North East Essex Clinical Commissioning Group
Report of proposals for future of maternity services in north east Essex
Contents
Executive summary
1.0 Introduction
2.0 Preparing to consult
3.0 Meeting the four tests for service change
3.1 Support from general practice
3.2 Strengthened public and patient engagement
3.3 Clarity on the clinical evidence base
3.4 Consistency with current and prospective patient choice
4.0 Equality and diversity
5.0 Service user engagement
6.0 Campaign materials
7.0 Independent analysis
8.0 Independent panel
8.1 scoring the options
8.2 Panel recommendations
9.0 Conclusion
Appendix one
Appendix two
NEECCG Maternity proposal report FINAL. 2015.03.16
Executive Summary
The need to address the sustainability of maternity services across North East Essex (NEE) has
been the subject of discussion for some time. In November 2013, the boards of North East Essex
Clinical Commissioning Group (NEE CCG) and Colchester Hospital University Foundation Trust
agreed the “case for change” document, identifying a commitment between both organisations to
work collaboratively to develop a definitive, sustainable model of maternity services across NEE.
Previous service user engagement exercises undertaken in 2012 captured the opinions about
current maternity services from local women and their families. This also included feedback from a
variety of health professionals including obstetricians, midwives, health visitors and specialist
community nurses. Opinion at the time confirmed that the service across North East Essex was
perceived to be inequitable.
The development of a more consistent model of care and equitable distribution of midwifery
resources, informed by national and local standards and feedback gained throughout the
engagement process in 2012 would result in more women and their families experiencing a
consistent and equitable level of service. This would result in a significant increase in service user
satisfaction.
From 15th October-10th December 2014 a public maternity consultation took place outlining two
possible options. The consultation document, „Right start‟ offered two options for the future
provision of services.
Option One- Clacton and Harwich to remain as “on demand” midwife led units. Antenatal and
postnatal care to continue.
Option Two- Clacton and Harwich to return to the status of midwife led units-24/7. Antenatal and
postnatal care to continue.
In addition to the choice of options, respondents were asked a series of questions to help identify
the key factors in the decision making process. A variety of consultation events and media were
used to enable a comprehensive response to the consultation.
In total, 233 people completed the public survey (online and in paper format) and an additional 16
narrative responses were received from individuals and groups. The narrative responses came
from charities, the local council, midwives, hospital consultants, GPs and unions/staff side
representatives. The Royal College of Midwives also responded.
Following an independent analysis of the findings of the consultation a panel was convened on the
27th February 2015 to score the options. The panel was chaired by Healthwatch Essex and
included attendees from a number of organisations including a service user representative. The
aim of the panel was to ensure a recommendation was made to both Colchester Hospital and the
CCG boards on the preferred option.
NEECCG Maternity proposal report FINAL. 2015.03.16
1.0 Introduction
In March 2014, the CCG was advised by Colchester Hospital University Foundation Trust that a
decision had been taken to temporarily close the midwife led units at Harwich and Clacton due to
ongoing concerns regarding midwifery staffing levels across the whole of maternity services.
Closure of the Tendring Peninsula units enabled midwives to be deployed in the busier obstetric
unit and Juno suite at Colchester Hospital. At the time of the temporary closures, a recruitment
drive for additional midwives was expedited.
On 12th June 2014 the Colchester Hospital board agreed Clacton and Harwich midwife led units
should re-open for births “on demand”, enabling a similar model of care to be provided. The only
difference being that a woman requiring the services of the midwife led unit outside of normal
working hours would contact the midwife on call who would meet her at the unit. This was opposed
to a midwife being present within the midwife led unit 24 hours a day, often when no births were
taking place.
This change in care delivery enabled the CCG and Colchester Hospital to discuss and agree the
proposed options for the future configuration of services and the subsequent formal consultation.
The proposed options took into account the strong feedback from stakeholders and the public that
the choice of maternity services should include the option to deliver in a midwife led setting at both
units in Tendring.
National guidance from the Royal College of Obstetricians and Gynaecologists (RCOG 2008)
suggested that successful maternity services were those that enabled women and their families to
choose the most appropriate care for each phase of their maternity experience. This too, is
essential, for women with complex health needs where higher level intervention is required.
Offering a range of options and discussing possibilities provides women with informed choices that
best meet their needs (RCOG 2008). Guidance from the National Institute for Health and Care
Excellence (NICE) supported choice, by advocating that women should have an option to have
their baby in a variety of settings including both standalone and co-located midwife led units.
The review of national guidance and service user feedback prompted the CCG and Colchester
Hospital to remove closure of the midwife led units from the options for consultation.
In June 2014, the CCG and Colchester Hospital jointly commissioned an external peer review of
maternity services with the East of England Strategic Clinical Network. The main purpose of the
review was to assess the opportunities for improvement in existing commissioned maternity
service provision. Assessing the viability to continue to provide intrapartum care on three sites was
also addressed. The review concluded that a longer term evaluation of strategic capacity was
required across maternity services to ensure safety and sustainability for the future.
In July 2014, maternity services were subject to an inspection by the Care Quality Commission
(CQC) as part of a wider inspection of the care delivered by Colchester Hospital. Whilst
suggestions for the sustainability of the Tendring midwife led units were not included in the report,
mention was given to the closure of the costal units and the reduction in options available to
women for birth.
NEECCG Maternity proposal report FINAL. 2015.03.16
In July 2014 the options appraisal paper for the maternity consultation was taken to both the CCG
and Colchester Hospital boards who agreed the proposed options and the need to formally consult
with the public
The options agreed were;
Option One- Clacton and Harwich to remain as “on demand” midwife led units. Antenatal and
postnatal care to continue.
Option Two- Clacton and Harwich to return to the status of midwife led units-one 24/7. Antenatal
and postnatal care to continue.
The principles underlying the public consultation were agreed by both organisations. These were
to:
1. Ensure that women and their families have access to high quality, safe and effective
maternity services that reflect the needs of the local population and are sustainable for the
future.
2. Work to promote and maintain choice for women and their families, creating an
environment that supports personalised care as integral to its service.
3. Ensure the best use of resources is made, creating fairness and consistency across north
east Essex.
4. Ensure that any changes to service delivery do not disadvantage women and their families.
5. Work to maintain or improve continuity of care for women throughout pregnancy, labour
and during the postnatal period.
6. Work with service users, clinicians and stakeholders in the development of any options for
change.
7. Ensure that all recommendations for consultation are based on a clear rationale and where
appropriate national and/or local guidance.
The NHS “Five year forward view”, published in October 2014 supported the need to ensure that
nationally, maternity services develop in a safe, responsive and efficient manner ensuring that
choice is supported and not inhibited. Although published after the commencement of the
consultation, it remained noteworthy to consider this as the consultation progressed.
2.0 Preparing to consult
Commissioning services and implementing change involves a complexity that requires input from
stakeholders, partners, providers, service users and the public.
In 2012/13 the CCG, supported by the north east Essex Maternity Services Liaison Committee
(MSLC), reviewed maternity services by undertaking a public engagement exercise with women
and their families, community groups, midwives, obstetricians, GPs and other health professionals.
A smaller review of the needs of women from black and minority ethnic (BME) communities was
also undertaken in 2013.
In the summer of 2014, further pre-consultation work was undertaken by the MSLC which included
the development of an electronic survey (which received 100 responses) and a series of service
user events across Colchester, Clacton and Harwich. These were hosted and independently
NEECCG Maternity proposal report FINAL. 2015.03.16
chaired by the CCG Health Forum and attended by representatives from Colchester Hospital, the
CCG and MSLC. The events were conducted using an approach that supported a question and
answer style panel.
On the 9th August 2014 a ‟Communications and Engagement‟ work stream was established by the
CCG and Colchester Hospital to ensure stakeholder and service user input was integral to the
development of the consultation programme. The main objectives of the communications and
engagement work stream were:

To ensure that service users and potential service users of maternity services locally,
commissioners, providers and those with an interest in maternity services were aware
and informed about the proposals for change.

To ensure that those people with an interest had an effective opportunity to give their
views on proposals and plans and that decision-makers had the benefit of a range of
patient, public and professional viewpoints and expertise.

To support clinicians, managers and commissioners in achieving a fair, transparent,
well-informed and smooth-running development programme for improving maternity
services in north east Essex.

To ensure adherence to statutory guidance relating to the requirement for NHS bodies
to consult their local communities on health plans set out by the NHS Act (2006),
Cabinet Office Code of Practice on Consultation (2008), Equality Act (2010) and Health
and social Care Act (2012).
Membership of the work stream included:
 MSLC chair (service user representative).

CCG and Colchester Hospital communications representative.

CCG Children and maternity commissioner.

Invitations were also extended to Outhouse (Lesbian/Gay/Bisexual/transgender group),
TACMEP (migrant community group) and disability groups.
On the 10th September 2014, the proposal for the maternity consultation was presented to the
Essex Health Overview and Scrutiny Committee (HOSC).
3.0 Meeting the four tests for service change
Recommendations made by the Secretary of State (2010) identified that prior to any major
changes in NHS services there should be support from GP Commissioners, strengthened public
and patient engagement, clarity on the clinical evidence base and consistency with current and
prospective patient choice. The CCG and Colchester Hospital have ensured that these four tests
for change have been integral to the maternity consultation process via a multitude of fora:
NEECCG Maternity proposal report FINAL. 2015.03.16
3.1 Support from General Practice
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NEE CCG has 43 GP member practices. The options for consultation were developed
in conjunction with the GP elected members of the CCG.
There are two GP elected members who take a lead on maternity services and who
have been consulted regarding the options and consultation process.
The consultation strategy and the consultation document were discussed at the CCG‟s
Transformation and Delivery Committee (TDC) which clinically reviews and agrees on
the CCGs clinical developments.
The options for the consultation and the process for consultation was discussed at the
CCG board
The consultation was discussed extensively at general practice fora in north east
Essex.
3.2 Strengthened public and patient engagement
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There has been extensive public and patient engagement during the development of
the options and the pre-consultation phase.
The chair of the MSLC (service user representative) was involved in the
communications and engagement work stream and attended some of the public
consultation events.
The consultation strategy was approved by the HOSC.
The consultation which ran for eight weeks (15th October-10th December 2014), was
widely advertised and achieved coverage in local broadcast media and newspapers
The pregnant population for north east Essex is approximately 4,000 per annum. 233
(5.86%) members of the pregnant population responded to the public consultation,
which compares favourably with other public sector consultations.
Service user representation was present at the independent panel convened on the 27th
February 2015.
3.3 Clarity on the clinical evidence base
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The options were discussed at the CCG‟s Transformation Delivery Committee (TDC)
which clinically reviews and advises on all CCG clinical developments.
The option appraisal paper and consultation document were fully referenced using
national clinical guidelines and quality standards and findings from national and local
reviews of maternity services.
Feedback from health professionals formed part of the public consultation. Feedback
from the Royal College of Midwives was also obtained.
Clinical representatives were members of the independent panel convened on the 27th
February 2015.
The criterion used to score the options was based on national best practice as outlined
by the Royal College of Obstetrics and Gynaecology.
NEECCG Maternity proposal report FINAL. 2015.03.16
3.4 Consistency with current and prospective patient choice
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Service user representation was present at the independent panel convened to score
the options on the 27th February 2015.
Patient choice, both current and prospective, was included as a thread across all
criteria used to score the options.
Service user feedback from the consultation will inform the development of the CCG
maternity strategy (2015-2018).
4.0 Equality and Diversity
The CCG and Colchester Hospital have a duty to comply with equalities legislation; to reduce
health inequality; and to promote integrated health services where this will improve quality.
Throughout the process of developing and implementing the consultation the CCG and Colchester
Hospital involved service users from across north east Essex ensuring that both the proposals and
the process met the requirements of equality and diversity policies and procedures.
An equality impact assessment (EIA) was undertaken prior to commencement of the consultation
which was circulated by the CVS to community groups for comment (see appendix one). No
responses were received.
Copies of the consultation document were translated into easy read, braille, audio and the most
commonly used languages other than English. The consultation did receive responses from people
with the following protected characteristics: disability, age, race and sexual orientation
Service user engagement with vulnerable or hard to reach groups included:
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A pre-engagement survey was undertaken with BME groups which looked at religious
and cultural issues as well as language barriers. Fathers were engaged as well as
mothers.
Events across the north east Essex area including Jaywick, Colchester, Clacton and
Harwich. All of the venues were accessible for people with disabilities and for service
users with pushchairs.
Two events were planned with teenage service users although one was cancelled by
Colchester Hospital due to staff sickness
A migrant communities workshop
A LGBT representative was invited to join the communications and engagement work
stream although declined. A service user with disabilities was also identified although
they did not attend the work stream.
5.0 Service User Engagement
The consultation ran from the 15th October 2014 through to the 10th December 2014. Service user
engagement forums were well publicised within the public maternity consultation document as well
as on the Colchester Hospital and CCG public facing websites. Details of those organisations or
persons contacted are outlined in appendix two.
NEECCG Maternity proposal report FINAL. 2015.03.16
Engagement methods included:
 Face to face meetings with service users at venues they were already attending including
children‟s centres and antenatal clinics.
 Events held in each of the maternity units at Colchester, Clacton and Harwich.
 Panel events chaired by the CCG Health Forum in Colchester, Clacton and Harwich.
 Social media to generate interest in and commentary on the service as well as completion
of the survey.
 Online survey and pull out survey in the printed consultation document to be returned
freepost. Copies of the document were widely circulated.
6.0 Campaign materials
A diverse use of media was utilised to promote the maternity consultation which enabled the public
to feedback in a variety of means.
In preparation for the consultation, the CCG worked with BBC Radio Essex to schedule a live
interview with the Clinical Commissioning Group‟s Director of Nursing and Clinical Quality. During
the consultation coverage was included on BBC “Look East” (morning, lunchtime and evening
broadcast).
A full news release was also issued at the start of the consultation and subsequent news features
were published in the Daily Gazette and East Anglian Times. Full page adverts were also included
in all editions of the Gazette.
Online adverts were placed with “Essex Baby” and the Gazette as well as on the CCG and
Colchester Hospital public facing websites. An online advert was also placed with Tendring District
Council.
Social media was utilised and links made to the CCG, Colchester Hospital and MSLC pages on
both Facebook and Twitter.
Visual displays and posters were provided both at the CCG and Colchester Hospital together with
opportunities to drop in and talk to representatives from both organisations as well as other service
user representatives.
Copies of the consultation document were distributed to libraries, GP surgeries, Children‟s Centres
and core health/social care and voluntary sector providers including:
 Colchester Hospital University Foundation Trust
 Anglia Community Enterprise
 North Essex Partnership University Foundation Trust
 Tendring and Colchester .community volunteer service
 Tendring District Council
 Colchester Borough Council
NEECCG Maternity proposal report FINAL. 2015.03.16
Healthwatch Essex made reference to the maternity consultation in their electronic newsletter.
The CCG Health Forum Committee newsletters included reference to the maternity consultation
and how to be involved. The minutes of the MSLC and Health Forum Committee made reference
to the maternity consultation.
7.0 Independent Analysis
Independent analysis of the consultation findings was undertaken by the Anglia Ruskin University
post graduate medical institute. Anglia Ruskin University received a pre-agreed consultation fee for
completing the independent review.
The decision to commission ARU was based on the strong academic reputation of their research
unit as well as their previous experience of providing detailed independent analysis reports.
At no point during the process of analysis did the CCG or Colchester Hospital have access to or
influence writing of the report. The completed report was sent to the CCG on the 23rd February
2015.
8.0 Independent Panel
On the 11th December 2014, the CCG Operational Executive Committee agreed that, following the
closure of the consultation and analysis of responses, an independently chaired, multi-agency
panel would be convened to score the options and make a recommendation to the CCG and Trust
boards. The panel would be chaired by Healthwatch Essex and provided with clear terms of
reference, as stated below
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The panel will comprise service user representatives and clinical and commissioning
representatives from agencies involved in maternity services in North East Essex
The panel will be independently chaired by Healthwatch Essex
The panel will use an agreed methodology for assessing and scoring the options which
aims to ensure objectivity and prevent bias.
The principles agreed between NEECCG and Colchester Hospital prior to commencing the
consultation is integral to the function of the panel.
The panel will make a recommendation for the future of maternity services to the boards of
NEECCG and the Colchester Hospital based on the scoring.
The CCG and Colchester Hospital were clear that the views of the public would be part of a wider
evaluation of the options; consultation on the options was not „a vote‟ for a particular or preferred
option. This was supported by the panel that agreed that the report compiled by ARU was part of a
multi-factorial approach to scoring the options and should not be considered in isolation.
The methodology for scoring the options was agreed by the Independent chair and based on the 7
appraisal criteria set out in the public consultation document;
 Clinical effectiveness
 Safety
 Efficiency
 Acceptability/Service User experience
 Access
NEECCG Maternity proposal report FINAL. 2015.03.16
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Equity
Relevance.
The seven criteria were expanded in line with the evaluation criteria for potential service models as
outlined in national guidance relating to the reconfiguration of women‟s services in the UK (RCOG
2013).
Prior to the panel date, all panel members were sent a data pack which enabled them to consider a
number of factors that impact upon maternity services nationally and locally. The data pack
included:
 National guidance- Reconfiguration of women‟s services in the UK.
 The “Right start” maternity public consultation document.
 Colchester Hospital maternity data- the previous 2 years‟ service and birth data, workforce
requirements, commonalities and differing needs of each of the Tendring midwife led units.
 Independent Review of Consultation Findings published by ARU.
 Panel terms of reference.
The panel was convened on the 27th February 2015 and included members from:
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Healthwatch Essex (Independent Chair)
NEECCG- Director of nursing and clinical quality and commissioner
Colchester Hospital- midwifery and obstetric clinical leads
GP representative
Practice manager Tendring
Children‟s services lead Anglia Community Enterprise
Children‟s services lead North Essex Partnership Trust
Commissioner Essex County Council (ECC)
Service User representative (MSLC)
8.1 Scoring the options
All members were reminded of the options outlined in the “Right start” public consultation
document and consideration of the service user voice and experience would inform deliberation of
each criteria, rather than being scored as a criteria in its own right.
The Chair and panel members agreed that, whilst the consultation response indicated a statistical
preference for Option 2, the decision should rightly reflect the many relevant factors involved.
The Chair and the panel agreed, that any additional views or recommendations related to or
extending beyond, the terms of reference, should be recorded and form part of the overall report to
the Boards of the CCG and Colchester Hospital.
The options were set out as follows:
Option One- Clacton and Harwich to remain as “on demand” midwife led units. Antenatal and
postnatal care to continue.
NEECCG Maternity proposal report FINAL. 2015.03.16
Option Two- Clacton and Harwich to return to the status of midwife led units open 24/7. Antenatal
and postnatal care to continue.
Each of the options was considered in line with the individual appraisal criteria and associated
questions. Each option was then scored accordingly (see section 8.2).
A synopsis of the narrative of the discussion relating to each of the appraisal criteria was captured
and recorded and is as follows:
Clinical Effectiveness.
There was general recognition that the “on demand” system (option 1) had been running well since
the units re-opened in July 2014. There has been no increase in clinical incidents or Serious
Incidents (SIs) and no increase in reported significant risks relating to the safety of women and
their babies. The on-call arrangements across maternity services were extended to include access
to each of the units out of hours.
Workforce requirements were discussed for both options and it was agreed by all panel members
that delivering a 24/7 service does not support a workforce model that is realistic or sustainable.
Option 1 supports a more sustainable workforce model and is in line with national guidance that
recommends that midwife led units need to attain approximately 250 births per year to warrant 24
hour cover. Staffing acuity assessments have been completed for both units.
In line with local and national commissioning priorities around choice in maternity services it was
agreed that option 1 did support this as well as a more flexible approach to service provision which
had been echoed in service user feedback both pre and during the consultation period.
There was acknowledgement that the funding stream for maternity services was in line with
national tariff. The panel considered that the financial implications of option 2 were less favourable
owing to the need to manage the “overheads” of the unit even when women and their families may
not be present.
It was agreed that education and training requirements were the same for both options 1 and 2.
It was recognised that service users and the public may perceive the “on demand” service to be
one that may result in a loss of midwifery services and therefore impact on clinical effectiveness.
Panel members, including the MSLC representative, reported that previous closures of the units
had resulted in a general anxiety amongst the public that closure was still a consideration. The
CCG representatives reminded the panel that closure had been removed as an option at the preconsultation stage. The panel discussed the likelihood that these generalised anxieties about
closure may have informed consultation responses.
The panel strongly supported the need to reduce the anxiety amongst the public and provide clear
information to families on their choices and asked that the boards of the CCG and Colchester
Hospital address this.
The options were scored as follows:
NEECCG Maternity proposal report FINAL. 2015.03.16
Option 1= 3
Option 2= 2.
Recommendation: There was agreement that the CCG and Colchester Hospital needed to take
steps to address public perception and anxiety and ensure women and families are offered
information on choices in maternity services in NEE.
Safety
There has been no reported increase in clinical incidents, serious Incidents or significant risks
relating to the safety of women and their babies since the re-opening of the midwife led units in
July 2014. Work with East of England Ambulance service was already underway to review and
enhance standardised operating procedures between the ambulance and maternity services. .
While it was recognised there may be public perception that option 1 would be „less safe‟ than
option 2, due to ambulance provision, it was determined by the panel this was incorrect. It was
recommended that the CCG and Colchester Hospital should take steps to address this public
perception and anxiety.
There were general discussions that both models supported an approach to care that promotes,
where possible, continuity of carer. The positive impact of this on the outcomes for women and
their babies were acknowledged. It was agreed that option 1 may increase flexibility in the
provision of antenatal and postnatal care by supporting families in their own homes and at other
venues such as Children‟s Centres. This would enhance service user experience.
There was recognition that option 1 did not allow for routine “postnatal stays” which historically had
been offered at times at the midwife led units. This is inequitable practice and clinical evidence
does not support postnatal stays as a safe option for women and babies and where possible the
transition to parenthood should be supported by care closer to or in the woman‟s home.
Both service models meet national guidance which suggests that commissioners and providers
ensure that all 4 birth settings are available to all women in the local area or in a neighbouring
area. These include:
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Home Confinement
MLU Freestanding
MLU (alongside Obstetric Unit)
Obstetric Unit
The options were scored as follows:
Option 1= 3
Option 2= 3.
Recommendation: Collaboratively review with the East of England Ambulance the protocol for the
safe transfer of patients from Clacton and Harwich to Colchester Hospital where required.
NEECCG Maternity proposal report FINAL. 2015.03.16
Efficiency
It was agreed that option one supported a more affordable financial model of care and that this was
worthy of consideration in view of the current and forecast financial climate. Option 2 is not an
affordable or efficient use of resources.
There was recognition that efficiency and best practice could continue to be delivered by operating
only 1 of the midwife led units in Tendring, although it was acknowledged that closure of either of
the units was not considered as part of the consultation. The options were scored as follows:
Option 1= 3
Option 2= 1.
Access
It was agreed that physical access for both options was equal.
Option 1 enables the service model to be more flexible in the provision of care. Since opening “on
demand” in July 2014, care provision has been expanded in other areas such as Children‟s
Centres, at GP clinics and in the woman‟s home as appropriate. This is particularly so in relation to
postnatal care where an increased need was identified from service user feedback
To staff the midwife led units on a 24 hour basis as in option 2reduces the availability of service
provision in children‟s centres, GP clinics and in the home..
The options were scored as follows:
Option 1= 3
Option 2= 2.
Equity
It was agreed that equity of service provision would be the same for both options. Both options also
support choice. Again, the panel agreed that it was important to tackle any perceived inequity in
moving to an „on demand‟ model.
The options were scored as follows:
Option 1= 3
Option 2= 3
Relevance
There was general discussion that an ageing population would have implications for maternity
services in terms of the obstetric risk for women having a baby at a later stage in life. However this
would not impact upon either option owing to the need for women classified as “high risk” to be
advised to have their baby at Colchester Hospital. Service user feedback highlighted the need for
more information on risk and choice.
Option 1 was deemed a more sustainable approach to care, especially in relation to the NHS 5
year forward view which could have implications for maternity service providers as new providers
are encouraged to enter the market. Option 2 would not support the national changes in the
commissioning of maternity services now and in the future.
NEECCG Maternity proposal report FINAL. 2015.03.16
Option 1 supports a more sustainable approach to the workforce
The options were scored as follows:
Option 1= 3
Option 2= 2
Recommendation: Colchester Hospital to review the information given to women and their
families around risk and choice.
8.2 Panel recommendation
The panel was in full agreement and recommended Option 1 having agreed that service user
experience and feedback had been fully considered and adequately reflected throughout.
Clacton and Harwich to remain as “on demand” midwife led units. Antenatal and postnatal
care to continue
It was recommended that future consultations and service improvement should capture not just
service user preferences but also the “lived experiences” as this can help better inform service
design and delivery. It was suggested by the panel that the “lived experience” of service users is
reviewed intermittently following conclusion of the consultation and that the MSLC would be in an
ideal position to do this with the support of Healthwatch Essex if required.
The final scores in relation to both options were:
Option One
Appraisal
Criteria
1
2
3
4
5
6
Total
Option Two
Appraisal
Criteria
1
2
3
4
5
Criteria
Score
Weighting
Clinical
Effectiveness
Safety
Efficiency
Access
Equity
Relevance
3
25
Overall score
(score x
weighting)
75
3
3
3
3
3
18
25
15
5
10
20
100
75
45
15
30
60
300
Criteria
Score
Weighting
Clinical
Effectiveness
Safety
Efficiency
Access
Equity
2
25
Overall score
(score x
weighting)
50
3
1
2
3
25
15
5
10
75
15
10
30
NEECCG Maternity proposal report FINAL. 2015.03.16
6
Total
Relevance
2
13
20
100
40
220
9.0 Conclusion
The conclusion of the maternity consultation will bring to an end the uncertainty around local
maternity services, enabling a model of care to be delivered that is efficient, safe and of high
quality Clarity on the options available for women and families will enhance choice and promote
well-informed decisions about maternity care.
Both the CCG and Colchester Hospital are keen to ensure that the views of local women and their
families continues to feature as a core aspect of service provision, guaranteeing that maternity
services reflect the needs of the local population.
NEECCG Maternity proposal report FINAL. 2015.03.16
Appendix One: Summary of Equality Impact Assessment.
Age
Re-designing maternity services will affect the provision of maternity care for women of
childbearing age. Specific groups such as teenage parents need to be considered in future
service design and delivery. There is also an increasing number of women choosing to
become pregnant towards the end of their child bearing years and this has an impact on
whether or not they are classified as needing midwifery or obstetric led care. The Maternity
Service Liaison Committee (MSLC) feels that older women should be able to make an
informed choice rather than having the decision imposed upon them.
Pregnancy and maternity
The focus of the maternity re-design is on pregnancy and the postnatal period/transition to
parenthood. How women access antenatal, perinatal and postnatal care may be affected.
Disability
The re-design of maternity services will affect women and their families across NEE. This
includes those with a disability. Access to maternity services for those with a disability will
need to be considered.
Gender reassignment
Maternity services changes will not affect this group
Race
A listening exercise undertaken by the Colchester MIND team in 2013 found that women
accessing maternity services in NEE were generally satisfied with birth but required further
information throughout pregnancy in a format suitable to them.
Religion or belief
The proposed re-design will need to take into consideration those with religious beliefs
which include:

no personal contact between the women and male staff

Those who have beliefs regarding the use of blood products.

Any other religious belief that impacts on maternity care delivery.
Safeguarding
The proposed re-design should promote pathways that support vulnerable people.
However, it will not be designed to increase vulnerability. We acknowledge that complex
social factors can play a part in the lead provider of care specifically midwifery versus
obstetric. The safety of the mother and child/ren is more important than choice in these
cases
NEECCG Maternity proposal report FINAL. 2015.03.16
Appendix 2
Consultation document and poster sent to:
Group or individual
Practice managers
All GP practices
Children‟s Centres
Patient Participation
Groups
Tendring District
Council
Colchester District
Council
Essex County Council
Voluntary sector via
Colchester and
Tendring CVS
Maternity Units at
Colchester, Clacton
and Harwich
Colchester Garrison
Essex University
Healthwatch Essex
Essex
Bernard Jenkins MP
Douglas Carswell MP
Bob Russell MP
National Childbirth
Trust
Royal College of
Obstetricians and
Gynaecologists
Royal College of
Midwives
Format
 Electronic with instructions
 Printed consultation documents and events poster
 Electronic with instructions
 Printed consultation documents and events poster
 Electronic with instructions
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
Electronic with instructions
Printed consultation documents and events poster
Electronic with instructions
Printed consultation documents and events poster
Electronic with instructions
Printed consultation documents and events poster
Electronic with instructions
Printed consultation documents and events poster
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
Electronic with instructions
Printed consultation documents and events poster
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

Electronic with instructions
Request to hold an event
Electronic with instructions
Request to hold an event
Electronic with instructions
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Electronic with instructions
Printed consultation documents and events poster
Electronic with instructions
Printed consultation documents and events poster
Electronic with instructions
Printed consultation documents and events poster
Electronic
Letter with copy of the document
Electronic
Letter with copy of the document


Electronic
Letter with copy of the document
NEECCG Maternity proposal report FINAL. 2015.03.16
Outreach events
NEECCG Maternity proposal report FINAL. 2015.03.16
Event
Date and Time
Number attending
St Nicholas Children‟s Centre
Harwich
Highwood‟s Children‟s Centre
Colchester
Clacton Hospital Maternity Unit
Thursday 16 October
10 -12 AM
Monday 20 October
10-12 AM
Tuesday 21 October
10.30am-11.30am
Wednesday 22 October
10.30am-11.30am
Thursday 23 October
10- 1.00 pm
20
Fryatt Hospital, Harwich, Maternity Unit
St Anne‟s Children‟s Centre
Colchester
Antenatal Clinic, Colchester General
Hospital (Constable Wing)
Clacton Hospital Maternity Unit
Fryatt Hospital, Harwich, Maternity Unit
Hemmington House Children‟s
Centre,Jaywick
Berechurch Health Centre
Antenatal Clinic, Colchester General
Hospital (Constable Wing)
TACMEP workshop with migrant women
First Site Colchester
MSLC meeting
YES Colchester
Thursday 23 October,
6pm-7pm
Saturday 1 November,
2.30pm-3.30pm
Sunday 2 November,
2.30pm-3.30pm
Monday 3 November
10-12am
Tuesday 4 November
2-4pm
Tuesday 4 November,
5pm-6pm
5 November
20
5
3
10
0
4
30
6 November
7 November
Manningtree Health Clinic
Wednesday 12
November. 10-12am
Early Years Starting Well event for
Thurs 20 Nov
professionals + parents Colchester stadium 3.30 - 7.30
St James Children‟s Centre
Monday 24 November
10-12am
Colne Children‟s Centre
Wednesday 26
YMCA. Brightlingsea
November. 10-12
Colchester Health Forum
Monday 1 December
2-4
Harwich Health Forum
Tuesday 3 December
2-4
Clacton Health Forum
Friday 5 December
2-4
NEECCG Maternity proposal report FINAL. 2015.03.16
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10
15
15
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