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Planning for Future Generations of women, babies and families

Over the last seven years, Liverpool Women’s has been working hard to continue the improvement and evolution of our services whilst planning for the long term future. This resulted in our Future Generations Strategy which we began working on in 2015.

Our preferred plan for the future is to move to a new Liverpool Women’s Hospital and be co-located on the same site as other adult acute services in the city. 

However, we know that any move would take a number of years to happen and this would also be dependent on a public consultation taking place before any plans could be approved. So as well as planning for the long-term future, we have also focused on shorter-term mitigations to address the existing clinical and operational risks that we have on our current hospital site.

Please access the tabs below for more information on Future Generations.

  • Why does Liverpool Women's need to move to a new hospital?

    An overview of services at Liverpool Women’s Hospital

    Liverpool Women’s NHS Foundation Trust primarily operates from its main site, the Liverpool Women’s Hospital (LWH) on Crown Street in Toxteth. The Trust’s 1,500 staff take care of more than 50,000 patients each year from the Liverpool city region, the surrounding areas and across the UK.

    LWH is the largest women’s hospital in Europe and specialises exclusively in the health of women, babies, and their families. It is the only hospital that provides maternity services in the city of Liverpool and it is the specialist regional centre for gynaecology cancer services, known as gynaecology oncology, within the Cheshire and Merseyside (C&M) Cancer Alliance. The Trust also provides a specialised regional clinical genetics service known as the Liverpool Centre for Genomic Medicine.  It serves a population of around 2.8 million people across Merseyside, Cheshire, and the Isle of Man, and provides a range of clinical genetic clinics across the region.

     

    What’s not working with the current Liverpool Women’s Hospital?

    The main hospital site at Crown Street, Toxteth, is isolated from other adult services and consequently, is less able to manage acutely ill or rapidly deteriorating patients, women with complex surgical needs and women with significant additional medical conditions to the standard expected of a modern adult acute health service. Therefore, women continue to be transferred to and from other Trusts for the care they need, often when they are at their most clinically vulnerable.

    Similarly, other adult acute sites in Liverpool are not co-located with women’s services and are therefore less able to meet women’s needs when they attend Accident & Emergency (A&E) or when they are admitted for conditions not relating to their pregnancy or gynaecological condition.

    LWH is the only specialist obstetric and gynaecology service provider in the country in this isolated position. This creates inequalities in access and reduced quality of care for women and their families. It also increases the risks that staff have to manage at the Crown Street site and other acute sites across Liverpool. 

    In summary, there is a current lack of:

    • A wide range of specialist clinicians on site to provide assistance when needed
    • Intensive care facilities and critical care services
    • 24-hour laboratory services
    • Therapies and recovery support
    • A blood transfusion laboratory
    • Imaging facilities to support timely diagnosis.

     

    Challenges for the wider NHS in the region as a result of Liverpool Women’s Hospital’s isolated location

    The challenges the NHS in Liverpool faces, because of the isolated nature of the Liverpool Women’s, are further illustrated by examples of recent activity which highlight the need for change:

    • Well over half of the women who book their maternity care with LWH are placed on an intermediate or intensive pathway. This means that they have complex needs such as other medical conditions, high BMI (body mass index), have had previous complications in pregnancy, or multiple pregnancies (e.g. twins, triplets); these women require much greater support and are at greater risk of experiencing complications for themselves and their babies.
    • Clinical staff based at the Royal Liverpool and Aintree Hospitals have reported that an average of 35 pregnant women present at the two A&Es (combined total) every month (i.e. at least 1 per day); there are no specialist obstetric or midwifery staff working in the A&Es.
    • 132 pregnant women, admitted to nearby hospitals, were supported by an outreach midwife in the 18 months between January 2020 and June 2021. 123 of these women (93%) were inpatients at either the Royal Liverpool or Aintree Hospitals.
    • There are about 340 ambulance transfers between LWH and either the Royal Liverpool or Aintree Hospitals per year; around half of these transfers are categorised as life threatening or emergencies.
    • In 2021, there were 10 maternity and 10 gynaecology transfers to other hospitals for critical care; the majority went to the Royal Liverpool.
    • There are over 1,000 bed days for high dependency patients at LWH every year.

     

    What will happen if things do not change?

    There are plans for CT scanning and blood transfusion services to be brought on to the Crown Street site, and for a wider range of diagnostics to be available in due course, via the current Community Diagnostic Centre (CDC) development. This will improve access to these services but women with the most complex needs will continue to need to be transferred for care elsewhere.

    There are also other issues that make the case for co-location even stronger, such as:

    • The medical and surgical complexity of patients is continuing to increase;
    • The medical workforce has become hyper-specialised with an increased reliance upon multidisciplinary care being factored into their training i.e. there is a need for a wide range of specialists to work together to provide best care;
    • Changes to medical training mean that there are fewer experienced junior doctors available (e.g. in anaesthetics) to support doctors;
    • Unlike the past, fewer midwives are registered nurses as well and they are therefore less able to deal with the range of nursing needs they may be faced with.

    If the situation continues, without a clear plan for co-location, there are real risks to women’s services being maintained in Liverpool which would result in some services having to be moved to other parts of the region.

  • What is the next stage of the Future Generations Strategy?

    Our Future Generations Strategy is still a key priority for the Trust Board, and during 2021-22 we commenced an update of our plans in response to the changing health landscape in the city over the last few years. This has included working internally with our clinical experts, as well as with our local stakeholders and health partners to bring our plans up to date and to develop them further. We are also seeking ongoing opportunities to secure capital funding to make any potential plans possible.

    We hope to share more details of these updated plans in public, later in 2022.

  • Making our current hospital site fit for future generations of care in the city

    Regardless of our long-term plans for the future, we will be staying at our current Liverpool Women’s Hospital site for a number of years and we will continue to keep our patients safe by investing in services. This is why you will continue to see our current hospital site and services develop over time.

    In 2020 we completed a £15m refurbishment to improve and upgrade our existing Neonatal Unit and we have recently commenced a £6.5m Crown Street Enhancements Programme to further address some of the clinical challenges we face on the current Liverpool Women’s site. This will see a number of additional services added to the Crown Street site including; CT Imaging and Colposcopy Suites, Robotic Assisted Surgery, a refurbished Fetal Medicine Unit, and we also have potential plans to develop a Blood Bank on site. You can read more about this exciting programme of work in the tabs below.

    The ongoing improvement and investment in our current hospital site also helps to secure the long-term use of Crown Street as a significant and valuable healthcare asset for the city, not necessarily just for Liverpool Women’s services but potentially for other health care partners as well.  

    Our current services at Crown Street are as safe as they can be and we continue to provide the best possible care to patients. Our preferred future plans are about ensuring that we can maintain this quality of care to keep the future generations of babies, mothers, and women of Liverpool safe.

    The future women and babies of Liverpool – our children, grandchildren and beyond - deserve the best quality care available and this is why we are so passionate about the need for change.

  • FAQs about our plans for the future

    We have produced a list of FAQs to provide more detail about our preferred plans for the future and to respond to some of the questions that regularly get asked. We hope this section of our website will be helpful going forward and as time progresses we will add further questions and answers.

    If there is a question you have that is not covered in the below please feel free to email communications@lwh.nhs.uk. We will review any questions received and will keep this section of the website regularly updated with additional questions and answers that we deem to be appropriate and relevant.

     

    Why do you want to re-locate to a new Liverpool Women’s Hospital?

    Whilst our current Liverpool Women’s Hospital site is an amazing place, the healthcare needs of women and babies have changed since it was built over 25 years ago (in 1995). Women are now living longer, with more complex conditions and health needs. Women are also having babies later in life, while advances in medicine mean more premature and unwell babies are surviving when they might not have done so in the past. All of these factors mean that women need more specialist and complex care; not all of this care is, or can be, provided at Liverpool Women’s. Our aim is to make sure that safe and sustainable services are provided for women, babies and families in Liverpool for decades to come. If we don’t act, the future of our services is at risk.

     

    What are the risks to women at the moment?

    The Trust is not able to provide some key elements of care for seriously ill patients or those who require complex care from the Liverpool Women’s site, such as intensive care. We are not co-located with other specialist services and their expert clinical staff, meaning that women can sometimes have long waits to be transferred to another hospital to receive the care they need or to bring a specialist doctor to Liverpool Women’s Hospital to see them. This can lead to new mothers being separated from their babies and some of our cancer patients need to be transferred to other hospitals to ensure their care is safe.

     

    Is this just a Liverpool Women’s problem?

    No, this is a problem for the city and region as a whole and impacts on other patients and healthcare providers as well as Liverpool Women’s. Other hospitals in Liverpool do not have access to on site maternity and gynaecology services, meaning women who are inpatients in acute trusts in the city can receive sub-optimal care and don’t always have the right staff on hand to support them. Examples include pregnant women who are being treated for non-pregnancy related conditions such as a heart condition, abdominal surgery and trauma, and pregnant women who are being admitted to other hospitals due to COVID-19. During the pandemic, pregnant women have been admitted to other hospitals in the city particularly since the delta variant has been in circulation and these women have not had direct access to maternity specialists. This has meant that staff at Liverpool Women’s have been providing care for these women between the two hospitals – if this had happened in a new Liverpool Women’s Hospital, all specialists would be based on the same site and able to rapidly provide clinical support.

     

    Would more funding fix these problems?

    While more funding can help us address some issues, there are some things that can never be resolved at the current site regardless of how much we invest in it. Other acute adult services, including intensive care, can never be safely provided at Crown Street, even if unlimited funds were available. To be delivered safely, complex and specialised care needs to be consolidated in one place, to ensure that different clinical teams can rely on and have immediate access to each other. Any separation of acute services leads to delay in making sure patients get the care they need.

     

    Why don't you just keep re-developing Crown St until all the challenges are addressed?

    For the same reasons as above, in other words the challenges can never be entirely addressed on the current site. We have a long history of developing innovative ‘clinical workarounds’ to make our patients as safe as possible while we look after them. We also have a good track record of successfully securing funding to invest in our services, to reduce risk as far as possible, including our new neonatal unit, and our plans to bring CT and MR imaging and blood transfusion services to Crown Street. However, no level of investment will mean we can fully address the key risks to our patients; we will never be able to bring intensive care or other adult acute services to Crown Street, and until we are co-located with other adult acute and emergency services, we will not be able to provide optimal care to women who are inpatient in other services.

     

    What will happen if you can’t move?

    Remaining at Crown Street as we are is not an option for the long-term future of our women, babies and families. Our counterfactual case demonstrates that within 5-10 years, services will be lost from Liverpool and possibly from C&M. Even if our current bid for funding is not successful, we will continue to work with our NHS partners across Cheshire and Merseyside to find a way to co-locate our services with an adult acute site. We are constantly reviewing and trying to improve the care we offer on the Crown Street site but without co-location at an adult acute site we will never be able to offer the services that we would want to give women the best care possible.

     

    Is the bid for funding that you submitted in September 2021 a new proposal?

    No – this is the same plan we have always had. The Trust has not deviated from its preferred option to co-locate services with an adult acute site and is continually reviewing evidence (such as whether we are able to meet clinical standards) and looking for ways we can reduce clinical risks at Crown Street. We have not had any feedback from the national bidding process as yet and expect to hear later in 2022.

     

    Does the recently submitted plan for the new hospital have a smaller clinical footprint compared to previous versions of the plan?

    No – actually it’s larger. In the Pre-Consultation Business Case produced by Liverpool CCG in 2016, the preferred option had a footprint of 20,676m2. The plan submitted in 2021 is based on a schedule of accommodation drawn up by architects, in line with hospital building standards, and has a footprint of 21,829m2.

    Would a new Liverpool Women’s Hospital be smaller than the current hospital on Crown Street?

    Whilst current plans for a new hospital are based on a smaller footprint compared to our current hospital building, there is no planned reduction in our actual clinical space. In some areas there is actually a planned increase in clinical space. Any reduction in space for the building as a whole would be for non-clinical areas, such as offices which could be located elsewhere. We are also looking at options to bring more of our outpatient services into the community, closer to people’s homes. This could include keeping some of our low-risk outpatient services at Crown Street.

     

    Would there be fewer beds in a new Liverpool Women’s Hospital?

    No, we have no plans whatsoever to reduce beds. The numbers of women having babies hasn’t decreased, and gynaecology activity is rising, so it would make no sense to reduce the beds in our hospital. Plans for the new hospital actually include more beds than are open at Liverpool Women’s now, and when we finalise plans, we will make sure they take account of population growth forecasts.

     

    Having a specialist women’s hospital in Liverpool is really important to me. Will the women’s retain its identity as a dedicated hospital for women and babies?

    Absolutely. Retaining our identity as a specialist provider of women’s services is very important to everyone who works at Liverpool Women’s. We want to keep providing the same excellent care we have always delivered to our women, babies and families. We will still be Liverpool Women’s; we will just be on a different site.

     

    Are you planning to sell the Crown Street building to the private sector?

    No – there are no plans to sell the building to the private sector. There have been no discussions with any private sector companies regarding sale of the building, nor has the Trust received any such approaches. Our intention is to work with partners to make sure that NHS services are provided from Crown Street in the long term.

     

    The current hospital is really important to Toxteth and the wider local community. What are your plans for the Crown Street Building and how can you assure the public that you would have any influence over this if you moved?

    Our intention is to make sure that NHS services are provided from Crown Street in the long term. The Crown Street site is a relatively modern building in good condition. It is perfect for the provision of low-risk services. While there are no agreed plans at the moment, our vision is to see a broad range of NHS services provided from Crown Street, catering to diverse groups, to improve access to healthcare, help address health inequalities and benefit the community of Toxteth and the people of Liverpool for the long-term future. We are already working closely with other local NHS providers to deliver some services from our current site and have been doing so during the COVID-19 pandemic to reduce pressure on the system and to support our NHS colleagues in other hospitals. It is this collaborative approach that would likely be how Crown Street would be used in the future if we did move to a new location. We are working with other NHS organisations in Liverpool on this approach at the moment.

     

    Has Liverpool Women’s suffered financial cuts that are causing all these issues?

    The plan to co-locate Liverpool Women’s Hospital with an adult acute site is clinically driven; our ‘case for change’ is entirely about reducing clinical risk and would remain the same no matter the financial position of the Trust.

    What is your response to people who currently do not agree with your plans for the future?

    We understand that the future of Liverpool Women’s is a very emotive subject and the current hospital building is close to people’s hearts. We have been really clear from the start of this journey that our plans are about what is in the best clinical interests for our women, babies and families in the future. All of the details of our proposals and why we think our preferred plans are the best for the future are publicly available on our website. We are also always happy to speak to anyone about these plans and answer any questions. However, what is often unhelpful is when inaccurate information is shared with the public by some individuals and groups that do not reflect LWH’s intentions. On those occasions we are very passionate and insistent about correcting any false claims so our patients and the public understand the facts. Our plans are not financially or politically driven – they are 100% about what is clinically best for the women, babies and families of Liverpool and beyond.

     

    How do you plan to engage with people now and in the future on your preferred plans?

    Over the last few years we (along with our commissioners) have undertaken a number of public engagement events and we have also kept people updated with our preferred plans regularly through avenues such as our public board meetings, annual members meetings, and annual reports. We intend to continue engaging with people at regular intervals and of course if and when we have approval from NHS England, a public consultation will take place before any of our preferred plans for the future are agreed. A public consultation would be led by our commissioners but would closely involve colleagues at LWH giving lots of opportunity to speak to our public, patients and staff in detail about our plans for the future.

  • Would you like to know more about our plans and get involved?

    We are pleased to say that we are now at a stage where we can start talking to our key stakeholders about Future Generations again including our patients, families, staff, and the wider community.

    Over the next few weeks and months we will be looking to engage with people who are interested in our plans for the future. This will include a range of engagement activities and we will keep you regularly informed about opportunities to get involved.

    To register your interest in getting involved with some of these activities, please complete the following form: https://forms.office.com/r/cDB57NHiVc

     

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