Ealing Joint Strategic Needs Assessment 2009-10. 103 / 105
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NHS Ealing and Ealing Council
Ealing Joint Strategic Needs Assessment (JSNA)
2009-10 update
Part Two: Appendices, pages 34 – 105 of 105
Contents of Part Two
8 APPENDICES 36
8.1 Maternity Needs Assessment 36
8.2 Dementia Needs Assessment 43
8.3 Diabetes Needs Assessment 60
8.4 Harm caused by Alcohol in Ealing 71
8.5 Programme Budgeting 76
Ealing Joint Strategic Needs Assessment (JSNA)
2009-10 update
8 APPENDICES
8.1 Maternity Needs Assessment
Birth Rate in London
The trend of births in London has been rising since 2001 with an additional 17,074 births recorded across all London boroughs since 2006 compared with the number of births in 2001. If this trend were to continue a resulting 4,000 extra births would occur annually yielding an average increase of 2.9% over the next 10 years.
Based on the LHO (London Health Observatory) report ‘Estimating Future Births in the Capital’ (Dec 2008) the average 5-year annual percentage change in live births (if extrapolated trends continue) for Ealing would amount to a predicted average annual increase of 3.4%. In 2008/9 we saw a 3% increase in deliveries at EHT and an overall increase in deliveries of 10% (6,262 in 2008/9, 5,678 in 2007/8) for all Ealing women.
Graph 1 - Borough 5-year average annual percentage changes in live births if extrapolated trends continue.
Source: ONS; LHO Analysis ‘Estimating Future Births in the Capital’ (Dec 2008)
The increase in births from 2001 – 2006 has been attributed to both mothers born in England and Wales and to mothers from Europe and the rest of the world. However borough analysis of changes in birth rates varies significantly across London with Ealing showing a 5.6% increase in births to mothers from A8 countries compared to the London average of 2.3%.
North West London sector Maternity activity
In 2007/8 there was a total of 28,099 births from the 8 PCTs in the NWL sector. The majority 92.5% (25,997) of these (NHS) births were delivered in maternity units within the North West London Sector with 7.5% (2,024) of births from NWL PCTs being delivered in maternity units outside the sector. Table 1 provides a breakdown of deliveries by NWL provider in 2007/8.
Site / NWL sector / NHS EalingChelsea & Westminster NHS Foundation Trust / 3,216 / 11.4% / 199 / 3.5%
Ealing Hospital / 2,882 / 10.3% / 2,648 / 46.6%
Hammersmith Hospital / 4,645 / 16.5% / 1,735 / 30.6%
Hillingdon Hospital / 4,046 / 14.4% / 599 / 10.5%
St Mary’s Hospital / 3,348 / 11.9% / 52 / 0.9%
North West London / 4,826 / 17.2% / 126 / 2.2%
West Middlesex University Hospital / 3,034 / 10.8% / 211 / 3.7%
Total deliveries for NWL PCTs by NWL Providers / 25,997 / 92.5% / 5,570 / 98.1%
Table 1 - Births by NWL Maternity units in 2007/8.
Graph 2 - Births by NWL Maternity units in 2007/8
Four-year annual trend in live births for NWL PCTs
Within NWL there was a 10% increase in births in 2007/8 compared with the number of births in 2004/5. There was an average increase of 3.1% in 2007/8 from the previous year’s position, across the sector for all deliveries ranging from 7.4% in Ealing to -3.9% and -1.6% at Kensington & Chelsea and Westminster PCT’s respectively. (The percentage reduction at K&C and Westminster is possibly due to an increase in deliveries at private hospital units).
Table 2 - Data source: Dr Fosters’ SUS data
Births by Ealing Borough wards
2008/9 SUS data shows a total of 6,262 deliveries across all providers for resident and registered women in Ealing. Some of these women are registered with an Ealing PCT GP however may be resident outside the zone of London Borough of Ealing (LBE) wards. Similarly some of these births are not attributable to EPCT GPs but are resident within the LBE wards. Of the 6,262 births 5,635 were attributable to EPCT. The number of births to LBE ward residents was 6,021. The table below shows the number of births to mothers resident within LBE wards and births to those resident in LBE wards and registered with an EPCT GP (i.e. those births funded by EPCT- overall total of 5,394). A further 241 births were funded by EPCT for women resident outside the LBE wards.
Graph 3 - 2008/9 births for women resident in LBE wards and EPCT
The table below shows the top five wards with the highest number of deliveries in 2008/9.
Highest number of births in 2008/9(All Ealing wards) / Highest number of births in 2008/9
(EPCT wards)
Greenford Broadway / Greenford Broadway
East Acton / Greenford Green
Greenford Green / Elthorne
Acton Central / Acton Central
Southall Broadway / Southall Broadway
308 – 355 births / 279 – 336 births
Table 3 – Top five wards with highest number of deliveries in 2008/9
With the exception of Hanger Hill, Norwood Green, Ealing Broadway and Southfield all other EPCT wards had over 200 births (at all Providers) in 2008/9.
Births by GP practice
In 2008/9 36% of EPCT GP practices had 100 or above births, 54% had between 20 – 50 births and 10% had less than 20 births. The table below provides further breakdown.
Volume of Births / > 150 births / >100 births / 70 – 100 births / 50 – 70 births / 20 – 50 births / <20 birthsNo. of Practices / 4 / 14 / 13 / 24 / 24 / 9
% of Practices / 4.6% / 16.1% / 14.9% / 27.6% / 26.4% / 10.3%
Table 4 - Birth range by EPCT GP practice in 2008/9
Type of Delivery
Births are coded using Healthcare Resource Groups (HRGs) under three broad categories; normal delivery, assisted delivery and caesarean section. These three categories are further classified as ‘with’ or ‘without complications’.
N06 – Normal delivery with complications N07 - Normal delivery without complications
N08 – Assisted delivery with complications N09 - Assisted delivery without complications
N10 – Caesarean section with complications N11 - Caesarean section without complications
From 2004/5 – 2007/8 normal births have averaged 59% of all births for Ealing PCT, caesarean sections have constituted 28% and assisted births have averaged 13% of births. A detailed breakdown is provided in the following two tables.
HRG / N06 / N07 / N08 / N09 / N10 / N11 / Total all HRGs2004/5 / 184 / 2,770 / 55 / 568 / 208 / 1,086 / 4,871
2005/6 / 198 / 2,826 / 62 / 587 / 246 / 1,231 / 5,150
2007/7 / 223 / 2,938 / 61 / 592 / 248 / 1,227 / 5,289
2007/8 / 274 / 3,017 / 93 / 691 / 322 / 1,281 / 5,678
2008/9 / 294 / 3,250 / 107 / 734 / 358 / 1,489 / 6,232
Table 5 - Numbers of Deliveries by HRG for Ealing PCT at all Providers
HRG / N06 / N07 / N08 / N09 / N10 / N11 / Total all HRGs2004/5 / 3.8% / 56.9% / 1.1% / 11.7% / 4.3% / 22.3% / 4,871
2005/6 / 3.8% / 54.9% / 1.2% / 11.4% / 4.8% / 23.9% / 5,150
2007/7 / 4.2% / 55.5% / 1.2% / 11.2% / 4.7% / 23.2% / 5,289
2007/8 / 4.8% / 53.1% / 1.6% / 12.2% / 5.7% / 22.6% / 5,678
2008/9 / 4.7% / 52.3% / 1.8% / 11.8% / 5.7% / 2.9% / 6,232
Table 6 - Percentage of Deliveries by HRG for Ealing PCT at all Providers
Comparative figures for NWL PCTs for the same period show that Hillingdon PCT had the highest average of normal births (63%) and the lowest average caesarean section rate (24%) while Kensington & Chelsea had the highest average of assisted births (16%) and the highest average caesarean section rate (32%).
PCT / N06 / N07 / N08 / N09 / N10 / N11Ealing / 4.2% / 55.1% / 1.3% / 11.6% / 4.9% / 23.0%
Brent / 6.1% / 55.1% / 1.1% / 9.9% / 5.7% / 22.1%
Harrow / 5.9% / 53.6% / 1.1% / 11.4% / 5.7% / 22.3%
Hounslow / 3.8% / 57.9% / 1.0% / 11.9% / 3.8% / 21.6%
Hammersmith & F / 2.3% / 53.8% / 0.8% / 13.3% / 3.8% / 26.0%
Hillingdon / 5.8% / 57.3% / 1.2% / 11.8% / 4.7% / 19.1%
Kensington & C / 3.1% / 48.8% / 1.0% / 14.9% / 4.3% / 27.9%
Westminster / 4.9% / 51.4% / 1.0% / 14.3% / 4.5% / 23.8%
Table 7 - Average percentage deliveries by HRG for NWL PCTs from 2004/5 – 2007/8
Developments in Maternity Care
Our maternity commissioning strategy is driven by the standards advocated nationally in the NSF for Children’s and Young People and Maternity Services (2004) and ‘Maternity Matters’ (DH 2007) and by the local implications of the findings of the Healthcare Commission review of Maternity services in 2007 and Lord D’arzi’s Healthcare for London report.
Our commissioning strategy plan for maternity services focuses broadly around four themes:
§ Greater choice around how and where women access and receive maternity care
§ Normalising birth and reducing surgical intervention in labour
§ Reducing inequalities and improving outcomes for mothers and their babies
§ Working collaboratively with our neighbouring PCTs and maternity service providers in NWL
Choice around how and where women access and receive maternity care
As the number of births to Ealing women exceeds the local hospital capacity NHS Ealing commissions maternity care from other providers and therefore there has been an element of choice by necessity for some time.
Realising a women’s first choice of maternity unit largely depends on how early the women makes contact with a healthcare professional and subsequently gets referred to a maternity unit. Of our two main out-of-borough providers i.e. Queen Charlotte’s and Chelsea Hospital and Hillingdon hospital, QCCH tends to get booked up early and access after 8 weeks gestation is difficult (unless on medical grounds). HHT will accept referrals up to 16 weeks gestation.
Early booking is key to realising choice
Ideally women would contact a HCP at around 8 weeks gestation to enable referral to a maternity provider by 10 weeks. This would then enable the women to have a health and social needs assessment by 12 weeks gestation and allow timely access to the National Screening Centre (NSC) recommended antenatal screening schedule.
A number of awareness raising initiatives using local publications have been put in place and a pregnancy information leaflet has been distributed through pharmacies across the borough.
A new maternity referral form has also been introduced in NWL sector which aims to assist Trusts in prioritising referrals and is expected to assist with achieving the DH 12- week assessment target.
Data for 2009/10 Q1 suggests an improvement in the number of women being booked by 12 weeks gestation. Using the number of maternities delivered in Q1 as an interim denominator, 87.8% of women have been booked by 12 weeks. The actual denominator to be used for the full year will be the number of women who have seen a midwife at 12 weeks and 6 days in Quarters 1 and 2 compared to the number of maternities delivered in Q3 & Q4 of 2009/10.
Antenatal and postnatal care
Another element of choice advocated in Maternity Matters is the ability to access antenatal and postnatal care in a range of convenient community locations. NHS Ealing has provided funding to increase the midwifery workforce at Ealing hospital in order to expand the community midwifery provision. A new team of 8 midwives and a Midwifery Support Worker will start a case-loading model of care from January 2010. The team will offer antenatal and postnatal care in the community venues starting initially with the new health centre in Jubilee Gardens and at the new Children’s centre at St John’s Primary school in West Ealing. This model of care will provide greater continuity for women and will be expanded over the next 2/3 years with further recruitment of midwives at EHT (allowing rotation from secondary to primary care).
Investment in additional workforce will also enable expansion of the services provided to vulnerable women such that the (Willow) team can support women throughout labour on a 24-hour basis. The Willow Team which caters for teenage mothers and other vulnerable groups currently provides antenatal and postnatal care at Sure Start CC in Northolt and in Southall Broadway.
Normalising birth and reducing surgical intervention in labour
We are aiming to promote birth as a ‘normal’ event and reduce medical intervention by developing care pathways that offer greater informed choice to women and address women’s individual social and medical needs.
Good progress has been made with reducing the caesarean section (c/s) rate at EHT in the first quarter of 2009/10, with a decrease from the 2008/9 position of 29.5% to 26.4%. Work is on-going and are aim is to achieve c/s rates closer to our neighbouring Trusts e.g. WMUH and HHT with c/s rates of 21.7% and 24% respectively in 2008/9.
In addition to funding 10 additional midwives and 4 MSWs NHS Ealing has agreed funding for a senior midwife post to lead on the development of care pathways to support the expansion of community midwifery and facilitate more community based care for low risk women.
Promoting and expanding midwifery led maternity care will pave the way for a stand alone local midwifery led facility in Ealing, plans for which are currently being executed.