and the transfer of neonatal and gynaecology services from the hospital.

To date, the following has been undertaken  The production of full equalities impact assessment of the proposed service changes at a North West London wide level as part of the Decision Making Business Case  The production of an Equalities Action Plan for the programme to be guided by as it progresses through its implementation phase  A number of meetings with providers across NW London to discuss anticipated equalities impacts at a high level  We have established a robust process of engagement through lay member and community sector involvement as part of the transition of services. This has included work with Healthwatch and engagement with families through the local children centres  The instigation of a maternity communication and engagement workstream for the transition of maternity services

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Engagement activity we are already planning

The Strategy and Transformation communications and engagement team will be undertaking a significant amount of engagement with groups and communities as part of this piece of work.

We will be:  Sending letters to all the community groups on our database (list available)  Attending community meetings such as ward forums where possible  Working with and through some of the community networks  Offering face to face engagement with groups including: o Children’s centres o Places of worship o Community groups  Providing posters and leaflets, information in a variety of formats

The work of this tender will be overseen by the maternity communications and engagement workstream, which includes lay partner representation.

Description of work needed

This tender focuses on groups or communities that the central team engagement team will not be able to effectively engage.

This tender is for a targeted, specialised piece of engagement with groups or individuals that are unlikely to have been effectively engaged with through our wider engagement activities, perhaps due to cultural or language barriers.

The map in appendix one shows the core area where women giving birth in Ealing Hospital tend to come from. This shows that the engagement activity should not be confined to Ealing borough.

We require interested groups to provide a detailed plan of who, within our target audience, they believe is unlikely to be effectively engaged through our overarching engagement strategy. The plan should include how you will engage with them and also the materials you require to undertake this work.

Materials required will be agreed with the Strategy & Transformation team once the tender is complete.

Core Objectives of the Work

1. To raise awareness and increase understanding of forthcoming changes to maternity services in Ealing within hard to reach communities that will not have been engaged by the programmes planned activities. 2. To provide information on options for maternity services in NW London 3. To provide feedback from the hard to reach groups to the programme 4. To be a trusted source of information on the maternity changes in Ealing amongst hard to reach groups. 5. To work closely with the S & T communications and engagement team to ensure our engagement activities operate in partnership 6. Working with us to develop an evaluation of levels of understanding

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Outcomes for work

 Regular feedback reports (frequency to be agreed)  End of project report  Quantifiable outcomes may be set upon appointment.

Types of organisations sought

Organisations interested will be expected to have a track record of working with groups and communities within the geographical area in question.

Groups should have an understanding of community engagement and development principles; this should include working with not only the local community but women and families from hard to reach communities.

Organisations that work within the field of childcare or groups that provide work with families or parents are actively encouraged to apply.

We would welcome groups that work with a number of key groups and communities prevalent in Ealing which includes, Somali, Eastern European, Afghani, and South Asian

Timescale

The timing of the transition of maternity services has not yet been agreed. The engagement work should commence after the decision on timing of the transition of maternity services has been made so a short planning phase is anticipated. The decision is currently anticipated to be made in May 2015.

You should anticipate that the work will need to be completed within 4-6 weeks of that decision.

Submission

The submission must cover:

 The groups you believe need to be targeted within this tender  The key activity you would propose undertaking as part of the project  The key challenges and opportunities and how they would be tackled by you.  Who will undertake the work - a summary of their experience/CV should be included  If the bid is a consortium bid, who are the groups involved and who will be the lead agency for managing the work  The proposed cost of the work  The materials required by you to undertake the engagement activity  Your planned reporting procedure

We are looking for concise, well-structured and clear proposals rather than volume.

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Decision Process

 Outgoing invitations to tender: 9th May 2015  Return of submissions: 15th May 2015 (by midday)  Evaluation: 15th May 2015 PM  Award: 18th May 2015 TBC  Contract start: 18st May 2015 TBC

APPENDIX 1: MAP

2013/14 Ealing hospital deliveries

The size of each bubble represents the number of deliveries from women in their respective areas of residence

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