The North West London Joint Health Overview & Scrutiny Committee met to discuss maternity provisions, adult mental health services, and the reconfiguration of the Integrated Care Board (ICB). The committee reviewed maternity safety and equity, highlighting disparities in stillbirth rates among different ethnic groups, and discussed strategies to address these inequalities. Members also received updates on adult mental health services and the ICB's reconfiguration plans, focusing on strategic commissioning and local partnerships.

Maternity Provisions in North West London

The committee discussed maternity provisions in North West London, focusing on outcomes and equity across the region. The number of births in 2024/25 across the six maternity units was 26,486, a 1% increase, contrasting with a national decline.

Pippa Nightingale, Chief Executive at London Northwest and the SRO for Maternity and Neonatal across Northwest London, reported a stillbirth rate of 2.9 per 1,000 births, lower than the national average of 3.3 per 1,000 births. However, Vicky Cochrane, Director of Midwifery at Chelsea in Westminster and also Director of Midwifery across Northwest London, highlighted disparities in stillbirth rates among ethnic groups, with Asian women at 3.7 per 1,000 and Black women at 2.5 per 1,000, compared to White women at 1.4 per 1,000.

The committee discussed the StartWell programme and its potential impact on maternity services in North West London. The StartWell programme is a North Central London Integrated Care System consultation that is predicted to result in 550 births being transferred to North West London, split between London Northwest and Imperial.

To manage activity and flow, a centralised maternity booking system is being implemented across the six sites. This system aims to prevent double booking and ensure a unified approach to care.

To address inequalities, the Maternal Reducing Inequalities Care Bundle is being implemented, focusing on early access to antenatal care and targeted interventions in specific boroughs. The committee heard that Central Hounslow is one area of focus.

The committee discussed service user feedback, with Katherine Shaw from Healthwatch noting concerns about safety at Northwick Park Hospital. Pippa Nightingale said that Northwick Park has completed the improvement programme and has been formally exited off that, and that it has met all of its actions to exit that.

Councillor Chetna Halai raised concerns about the high stillbirth rate within the Asian community and asked what targeted interventions were being planned. Vicky Cochrane responded that the centralised booking hub and early access to care would come hand in hand, and that recommendation number four is about implementing the Maternal Reducing Inequalities Care Bundle.

Councillor Concia Albert raised concerns about race being inappropriately used to make clinical judgements, particularly regarding consultants pushing for inductions based on race and age rather than health needs.

The committee made the following recommendations:

• Develop a plan for cultural competency.
• Provide more information on the strategy for the Northwest London targeted work.
• Share the 97% friends and family score for Northwick Park.
• Address the importance of capturing quality data and upgrading the maternity IT system.

Reconfiguration of the ICB and Implications on Services

Rob Hurd, gave an update on the reconfiguration of the ICB and its implications for services. He explained that the ICB's running costs would be reduced by 41%, and that the ICB would focus on strategic commissioning, working with health and wellbeing boards and place-based partnerships¹. The ICB is considering a formal merger with North Central London to share services and infrastructure. A decision on this matter is expected next Wednesday.

Councillor Nick Denys, Chair, Health & Social Care Select Committee, asked about decision-making processes in the new structure. Rob Hurd responded that an integrator would be assigned to each borough to coordinate services, with governance and accountability devolved to the integrating unit.

Rory Hegarty said that community engagement was very important, and that the ICB would be working more closely with local government and voluntary organisations.

Adult Mental Health

Toby Lambert, gave an update on the adult mental health strategy for North West London. The strategy has three major themes: raising awareness and promoting well-being, increasing equity and equality of access, and ensuring care in the right place.

Pilots are underway to reach seldom-heard communities and reduce accident and emergency attendances. A mental health crisis assessment service at St Charles now covers Westminster, Kensington and Chelsea, Hammersmith and Fulham, and parts of Brent. Similar services are being set up in Ealing and Hounslow, with reforms to the mental health emergency centre and the lighthouse at Hillingdon and Norfolk Park.

Chris Hilton, added that the focus is shifting towards patient experience and recovery, and that the ICB is working to provide assertive interventions for patients with complex needs.

Councillor Chetna Halai raised concerns about the increase in mental health issues, especially among young people, and asked how the ICB is working with schools. Toby Lambert responded that mental health support teams are now in half of the schools, with plans to expand this further.

Councillor Concia Albert asked how primary care networks (PCNs) are being held accountable for using population health data when deciding on their budgets. Chris Hilton said that most PCNs have invested in additional roles reimbursement scheme mental health workers, and that the trusts are working to understand whether expectations were mismatched.