Although some of these issues around gynaecology and maternity services in Liverpool have been looked at before, this is a new process which will focus on the challenges as they stand today.   

It’s really important to stress that no proposals are being put forward just yet, and no decisions have been made about how services might look in the future.  

It’s still far too early in this process to speculate about how services might look in the future. However, the Crown Street site is an important NHS asset, and we are continuing to develop services there. 

There are no plans to close Crown Street, and whatever proposals might be put forward for the future of gynaecology and maternity services, the current hospital site will continue to be used for the provision of NHS services.

No, this work is aimed at reducing clinical risks, improving the quality of care that patients receive, and making these services sustainable for the longer term.

Whatever potential future options are identified, it is likely that some additional investment into these services will be required. However, at the moment it’s still far too early in the process to say what this might be. 

No, this process is not about reducing any services. It’s about improving the gynaecology and maternity services that we have already, and protecting them for the future.

Making sure that these services meet national care standards and making them more sustainable, is also likely to help attract more funding, research and development opportunities, positioning these services for future expansion.

Yes, gynaecology and maternity services in Liverpool are arranged in a different way to elsewhere in country.

All other specialist centres for maternity care in England are located alongside acute and emergency hospital services.

The biggest challenge facing these services is the fact that they are on a different site to most other acute and emergency hospital care – and Liverpool Women’s is the only specialist centre for gynaecology and maternity in the country where this arrangement exists.

It’s a situation which can create problems and delays with care, with seriously ill patients sometimes having to be transferred by ambulance to other local hospitals.

Around 220 ambulance transfers are made between Liverpool Women’s Hospital and the Royal Liverpool or Aintree hospitals every year, and about half of these ambulance journeys happen in emergency situations.

It also means that all of the city’s gynaecology and maternity specialists work at Liverpool Women’s, so other hospitals are less able to meet women’s medical needs when they present at accident and emergency (A&E), or when receiving care under another service. 

Every day, an average of 4 pregnant women visit A&E at either the Royal Liverpool or Aintree hospital, with around 70% having a condition that could impact on their pregnancy.

Because Liverpool Women's gynaecology and maternity care is located separately from other adult hospital care, there can be challenges providing care to patients who: 

• Have another health condition that needs managing alongside their gynaecology or maternity care

• Have unexpected complications during their care which needs urgent support from a different specialist team

• Become seriously unwell or rapidly deteriorate during their care and need support from an intensive care unit

• Have very complex surgical needs, including many patients with gynaecological cancer.

No, these are not small numbers. Around 60% of women (approximately 5,000 women per year) who have their babies at Liverpool Women’s have complex health needs or another significant  condition that need to be managed by other hospital teams alongside gynaecology or maternity care.

In addition to this, there can also be challenges providing care to people who:

• have unexpected complications during their gynaecology or maternity care which needs urgent support from a different specialist team based at another hospital  r
• become seriously unwell or rapidly deteriorate during their care and need support from an intensive care unit
• those who have very complex surgical needs, including many patients with gynaecological cancer.

The challenges facing hospital gynaecology and maternity services aren’t to do with the Liverpool Women’s Hospital building. They’re about the way that medicine, and the health needs of our population, have changed over the last 30 years.

Key changes that have taken place during this time include:

• More people with serious health conditions are able to have children
• More people are having babies at a later age
• Demand for gynaecological services is increasing
• Advances in cancer treatment (including for gynaecological cancers) 

Although lots of measures are helping to improve the quality and safety of hospital gynaecology and maternity services in the short-term, they cannot resolve every clinical risk or ensure the longer-term sustainability of these services.

This is because the single biggest safety issue is that women’s services are not provided in the same place as most other specialist surgical, medical and support teams.

So although we’re managing the risks well for now, we want to work towards a future where those risks don’t exist for our patients.

The way that hospital gynaecology and maternity services are currently organised in Liverpool is actually disadvantaging women’s health, when compared to:

• those using services at other hospitals in Liverpool
• women using gynaecology and maternity services in other parts of the country.

Without a permanent solution being found, patients in Liverpool will be left with poorer quality care than gynaecology and maternity patients receive in other parts of the country.

This situation is likely to increase health inequalities that are already experienced by many of our local communities, particularly those from ethnic minority groups and socially deprived backgrounds, who are already more negatively affected by the way that services are organised.

There is clear evidence that patients who attend A&E departments at the Royal Liverpool or Aintree hospitals with conditions affecting their pregnancy, and those who need ambulance  transfers for critical care, are more likely to come from a socially deprived and/or ethnic minority
background.

Between 2018 and 2022, all of the maternity cases and more than 90% of gynaecology cases which needed an ambulance transfer to another hospital, were for patients who live in the poorest 10% of our communities.

There is very clear guidance (first published in 2014) which states that these services should all be provided on the same hospital site. This is because in an emergency, health professionals need to be able to respond within a very short time frame to avoid patient harm and achieve good outcomes.

Because hospital gynaecology and maternity care in Liverpool isn’t provided in the same location as some other important hospital services, such as an emergency department and an adult critical care unit, it does not meet current national care standards.

If this situation isn’t resolved and the required standards aren't met in Liverpool, it could mean that in the future some specialist gynaecology and maternity care can no longer be provided in Liverpool, and in fact some patients already have to go to Manchester to have their babies because they have a very high-risk condition.

Although other local hospitals might not seem very far away from Liverpool Women’s Hospital, when an emergency occurs, any distance at all is a problem.

Doctors might need to stop what they are doing at one hospital and travel to another to support a patient, or patients may have to be transferred by ambulance, which can take hours to organise safely.

It is simply not possible for the NHS to deliver care in this way. This is because there are simply not enough specialist doctors, nurses and support teams available to be able to duplicate all types of care at every hospital site.

The issues facing hospital gynaecology and maternity services in Liverpool are not staying still. As the number of people with complex health needs continues to grow, so too will the clinical risks.

The way that these services are currently arranged in Liverpool means that some care does not meet national standards. If this isn't addressed, in the future it might not be possible to provide some specialist gynaecology or maternity care in Liverpool.

In summary, if we do nothing:

• The clinical risks for patients will continue to grow
• Access to specialist gynaecology and maternity care in Liverpool will be reduced
• Staffing difficulties will worsen
• Medical research and funding will be negatively impacted
• Health inequalities will widen in our city.

There is a concern that women receiving care from women’s hospital services, their families, and the staff delivering care, may be more at risk of psychological harm due to the current configuration of services. 

National research shows that 4-5% of people develop post-traumatic stress disorder (PTSD) every year after giving birth (Birth Trauma Inquiry 2024). High numbers of staff working in gynaecology and maternity services also report work-related trauma symptoms.

As many as a quarter of all Liverpool Women’s staff (400 people) have either self-referred, or been referred, to the trust’s staff trauma-based psychology service in the last 18 months.

The challenges facing hospital gynaecology and maternity services in Liverpool are complex. While proposals have been developed before, at that time it was not possible to identify the necessary funding to take them forward. However, we have not stopped looking at these issues since then, and have continued to take steps to manage the risks in the short-term.  

Although the issues being described here are not new, this work is now supported by increasing patient data and evidence, and all of the NHS organisations involved in providing this care in Liverpool are now fully focused on owning and working together to resolve the challenges facing these services.