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Findings of public engagement about improving hospital gynaecology and maternity services in Liverpool published 

Introduction 

NHS Cheshire and Merseyside has published an independent report today on the findings of a six-week public engagement period on improving hospital gynaecology and maternity services in Liverpool.

The report sets out feedback from the engagement period, which ran from 15 October until 26 November 2024, inviting people to comment on a newly published Case for Change document. It did not present any proposals for change, as the process of developing potential options has not yet begun.

Headlines from the report

The majority of people who took part in the questionnaire (62%) felt that the NHS had fully described why hospital gynaecology and maternity services in Liverpool need to change, and a further 26% of respondents felt that the NHS had partly described why services needed to change.

There was also broad consensus expressed regarding the need to make changes to hospital gynaecology and maternity services, with a total of 82% of respondents to this question agreeing.

As part of the engagement, people were also asked to identify what was most important to them when considering the future of hospital gynaecology and maternity services in Liverpool. Responses highlighted five common themes:  

•    Patient experience 
•    Accessibility and equity of care 
•    Waiting times and appointment delays 
•    Patient safety 
•    Staff compassion and competence 

In addition, people who had lived experience of using hospital gynaecology or maternity services in Liverpool (either as a patient, partner, or close relative or friend) were invited to rate their experiences of using the services - with 56% of respondents describing it as a positive experience, 25% describing it as negative, 18% describing it as neutral, and 1% saying that they did not know.

About the engagement

The main mechanism used to collect feedback during the engagement period was a questionnaire, which was available online and as a printed version. Alternative formats and languages were also made available on request – in total, materials were translated into 16 different languages. A contact number was also provided for those who preferred to share their feedback over the telephone. 

The questionnaire was completed by a total of 913 people - including people who completed it in languages other than English, which were then translated for analysis. 
Six public engagement events took place during the six-week engagement period – including two online and four in-person, which were attended by 71 different individuals – with some attendees choosing to attend multiple sessions. Notes were taken by facilitators during table discussions at these events, and the key themes that arose are set out in the report.

In addition, six VCFSE (voluntary, community, faith and social enterprise) organisations were commissioned to carry out additional targeted activity amongst some seldom heard groups. This approach was designed to improve the reach of the engagement, using their existing community channels and networks. 

The engagement report was produced by Hood & Woolf, an independent organisation which specialises in healthcare communications and engagement. It is available on the programme website at: www.gynaeandmaternityliverpool.nhs.uk – which also hosts a range of supporting information, including the engagement materials, and a series of case study videos with people who work in women’s services in Liverpool.

Next steps

The engagement findings will now be used to help inform the next phase of the Women’s Hospital Services in Liverpool programme.

Over the coming months, the programme will further explore the current issues affecting hospital gynaecology and maternity services, and start to develop potential options for how these services could look in the future.  

This process will involve a wide range of people, including staff who work in these services directly, those from other services that interface with them, and various support teams who work alongside them in different ways. 

The involvement of those with personal lived experience of using hospital gynaecology or maternity services in Liverpool will also continue to closely inform this work, including patients, carers, and family members. 

NHS Cheshire and Merseyside has already developed a Lived Experience Panel which compromises of around 25 people who have volunteered to share their own experiences with the programme, and we are keen to expand this further. Anyone who would like to express an interest in this opportunity, or find out more about what it involves, can email: engagement@cheshireandmerseyside.nhs.uk 

Members of the public who want to keep updated on how this work in progressing, can join our Virtual Reference Group to receive email updates. They can also learn more about this work via the programme website at: www.gynaeandmaternityliverpool.nhs.uk  

It is expected that the options process will take place throughout spring and summer 2025, with a further update on the programme to be made in Autumn 2025. 

Alongside the options process, we will also continue to look at how we involve people in the next stage of the programme, although the approach taken will depend on how the next phase of work progresses. At this stage it is still too early to confirm what this might look like. 

Welcome to the first Women’s Services Committee Chair’s briefing of 2025. 

As we begin the new year, I’d like to reflect on the progress we made during 2024 with the programme to improve hospital gynaecology and maternity services in Liverpool, and look ahead to what’s planned during the next 12 months.
 
We started this year by putting in place strengthened arrangements to deliver the requirements of the programme, including establishing a new programme board, led by local NHS trusts. Having produced a plan for managing the first phase of this work, the programme board then quickly moved ahead with the development of a case for change (https://www.gynaeandmaternityliverpool.nhs.uk/media/0jnjnzdw/case-for-change-230924-v06-final.pdf#), setting out the challenges facing hospital gynaecology and maternity care. Many of you will be aware that issues around these services have been discussed in the past, but while previous work provides an important foundation for where we are now, it was really important that the new case for change reflected the latest data and intelligence around what’s happening in these services. The content was provided by those working across women’s services locally, and a draft of the document was discussed with key health and care organisations during the summer, before it was approved by the Board of NHS Cheshire and Merseyside in October 2024. 

Soon after the approval of the case for change, we launched a six-week public engagement, to give people an opportunity both to reflect on the issues the document covers, and share their own experiences of care. We developed a number of different materials to support the engagement, and it was great to have input from our Lived Experience Panel members to make sure that the information we published was clear and accessible – all the materials are still available on our programme website (https://www.gynaeandmaternityliverpool.nhs.uk/), together with a number of video case studies from local NHS staff. You might remember from previous briefings that the Lived Experience Panel was set up during the summer, and consists of people who have used gynaecology and/or maternity services in the past, either as patients or carers. Importantly, it includes people from a diverse range of backgrounds, who bring experience from a number of different women’s health services locally. 

We had hundreds of responses to the public engagement, and we’re delighted that so many people took the opportunity to get involved and share their views, including those who completed a questionnaire, took part in discussions held by one of the community and voluntary sector organisations we worked with, or joined us for an engagement event. An independent company is now in the process of analysing all the feedback we received, and setting out the findings into a report. We’re intending to publish this at the end of March. 

It’s really important to stress that the public engagement was not a public consultation on proposed changes to services, but a chance for people to comment on the issues being presented. The findings from the engagement will provide us with an important basis for the next phase of work, which will include beginning to develop some potential options for how services could look in the future. It’s a process which will involve a wide range of people, including staff who work in gynaecology and maternity services, and the Lived Experience Panel. In preparation, clinicians working across Liverpool’s health and care organisations recently came together to discuss next steps for the programme, and we’ll be holding more sessions like this during the coming year. However, even as work to think about the future gets underway, we’re still only at the point of exploring potential options – no proposals have been put forward, and no decisions have yet been made. We’ll of course be continuing to involve people as we move forward, and looking at the most effective and appropriate ways to do this, whether that means further communication, engagement or formal public consultation, but this will be dependent on how the programme progresses. 

I hope this has been a useful briefing. We’ll time the next one to coincide with the publication of the public engagement feedback report, which will also be an opportunity to provide an update on the wider programme, including the clinical engagement event mentioned above. If you have any questions or comments in the meantime, you can email engagement@cheshireandmerseyside.nhs.uk

If you haven’t done so already, I’d also encourage you to sign up for our Virtual Reference Group (https://www.gynaeandmaternityliverpool.nhs.uk/get-involved/virtual-reference-group/), so that we can let you know as and when we publish any new information.

Best wishes

Professor Hilary Garrett CBE, Chair, Women’s Services Committee

Welcome to the latest update from the Women’s Hospital Services in Liverpool Programme, my first since taking over from Raj Jain as Chair of the Women’s Services Committee in July.

This update is coming to you slightly later than intended, owing to a pause in our communications during the pre-election period. However, the programme has been continuing to move forward, and a number of key developments have taken place over recent months.

A draft clinical case for change has now been developed, setting out the challenges and risks facing hospital-based gynaecology and maternity services in Liverpool, alongside the latest insights about the impact of current arrangements. We’re now in the process of taking the case for change through our governance structures, and holding conversations with some key stakeholders to gather feedback and refine the document ahead of it being finalised. We’ve also held discussions with colleagues at NHS England, which oversees service change processes, to update them on the programme.

We’re aiming to publish the case for change in the autumn, at the point it will be presented to NHS Cheshire and Merseyside Integrated Care Board (ICB) for approval. Subject to the board’s approval, we then plan to hold six-weeks of public engagement, to gather people’s views on the issues described and their own experience of women’s services. The plans for this are currently in development, but we’ll share more information nearer the time. It’s important to stress that the case for change won’t set out proposals for how services might look in the future. We’ll need to do more work – including considering the feedback we get from the public engagement – to begin developing potential options.

Although the public engagement will be a key opportunity for us to gather feedback, we’ve been clear about our commitment to involving people throughout the programme. As part of this, during July we began recruiting to a Lived Experience Panel, open to anyone with experience of hospital gynaecology and/or maternity services in Liverpool, either as a patient, family member or carer. It’s been a priority to ensure that as far as is possible the panel reflects the communities we serve, and it’s been great to have the support of so many local groups and networks to help promote the opportunity to get involved. We’ve been really pleased with the response we’ve received, and we’ll be working with panel members to make sure that our plans for public engagement are as accessible and effective as possible.

As the Women’s Hospital Services in Liverpool programme progresses, it’s important to highlight that work is continuing on a range of short-term quality and safety initiatives to support gynaecology and maternity services. This includes looking at how different local hospitals work together to make sure that the right care is in place for people whose condition is deteriorating, and a number of new recruitment and training developments. While this work is separate from the main programme, it’s critical for ensuring that services remain safe and effective while we look at how best to address longer-term challenges.

I hope this has been a useful update, and look forward to bringing you more news in the autumn, as we prepare for publication of the case for change and the start of public engagement.

Professor Hilary Garrett CBE, Chair, Women’s Services Committee

13 March 2024

As a valued partner and stakeholder, I am writing as chair of the Programme Board to keep you updated about the work of the programme, and set out next steps for the year ahead.

Overview

As you will know, the purpose of the programme is to look at the issues facing hospital maternity and gynaecology services in Liverpool. The city’s unique arrangements mean that these services, which are delivered at Liverpool Women’s Hospital, are isolated from other specialist adult services that women need to access at other hospitals in the city.

This presents significant clinical risks and challenges, and impacts on the care given to women and their families. For example, the arrangements can create delays in care, and there is sometimes a need to transfer women between different hospitals, often when they are at their most vulnerable. We are committed to finding a long-term solution that will improve the quality and safety of services, giving women the care they need and deserve, wherever they are being treated.

Hospital staff manage these risks in a number of ways, and there have been developments on the Liverpool Women’s site over recent years to improve services. Liverpool Women’s NHS Foundation Trust and Liverpool University Hospitals NHS Foundation Trust (which operates the Royal Liverpool University Hospital and Aintree University Hospital) are working together closely to ensure services are as safe and effective as possible in the short to medium term, which includes the two trusts sharing clinical expertise.

Delivering this work and next steps

The Women’s Hospital Services in Liverpool Programme Board reports to the Women’s Services Committee, which is a sub-committee of NHS Cheshire and Merseyside Integrated Care Board (ICB).

We have now agreed the plan for the first phase of the programme, which is built on the principles of ensuring openness and transparency in how we develop potential options for the longer-term. Central to this is the engagement and involvement of patients, carers, families, key stakeholders and the public in shaping the future design of services.

We anticipate that the next steps for the programme will be:

1. Development of clinical case for change – spring/summer 2024: This document will identify the challenges and risks facing services, but it will not make any proposals for how they might look in the future.
2. Publication of clinical case for change and start of public engagement – autumn 2024: When the case for change is published, we’ll hold a period of public engagement to give people an opportunity to share their views.
3. Service design – winter 2024/25: Using feedback from the public engagement, we’ll work with staff, those with lived experience of services, and others, to start looking at how we might design services for the future.

At this point, we will use the engagement feedback and outputs of the design work to decide on next steps. Any future options development work would be likely to begin in early 2025.

I want to be clear that at this stage, no decisions about how these services might look in the future have been made. We are only committed to a process that will help shape the future service design.

We need to work through each step before moving to the next, which means that timescales are subject to change. As there will be a general election in the UK by the end of January 2025, the timescales might also be impacted by the pre-election period.

Involvement

It’s really important that we involve those who use and depend on women’s services throughout this programme of work, including the public, patients, carers and families. We’re putting in a number of measures to support this:

• Public advisors: In May we will be appointing two people to act as independent public advisors to our involvement process for the Women’s Hospital Services in Liverpool Programme. These funded roles will represent wider patient and public voices, and will sit on the Women’s Services Committee and jointly chair a Lived Experience Panel.
• Lived Experience Panel: During May we will also begin recruiting to a wider panel of people with experience of women’s services (either as a patient, carer, or family member), who can help inform both communications and engagement planning, and the wider women’s services programme. Members will be volunteers.
• Virtual Reference Group: Over the summer we’ll be establishing a Virtual Reference Group, to allow people to sign up via email for updates and details of opportunities to share their views.

We’ll issue a further update in May, as we start to put our involvement arrangements in place.

Yours sincerely

James Sumner

Chair, Women’s Hospital Services in Liverpool Programme Board

Welcome to the first Chair’s briefing of 2024 and happy new year!

In my last briefing I wrote about how NHS Cheshire and Merseyside Integrated Care Board (ICB) had agreed proposed changes to the way that the Women’s Services programme was structured. Following this, the Women’s Services Committee met on 17 January to put in place final arrangements to support the changes, and you can read updated terms of reference for both the Committee and the new Programme Board under the section more information.

The main purpose of the programme is to develop a clinically sustainable model of care for hospital-based maternity and gynaecology services delivered in Liverpool. However, it’s really important to have clarity about exactly which areas we’re focusing on – including being clear about what isn’t part of the programme – so the Programme Board has developed a Programme Definition. This document explains what is included in the programme, sets out how we will manage the process of understanding the issues facing these services, and explore how they might be addressed over the short, medium and long term.

The Committee heard from James Sumner, Chief Executive of Liverpool Women’s NHS Foundation Trust, and chair of the Programme Board, about the approach to managing the clinical challenges facing services. James spoke about how colleagues from Liverpool Women’s and Liverpool University Hospitals Foundation Trust are working together to put in place additional specialist staff, equipment, and training, so that services provided to women are the safest and the highest quality they can be, in the immediate term.

The Programme Board now needs to look at more complex clinical sustainability issues, which are likely to take longer to address. We will receive a further update on how this will be approached at the next Committee meeting in March. To support this, the Programme Board is currently developing a detailed programme plan, setting out how this will happen and expected timescales. We’ll share further details on this following the March meeting, as well as providing information about the next steps for getting people involved in the programme – this is a critical part of our work, and we’re putting in place plans to ensure that those with lived experience are engaged at the earliest stages.

Raj Jain

Chair, NHS Cheshire and Merseyside ICB, and Women’s Services Committee

This is a very short update, following on from the meeting of NHS Cheshire and Merseyside Integrated Care Board (ICB) on Thursday 30 November, to let you know that the board approved the changes it had been asked to consider around the way that the women’s services programme is structured. 

You can read more detail about what this will mean in my last briefing, however the main action that will take place as a result is that a new Programme Board will now be established to manage the development and delivery of the programme, so that the Women’s Services Committee can focus on its oversight role.

The decision means that we can move ahead with setting up these new arrangements, and continue with work to take the programme forward, including progressing our plans for public and patient involvement as a priority. I’ll provide a further update on this early in the new year.

Raj Jain

Chair, NHS Cheshire and Merseyside ICB, and Women’s Services Committee

In my last chair's briefing, I explained that we were in the process of reviewing how we organise the women’s services programme, to make sure that we had effective arrangements in place to deliver this critical piece of work.

As a result of discussions over the last few weeks, a proposal to make some changes to the way the programme is structured has been developed. This week, NHS Cheshire and Merseyside Integrated Care Board (ICB) will be asked to approve these changes, which if they go ahead would mean separating out some responsibilities which currently sit with the Women’s Services Committee.

You can read the full report in the ICB papers on the NHS Cheshire and Merseyside website, but in summary, the changes would mean:

• The Women’s Services Committee, which was set up to oversee the development of a safe and sustainable future care model for women’s hospital services in Liverpool, would retain an oversight role. It would be focused on ensuring that the work required was delivered, and followed the right processes. However, the committee would no longer be responsible for also developing and delivering this work in the first place – currently, the committee is responsible for both doing the work, and providing the assurance, which means it has a dual role.
• A new Programme Board would be established to manage the development and delivery of the programme plan. It would take on some of the current delivery functions of the Women’s Services Committee, such as overseeing the development of a case for change, and exploring potential options for services.

Under the proposals, I would continue to chair the Women’s Services Committee, and James Sumner, Chief Executive of Liverpool University Hospitals NHS Foundation Trust and Interim Chief Executive of Liverpool Women’s NHS Foundation Trust, would chair the Programme Board. The Programme Board would report to the Women’s Services Committee, which would continue to report to NHS Cheshire and Merseyside Integrated Care Board.

Subject to the board approving this approach, the Programme Board would be set up during December and January, so that work on the programme could continue. The Women’s Services Committee would then meet in January, to put in place arrangements to support its new role.

I hope this is a useful update. I appreciate that there is a strong appetite to see this work progress, but this is a complex programme, and it’s really important that we organise ourselves in a way that makes sense. I’ve previously written about how important it is that we hear the voices of patients and the public throughout this process, and this remains a key principle for the programme. Although it’s been necessary to take some time to get our structures right, it remains the case that no proposals for services have yet been made – as soon as we are at the stage where we can begin developing potential options for the future, we will be involving people in this work, including those with lived experience of these services.

In my next briefing, I’ll provide a further update on how we are moving forward with this process.

Raj Jain

Chair, NHS Cheshire and Merseyside ICB, and Women’s Services Committee

Welcome to the second Women’s Services Committee Chair’s briefing.

The most recent meeting of the committee was due to take place at the end of September, however we took the decision not to go ahead with this. Instead, we’re using the next few weeks to take a more detailed look at the scope of the women’s services programme, the plan for delivering this work, and the roles that different NHS organisations locally will play in making it happen.

We recently appointed an independent clinical lead and a programme director for women’s services, and they have been helping us review where we have got to so far. In addition, a shared interim Chief Executive for Liverpool Women’s NHS Foundation Trust has now been announced, and it’s important that we take the impact of this new leadership into consideration. We’ll be discussing how we move forward at the next meeting of the Women’s Services Committee in early November, and I’ll provide another update on this page afterwards.

Finally, you might be aware that a march about several NHS-related issues, including the future of Liverpool Women’s Hospital, took place in Liverpool on 7 October. In light of this, it’s really important that we’re clear about where the programme is up to, and stress that at this stage no decisions or proposals have been made about women’s services. Although this issue has been looked at in the past, we need to fully consider the situation as it stands now, and develop potential options for the future, and we’ll be involving patients, carers, the public, and other stakeholders in this work. Kathryn Thomson, Chief Executive of Liverpool Women’s, shared a message on the trust’s website, which sets out what has happened to date.

I look forward to providing a further update on the work of the committee in a few weeks’ time.

Raj Jain

Chair, NHS Cheshire and Merseyside ICB, and Women’s Services Committee