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North West London Integrated Care
System and Local Maternity System
Equity and equality analysis
and action plan for
maternity services
2
Please note, within this report when we refer
to a woman, women, mother or mum, we are
including anyone regardless of gender identity.
Key messages
1 Equality and equity runs through everything
that we do as a Local Maternity System and
Integrated Care Board
2 NW London Local Maternity System
understands our gaps and we are committed
to closing them
3 System level Engagement and Co-production
is the foundation for service redesign that
meets the needs of our people (service users,
partner organisations and staff)
4 This will be an evolving and fluid strategy
responsive to change as need emerges
3
Executive Summary
Addressing health inequalities is a core principle of the way we approach
maternity service design and delivery across NW London. We know that
80% of what impacts health inequalities happens outside of healthcare
settings. All responses and actions require a system wide approach to
ensure we improve health outcomes for our communities. Developing
this strategy has been an opportunity to bring all stakeholders and
networks together to ensure that the system is listening and responding
to the inequality agenda. This is about creating real change in how we
work with our residents.
This strategy should be viewed as an action plan,
subject to iteration and expansion as the needs of our
population and staff evolve over time. It aims to lay
the foundation for future service development and
puts listening, understanding and responding at the
heart of maternity care in NW London.
Addressing the five priorities, as laid out in the ‘Equity
and equality guidance for local maternity systems’ (NHSE, 2021) www.england.
nhs.uk/publication/equity-and-equality-guidance-for-local-maternity-systems/, we
have identified gaps in our data collection and service provision. Gaps that NW
London LMS is committed to close. We acknowledge that this will be a complex
journey and to do it properly will take time.
80%
of what impacts on
health inequalities
happens outside of
healthcare settings
4
Priority 1
Priority 1 reflects on how stakeholders in
maternity and neonatal services came together
to provide a coordinated response to the global
Covid-19 pandemic, enabling maternity services
to continue throughout. Adaptations to the way
we work and deliver care had ramifications that
continue to this day. A number of innovations,
specifically targeting those at increased risk of the
adverse effects of Covid-19 during the pandemic
were developed and have been maintained. This
includes online appointments such as antenatal
online open forums with midwives and doctors
to discuss topics of interest or concern, increased
social media presence and access to a modified
social prescribing intervention..
Priority 2
Actions taken and further plans in
development to mitigate against digital exclusion
are covered in Priority 2. This section includes
understanding how our population use and
interact with digital tools for health, and how
the LMS and ICS ensure that no person is left
disadvantaged because of the technology used to
deliver care.
Priority 3
Priority 3 is an analysis of where we are
at as a system in terms of our compliance of data
submission on ethnicity and deprivation to the
Maternity Systems Data Set (MSDS). Maternity
services across the eight boroughs covered by
North West London ICS are at differing levels
of digital maturity. With the establishment
of the ICS, in July 2022, and acute provider
collaborative, in September 2022, we expect to
see accelerated progress towards achieving our
digital ambitions. A maternity digital strategy,
aligned to ICS digital ambitions will be shared in
late autumn 2022.
Priority 4a
Addressing wider determinants of health
inequality is central to all our strategic work
streams, with a desire to drive and implement
meaningful change that makes a difference to
local women and our workforce. In Priority
4a, we look at our population demographic
including, ethnic diversity and levels of
deprivation. A community asset map commenced
in May 2022 and continues to be refined, as
we evolve our understanding of how maternity
services interact with existing community
agencies and networks. This enables holistic
care that encompasses interventions to support
the wider determinants of health. Workforce
inequalities are addressed through analysis of the
8 NHS Workforce Race Equality Standard (WRES)
indicators.
Priorities 4b-4e
In Priorities 4b to 4e we address how we
mitigate health inequalities for local women with
actions on prevention, treatment and education.
Over the coming five years, we expect more
participation in the design and development
of our services by those who use them. We
will breakdown organisational, cultural and
hierarchical structures to ensure that all barriers
to the receipt of high quality, safe maternity and
neonatal care for all are removed. For our staff,
we describe plans that aim to reduce conscious
and unconscious bias in the workplace and grow
a culture of mutual respect and inclusion for all.
Action plans are in place across the hospital trusts
5
in NW London to reduce race inequality and
create proportional representation of staff at all
levels of service.
How we work together as a system will be
crucial to achieving maternity equity and equality
ambitions for NW London. The foundations for
collaborative service design and delivery with
all our ICS partners are being laid. Perinatal and
Maternity Services are joining the local place-
based partnership forums to ensure alignment of
priorities across the system.
Priority 5
Priority 5 discusses how the LMS is
embedded into the ICB programme and
governance structure and how we envisage
future partnership working.
A lot of work has already been undertaken to
develop this formal strategy and align it with
the ambitions of the ICS. We see this as only
the start of a much greater vision. The need for
greater engagement and co-production with
our population and staff has never been more
apparent than in the current climate, as we
continue to work with employees and citizens to
keep them safe through the evolving Covid-19
pandemic. We know that understanding
the local population, maternal and perinatal
needs is not simply about having the data and
stating ambitions, but also about continuous
engagement with our people. We will
take the time to stop and listen
to the people’s voice to ensure
that it informs all areas of
maternity service, design
and delivery. The LMS
and ICS are committed
to further investment in
engagement activities in
order to ensure that action
taken towards reducing
inequalities is meaningful to
the population.
During the period from December 2021 to May
2022, work has been undertaken to improve
data analysis to help us better understand our
population’s health needs. Significant progress
has been made, yet there is more to be done. At
the end of every section within this report, there
is an ‘action box’ outlining what further actions
need to be undertaken. Progress against these
actions will be monitored monthly through the
NW London maternity cultural safety group.
The production of this report enables the system
to realise our baseline position, understand
where gaps are present and thus take directive
action towards reducing inequalities and inequity
in maternity services. The report tells us both
what we do and what we don’t know. The
pandemic years have highlighted the ability of
the NHS to rapidly respond to changing need.
Acutely aware of the internal pressures within
maternity and the wider NHS and externally from
changes in our society, the priorities laid out
here are subject to change. As we demonstrated
during the pandemic, NW London LMS is
adaptable and resilient to change.
This strategy will act an anchor
to ensure that equity and
equality is at the heart of
what we do, pointing us
in the right direction to
make systemic changes to
maternity service provision
that are equitable,
inclusive and responsive to
the needs of the population
we serve.
Work has been undertaken
to improve data analysis to
help us better understand our
population’s health needs.
6
Contents
North West London Integrated Care System and Local Maternity System
Executive Summary 3
Introduction 8
Aims 8
Values 8
Background to North West London Local Maternity and Neonatal System and
Integrated Care System 9
Priority 1: Restore NHS services inclusively 12
Intervention 1: continue to implement the Covid-19 four actions 17
Priority 2: Mitigate against digital exclusion 18
Intervention 1: Ensure personalised care and support plans (PCSPs) are available
in a range of languages and formats 18
Priority 3: Ensure datasets are complete and timely 25
Intervention 1: on maternity information systems continuously improve the data
quality of ethnic coding and the mother’s postcode. 25
Priority 4: Accelerate preventative programmes that engage those at greatest
risk of poor health outcomes 29
Priority 4a: Understand your population and coproduce interventions 29
Intervention 1: understand the local population’s maternal and perinatal health
needs (including the social determinants of health). 29
Intervention 2: Map the community assets which help address the social
determinants of health 46
Intervention 3: Baseline assessment of maternity and neonatal staff experience by
ethnicity priority 56
Intervention 4: Plan to co-produce interventions to improve equity for birthing people,
babies and race equality for staff 75
Priority 4b: Action on perinatal mortality and morbidity 80
Intervention 1: Implement maternal medicine networks to help achieve equity 80
Intervention 2: offer referral to the NHS Diabetes Prevention Programme to women with
a past diagnosis of gestational diabetes mellitus (GDM) who are not currently pregnant
and do not currently have diabetes. 87
continued...
7
...Contents
Intervention 3: Implement NICE CG110 antenatal care for pregnant women with
complex social factors 89
Intervention 4: implement maternal mental health services with a focus on access by
ethnicity and deprivation 91
Intervention 5: ensure personalised care and support plans are available to everyone 95
Intervention 6: ensure the MVPs in your LMS reflect the ethnic diversity of the local
population, in line with NICE QS167 99
Intervention 7: Additional intervention 102
Priority 4c: Action on perinatal mortality and morbidity 103
Intervention 1: implement targeted and enhanced continuity of carer, as set out
in the NHS Long Term Plan 103
Intervention 2: implement a smoke-free pregnancy pathway for mothers and their partners 107
Intervention 3: implement an LMS breastfeeding strategy and continuously improve
breastfeeding rates for women living in the most deprived areas 110
Intervention 4: culturally-sensitive genetics services for consanguineous couples 112
Recommendations/Actions 113
Priority 4d: Support for maternity and neonatal staff 114
Intervention 1: roll out multidisciplinary training about cultural competence in maternity
and neonatal services. 114
Intervention 2: when investigating serious incidents, consider the impact of culture,
ethnicity and language 117
Intervention 3: implement the Workforce Race Equality Standard (WRES) in maternity
and neonatal services 120
Priority 4e: Enablers 132
Intervention 1: Establish community hubs in the areas with the greatest maternal
and perinatal health needs 132
Intervention 2: work with system partners and the VCSE sector to address the social
determinants of health 134
Priority 5: Strengthen leadership and accountability 137
Action plan and high level time line October 2022 – April 2026 142
Conclusion 156
Appendix 1 Glossary 158
Appendix 2: List of organisations we work with 163
Appendix 3: Action plan 169
8
Aims
To improve:
• equity for mothers and babies from black, Asian and
mixed ethnic groups and those living in the most deprived areas.
• race equality for staff.
Priority 1:
Restore
NHS services
inclusively.
Priority 2:
Mitigate
against digital
exclusion.
Priority 3:
Ensure datasets
are complete
and timely.
Priority 4:
Accelerate preventative
programmes that
engage those at
greatest risk of poor
health outcomes.
Priority 5:
Strengthen
leadership and
accountability.
Introduction
The national maternity equity and equality guidance published by NHSE in
September 2021 set out two aims guided by three values and presents five
priorities. www.england.nhs.uk/wp-content/uploads/2021/09/C0734-equity-and-
equality-guidance-for-local-maternity-systems.pdf
Five priority areas
Proportionate
universalism
To ‘raise and flatten’ the
inequalities gradient,
universal action is needed
with a scale and intensity
that reflects need.
Collaboration
Achieving equity will require
unity and co-ordinated
effort across many
stakeholders, especially
to tackle the social
determinants of health.
Co-production
Interventions are more likely
to be culturally, socially
relevant and clinically
effective if parents and
staff work in partnership to
improve clinical quality.
Values
www.england.nhs.uk/wp-content/uploads/2021/09/C0734-equity-and-equality-guidance-for-local-maternity-systems.pdf
9
Background to North West London
Local Maternity System
North West London’s Local Maternity System (NW London LMS) covers
a population of over 2.1 million people across eight London boroughs
(WSIC, 2021).
The birth rate in NW London has declined (as predicted by ONS data) year on year since 2018/19. In
2021/22 there were 27,341 live births across the six maternity units encompassed within the NW London
ICS footprint. Pregnant women can choose where to give birth, subsequently not all births are to families
registered with GPs in NW London. However, within our geographical boundaries approximately 25,000
births a year, are to families registered with GPs in NW London. Extending across acute and community
provision, our maternity services are accessible for all, with the choice of birth at home, in a midwifery
led birth centre or on an obstetric led labour ward available at each of the six maternity units.
Established in January 2017 as a recommendation from the Better
Births Five Year Forward View for maternity www.england.nhs.uk/wp-
content/uploads/2016/02/national-maternity-review-report.pdf, the NW
London LMS brings together obstetric, midwifery and neonatal leads,
commissioners, service users and other stakeholders involved in the
provision of maternity and neonatal services. Recognising that neonatal
care is intrinsically linked to maternity services, the NW London LMS now
includes representation from neonatal services and has evolved into the
NW London local maternity and neonatal system (LMNS) in June 2021.
NW London LMNS is firmly established within the NW London
Integrated Care System. Maternity, recognised as a priority for the ICS
has a programme team to enable the LMNS to achieve its ambition to work collaboratively to deliver
high quality, safe services that are tailored to the needs of the population we serve. As the ICS evolves
we are developing stronger links with our colleagues in acute, primary and community settings and with
borough based partners.
NW London Integrated Care System
The NW London Integrated Care System (ICS) covers the eight boroughs of NW London and brings
together all health and care organisations working to deliver against the four core national objectives of
ICSs which are to:
Our ICS is currently led by an independent Chair, Penny Dash, and Chief Executive, Rob Hurd.
• Improve outcomes in population health and health care
• Prevent ill health and tackle inequalities in outcomes, experience and access
• Enhance productivity and value for money
• Support broader economic and social development
27,341
live births across the
six maternity units
in 2021/22
10
Integrated Care Board
The Integrated Care Board in North West London is called NHS
NW London. It is the statutory NHS organisation responsible
for developing a plan for meeting the health needs of the
population, managing the NHS budget and arranging for the
provision of health services in NW London. Now ICBs are legally
established, clinical commissioning groups (CCGs) have been
abolished.
We serve a population of over 2.1 million people who live across the eight boroughs of NW London.
We plan and allocate NHS resource to deliver a wide range of services including mental health services,
urgent and emergency care, elective hospital services, and community care.
NHS NW London takes on the NHS planning functions previously held by clinical commissioning groups
(CCGs) and is likely to absorb some planning roles from NHS England in the future.
Borough Based Partnerships
In NW London we have eight borough based partnerships bringing together the NHS, local authority and
other local partners in the delivery of local healthcare.
Maternity and neonatal services at NW London acute hospital trusts
There are four acute hospital trusts that provide maternity and neonatal services in NW London, located
across the system with six maternity units. The number of births at each unit varies between 3,000 and
5,700 per year. There are two level three neonatal units, three level two and one special care unit. Figure
1 shows the trusts and the number of births and level of neonatal care available at each hospital and
figure 2 shows the position of each maternity unit in NW London.
Acute provider trust Maternity unit
Annual number
of live births
(2021/22)
Neonatal care
provision
Chelsea & Westminster
Hospital Foundation Trust
(CWHFT)
Chelsea and Westminster Hospital 5,643 Level 3
West Middlesex Hospital 5,019 Special care
baby unit
Imperial College Healthcare
NHS Trust (ICHT)
Queen Charlotte’s and Chelsea Hospital 5,402 Level 3
St Mary’s Hospital 3,172 Level 2
London North West Hospitals
NHS Trust (LNWHT) Northwick Park Hospital 3,968 Level 2
The Hillingdon Hospitals NHS
Foundation Trust (THH) Hillingdon Hospital 4,137 Level 2
Total live births 27,341
We serve a population of over
2.1 million
people who live
across the eight boroughs
of NW London
Figure 1. Maternity and Neonatal Services in NW London
11
There are six hospital maternity
units in North West London
To find out more speak to your GP or a midwife
Hammersmith
& Fulham
Kensington
& Chelsea
21 City of
Westminster
3
Northwick Park Hospital
Maternity Department
Watford Road, Harrow, HA1 3UJ
020 8869 5252
www.lnwh.nhs.uk
Northwick Park or Kenton
Kenton
114, 182, 183,186, 223, H9, H10,
H14, H18, H19, N18
Hillingdon Hospital
Maternity Department
Pield Heath Road, Uxbridge,
Middlesex, UB8 3NN
01895 279471
www.thh.nhs.uk
Uxbridge or West Drayton
U1, U2, U3, U4, U5, U7 and via
Uxbridge Road 427, 607
Ealing
Hounslow
Hillingdon
Harrow
Brent
1
2
3
H
H
H
H
H
H
Queen Charlotte’s
and Chelsea Hospital
Maternity Department
150 Du Cane Road, London W12 0HS
020 3312 6135
www.imperial.nhs.uk
East Acton or White City
7, 70, 72, 95, 220, 272, 283, N7
Chelsea and Westminster Hospital
Maternity Department
369 Fulham Road, London, SW10 9NH
020 3315 6000
www.chelwest.nhs.uk
Earl’s Court or South Kensington
328, C3 from Earl’s Court Tube or 14,
414, 211 (from South Kensington), N31
West Middlesex University Hospital
Maternity Department
Twickenham Road, Isleworth,
Middlesex TW7 6AF
020 8321 5007 / 6420
www.westmidmaternity.org.uk
Hounslow East
Isleworth or Syon Lane
110, 117, 267, 235, 237, 481, H20,
H28, H37 and N9
St Mary’s Hospital
Maternity Department
Praed Street, Paddington, London, W2 1NY
020 3312 6135
www.imperial.nhs.uk
Paddington Station
Paddington Station
7, 23, 27, 36, 46, 205, 332, 436, N7,
N205
Figure 2: Geographical representation of maternity units across LMS area
12
Priority 1:
Restore NHS services inclusively
INTERVENTION 1:
Continue to implement the Covid-19 four actions.
Work is ongoing to address Priority 1 to ‘Restore NHS service Inclusively’, with
the ICB working collaboratively in close partnership with providers, colleagues
in public services, the voluntary sector, and with communities to increase the
scale and pace of the NHS action plan to tackle health inequalities and protect
those at greatest risk.
Women from black, Asian and ethnic minority
backgrounds have long been known to face additional
maternity risks, with maternal mortality rates significantly
higher than for white women. The Covid-19 pandemic
further highlighted stark health inequalities and urgent
action has been taken by NHS England (NHSE) to
recommend additional measures to protect expectant
mums, including increasing uptake of Vitamin D and
undertaking outreach in the neighbourhoods and
communities and have a lower threshold for referral,
MDT escalation and admission.
The four specific actions have been addressed collaboratively by the LMS, with local
variations allowing for local needs and specifications.
1.
Increasing support of at-risk pregnant women – e.g., Making sure clinicians
have a lower threshold to review, admit and consider multidisciplinary
escalation in women from a black, Asian and ethnic minority background.
All trusts are using the NW London antenatal and postnatal Covid-19 screening tool co-produced
collaboratively by NW London maternity voices partnership (MVP) and LMS. The tool increases service
user awareness of their individualised risks, which can be influenced by social, psychological, or physical
co-morbidities. It enables health professionals to ensure that all pregnant women receive individualised
risk assessments. The tool also emphasises that those who fall into high categories should be
opportunistically advised that they may be at higher risk of Covid-19 complications and should seek help
early if they are concerned about their health. The tool outlines specific high-risk categories to ensure
that clinicians are aware and escalate appropriately.
The Covid-19 pandemic
further highlighted stark
health inequalities and
urgent action has been taken
by NHS England (NHSE)
to recommend additional
measures to protect
expectant mums
13
Primarily directed at the attention of service users, the tool should be
completed by the service user and used to prompt conversation with
the healthcare provider at: booking, 28, 36, 40 weeks’ gestation, and
at every antenatal triage assessment or antenatal admission. Where
one or more risks are identified, the woman is given a ‘think covid,
think co-morbidities’ sticker to place on their notes to further alert.
The postnatal element of the screening tool is completed prior to
discharge from the maternity unit and placed with the discharge notes
for the community midwives.
At both London North West University Hospital (LNWUH) and Chelsea
and Westminster Hospital Foundation Trust (CWHFT), the screening
tool has been embedded within the antenatal notes for discussion
during booking and follow-up antenatal appointments. At the
Hillingdon Hospital NHS Trust (THH) and Imperial College Healthcare
NHS Trust (ICHT), the tools are available for clinicians to add to hand-
held notes.
In addition to the screening tool, all providers developed and implemented local Standard Operating
Procedures (SOP), that clearly state the escalation process for symptomatic and non-symptomatic
pregnant women. The SOP provides staff with guidance for Covid-19 screening and helps the clinician
act accordingly. All current guidance clearly states that clinicians should advise women of black and
Asian ethnicity that they are at higher risk of complications due to Covid-19 and to seek medical advice
early. In addition, it states that clinicians should apply a
low threshold for testing, reviewing, multidisciplinary team
(MDT) escalation and admitting women from black, Asian
or ethnic minority backgrounds who present with suspected
or confirmed Covid-19. The SOPs have localised pathways
of care and flowcharts to support clinicians in selecting
the most appropriate care for those affected by Covid-19
at each stage of their maternity episode (antenatal,
intrapartum, and postnatal).
All NW London maternity service providers recommend
the Covid-19 vaccination for service users and staff and
have been involved in sector-wide and regional initiatives
to increase uptake of vaccination. The Covid-19 recovery
and response plans are discussed, developed, reviewed, and
amended collaboratively by the LMS board monthly.
All NW London maternity service
providers recommend the
Covid-19 vaccination for service
users and staff
14
2. Reaching out and reassuring pregnant black, Asian and minority ethnic
women with tailored communications
During the first wave of the Covid-19 pandemic, the NW London Maternity Transformation Programme
(MTP) seized the opportunity to accelerate its support to the birthing community with a range of
interventions developed in partnership with the NW London MVPs. The LMS worked closely with all its
stakeholders to deliver not only tailored communication but also tailored services to women and families,
focusing specifically on those known to be at increased risk of Covid-19 co-morbidities.
Reduced fetal movement videos
In response to service user uncertainty about the availability of maternity services during the height of
the pandemic, an initiative started at LNWUHT and further developed by the LMS and MVPs created
video messages in 20 languages and British Sign Language to alert women to the need to seek medical
attention at any time, day or night, for reduced fetal movements. The videos were co-produced with
support from the London Perinatal Board (LPB) and distributed on social media and uploaded to clinical
commissioning group (CCG) provider, and primary care websites across the capital.
Healthy pregnancy
infographic
Working with service users in NW London,
LMS developed an infographic (figure 3) to
inform women about how to stay healthy
in pregnancy and beyond, including the
importance of vitamin supplementation,
hand hygiene, social distancing, healthy
diet, and exercise. The poster was printed
and distributed to children’s centres, GP
surgeries, maternity units, pharmacies and
posted on websites and social media sites
throughout the sector.
Figure 3 Example of peer lead tailored
communication, designed by service users for
service users.
15
Meet the Midwife virtual events
During the Covid-19 pandemic, to counteract increasing uncertainty, isolation, and reduced contact with
healthcare professionals, each of the maternity providers with their MVPs set up virtual online sessions
with midwives and obstetricians via a range of social media and video conferencing channels. The
events, covering a range of topics, proved popular and reached diverse groups of service users. Many of
these virtual forums continue today.
Supportive signposting
Based on the social prescribing model introduced into primary care in 2019 as a Long Term Plan initiative,
the LMS developed a modified version named ‘Supportive Signposting’ (SSP). This was launched to
counteract reduced contact with midwives during the pandemic. SSP is designed to support people
with a wide range of social, emotional, or practical needs. It can help to strengthen personal resilience
and reduce health inequalities by addressing the wider determinants of health, such as debt, poor
housing, and physical inactivity, by increasing people’s active involvement with their local communities. It
particularly works for people with long-term conditions (including support for mental health), for people
who are lonely or isolated, or have complex social needs which affect their wellbeing.
One year after inception, whilst still in the mists of the pandemic, an evaluation of the SSP service,
demonstrated there was a substantial uptake from black, Asian, and ethnic minorities. Further details
regarding this service are discussed in priority 4a, intervention 2.
NW London Post-Birth Contraceptive Service
The NW London Post-Birth Contraceptive Service
www.nwlondonics.nhs.uk/news/news/postnatal-
contraception-NW-London launched in early
2019, is a collaboration between sexual health
services, local authorities, commissioners, and
maternity service providers. Long-Acting Reversible
Contraceptives (LARCs), such as intrauterine devices/
systems (IUD/IUS) and subdermal implants (SDI),
are the most effective methods and can be inserted
immediately after childbirth. Practical training to
insert the devices occurred in all the trusts, with
a good uptake from all clinicians. In response
to women experiencing increased difficulty in
accessing the full range of contraceptives during
the pandemic, implementation of the service was
expedited to ensure that women were offered their
contraceptive of choice prior to leaving the hospital
after giving birth.
The NW London Post-Birth Contraceptive
Service launched in early 2019, is a
collaboration between sexual health
services, local authorities, commissioners,
and maternity service providers.
16
Managed quarantine services and Afghan evacuee response
In August and September 2021, NW London was at the epicentre of the managed quarantine service (MQS)
hotels and response to receiving evacuees from Afghanistan. Out of a total of 73 MQS hotels in England,
24 were based in NW London. It quickly became apparent that many families detained in quarantine
required maternity care, both acute and advisory. The MTP coordinated a response that provided tailored
communication for new arrivals. Information packs detailing how and when to access services were
distributed to all hotels. Community midwives, accompanied by interpreting services were mobilised to attend
where required, with transfers into maternity units arranged for service users requiring acute care. Many
families arrived in England without essentials. The response package included the distribution of nappies,
clothes, and new-born equipment (prams, sterilising kits, slings etc) to those in need.
The provision of tailored and individualised communication continues to be a priority in NW London. All
our maternity and neonatal services have increased their use of interpreting services and are exploring
innovative models of improved communication. Regular online Q&A sessions with midwives continue and
Maternity Voice Partners (MVPs) are working hard to reach out to those known to be at increased risk of
adverse outcomes.
Our experience during the pandemic demonstrated that
NW London LMS has the capabilities and resilience to
rapidly mobilise to changing needs. Information and
guidance regarding Covid-19 continues to be updated
on websites, social media and via the Mum and Baby
app, which is being translated into alternative languages.
We remain prepared for further mobilisation should it be
required.
3. Ensuring discussions about vitamins, supplements and nutrition in
pregnancy are taking place with all women. Women with low vitamin D
may be more vulnerable to coronavirus so women with darker skin or those
who always cover their skin when outside may be at a particular risk of
vitamin D insufficiency and should consider taking a daily supplement of
vitamin D all year.
People of black, Asian and minority ethnic backgrounds with melanin-pigmented skin and those who
cover their skin whilst outside are at an increased risk of developing vitamin D deficiency. The current
UK NHS advice www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/ recommends
vitamin D supplementation to all pregnant women from black, Asian and minority ethnic backgrounds.
NW London clinicians, midwives, GPs, and obstetricians routinely discuss the importance of vitamin D
supplementation. All guidelines alert professionals to the need for those who are pregnant and breast-
feeding and from black, Asian, and minority ethnic backgrounds to take a higher dose of vitamin D
supplement. Clinicians will offer testing to those who present as symptomatic of vitamin D deficiency at
any stage of pregnancy. The LMS have released communication on vitamin D prophylaxis to reiterate the
importance of maintaining an adequate vitamin D level during pregnancy and breastfeeding via the ‘NW
Our experience during the
pandemic demonstrated that
NW London LMS has the
capabilities and resilience
to rapidly mobilise to
changing needs
17
London Covid-19 Screening tool’ and healthy pregnancy infographic. In addition, midwives encourage
women to sign up for the Healthy Start scheme www.healthystart.nhs.uk/ that supplies vitamins for free.
NW London sector-wide guidelines for Vitamin D testing and supplementation advise testing for vitamin
D deficiency only if symptomatic. However, London North West University Hospital Trust (LNWUHT)
has introduced routine vitamin D testing at booking for all service users, enabling those who have low
vitamin D to receive a higher dose prescription before becoming symptomatic and severely deficient.
THH, ICHT, and CWHFT aspire to introduce similar policies and are working with the NW London ICB
medicine management team to develop revised sector-wide guidelines to this effect should the audit
from LNWUHT be favourable to the change in policy.
4. Ensuring all providers record on maternity information systems the
ethnicity of every woman, as well as other risk factors, such as living in a
deprived area (post code), co-morbidities, BMI and aged 35 years or over,
to identify those most at risk of poor outcomes.
Recent Maternity System Data Set (MSDS) submissions from all NW London maternity service providers
demonstrate Clinical Negligence Scheme for Trusts (CNST) compliance regarding deprivation, co-
morbidities, BMI, age, ethnicity or complex risk factors. Maternity services in NW London are developing
a digital strategy that will address further improvements required to improve data capture, accuracy and
our use of data intelligence.
Action
Priority 1 : Restore NHS services inclusively
Intervention 1:
continue to implement
the Covid-19 four
actions.
Fully embed the Covid-19 screening tool both the antenatal and
postnatal elements at all units
Audit Covid-19 screening tool for effectiveness
Evaluate impact of tailored communications – healthy pregnancy
poster, reduced fetal movement videos
Evaluate impact of routine vitamin D testing for all pregnant women at
LNWUHT
In collaboration with Primary Care and Medicine Management develop
standardised NW London agreement for testing and treatment of
vitamin D deficiency in pregnancy
Work with providers to improved capture of ethnicity and derivation
status and reporting on maternity IT systems
18
Priority 2:
Mitigate against digital exclusion
INTERVENTION 1:
Ensure personalised care and support plans (PCSPs) are
available in a range of languages and formats
NW London LMS is committed to offering its population the flexibility of digital
and face to face consultations. Our aim is to ensure that evidenced based,
meaningful discussions with a clinician in either digital or personal interactions
is available for those using our services and that a risk assessment, at each
consultation occurs and an outcome documented.
Service users are provided with information in both
paper and digital format via a range of sources and in
a range of languages. Translation services are available
and widely used in all maternity units and community
midwifery settings. Evaluation of all our services is
important to assure quality of provision and is central
to exclusivity and personalised care for families.
The need for personalised care in maternity services
is a core recommendation in the Better Births report
Our aim is to ensure that
evidenced based, meaningful
discussions with a clinician
in either digital or personal
interactions is available for
those using our services
19
(2016) and the NHS Long Term Plan (2019). In March 2021,
the NHS published a personalised care and support planning
(PCSP) guidance for LMS
www.england.nhs.uk/wp-content/uploads/2021/03/B0423-
personalised-care-and-support-planning-guidance-for-lms.pdf
focusing on various aspects, including the availability of PCSPs
in different languages. This national guidance and the NW
London ICB strategy on personalised care are explored more
in priority 4b intervention 5.
NW London ICB is highly motivated to develop a robust digital
strategy to act on reducing inequalities, support digital inclusion and obtain accurate data to understand
deprivation and ethnicity within our population. The maternity digital strategy is a vital element of
the wider ICB strategy of working in partnership with LMS and MVPs. The strategy is based on the
NHS plan for digital health and social care www.gov.uk/government/publications/a-plan-for-digital-
health-and-social-care/a-plan-for-digital-health-and-social-care, published in June 2022 in conjunction
with the maternity transformation programme digital work stream. The strategy includes solutions for
interoperability and accessibility to the wider population and considers solutions for those most in need.
The digital strategy is currently in development and will be submitted to NHSE in October 2022.
As described in priority 4a, the population of NW London is diverse, with ethnic minority groups
accounting for over 50% of the total population in some of our localities.
NW London ICB was awarded funding as part of the ‘Addressing Digital Inequalities in Clinical Pathways’
programme. This funding was used in partnership between CNW London’s Digital Innovation Group and
West London NHS Trust to conduct a mapping of the types and extent of digital exclusion across the
North West London region. Out of a NW London population of 2.1 million, they found that:
• Approximately 110,125 adults (6.6%) are offline (ONS,
2017-2020) – that is to say they have never used the
internet, or last used it over 3 months ago.
• 314,000 adults (19%) lack at least some ‘Essential Digital
Skills for Life’, of whom around a third (32%) are aged over
65 years old (101,943)
• 77,200 adults (5%) do not have ‘Foundation digital skills’
including the ability to turn on a device, connect to a safe
and secure Wi-Fi, or use the controls of a device.
• 286,000 (18%) adults have no smartphone in their
household.
• 83,000 (5%) adults do not have any of the main
computing devices in their household.
• 86,900 (5%) adults have no internet connection at home.
• 170,000 internet connections are at speeds below
Superfast Broadband (14.4%), and 56,420 (4.8%) are under 10Mbps.
286,000
18% adults have
no smartphone
in their household
77,200
adults (5%) do not have
‘Foundation digital skills’
including the ability to
turn on a device or connect
to a safe and secure Wi-Fi
20
Additional work is ongoing in each borough to address digital exclusion and digital poverty that has been
brought into the spotlight by the Covid-19 pandemic.
The data in the table below highlights pregnant women living in the lowest decile of the index of
multiple deprivation (figure 5). It is apparent that the majority of maternity service users in the NW
London localities fall into the 3rd to 6th deprivation decile. This correlates to income from £6,569 to
£19,706 (figure 6).
NW London collaborated with
the national Citizen Online charity
www.citizensonline.org.uk/ to
conduct research into geographical
prevalence of digitally excluded
people in NW London. The research
estimated that the areas of highest
digital exclusion are to be found
within;
• southern parts of Brent
• northern parts of Westminster
and Kensington & Chelsea
• Stanmore Park in Harrow
• western parts of Ealing.
These areas are highlighted with
pink boundaries in figure 4.Figure 4: Areas of high prevalence of digital exclusion by pink boundaries
Figure 5
Count of pregnancies by index of multiple deprivation decile North West London 2020 to 2021
0
2,500
5,000
7,500
10,000
12,500
1 2 34 56789 10
IMD Decile
Count of pregnancies by index of multiple deprivation decile North West London 2020 to 2021
21
Majority of maternity service users ranked by correlation to income in NW London
Maternity services - Decile correlation by income (highlights show where majority of NW London
maternity service users are).
Decile Decile description Ranks
1 10% most deprived 1 to 3,284
2 10% to 20% 3,285 to 6,568
3 20% to 30% 6,569 to 9,853
4 30% to 40% 9,854 to13,137
5 40% to 50% 13,138 to 16,422
6 50% to 60% 16,423 to 19,706
7 60% to 70% 19,707 to 22,990
8 70% to 80% 22,991 to 26,275
9 80% to 90% 26,276 to 29,559
10 10% least deprived 29,560 to 32,844
Figure 6 Source: English Indices of Deprivation 2019 (IoD 2019)
www.gov.uk/government/statistics/english-indices-of-deprivation-2019
The data in table below (figure 7) shows internet usage per household in each NW London local
authority over the course of the last four years from 2017-2020. The next table (figure 8) shows the
percentage of households who never used internet. The final table (figure 9) shows ethnicity of users
with Bangladeshi households having the least amount of usage followed by White, then Pakistani.
Percentage of individuals who have used the internet in the last 3 months prior to data collection.
2017 2018 2019 2020
Westminster 91.5 93.9 85.9 90.7
Kensington & Chelsea and
Hammersmith & Fulham
95.6 95.8 97.1 94.1
Brent 85.6 93.4 90.2 96.7
Ealing 93.8 93.7 94.7 95.2
Harrow and Hillingdon 91.6 88.4 92.9 91.2
Hounslow and Richmond upon Thames 93.9 95.6 92.8 92.9
Figure 7. Source. (ONS April 21)
22
Percentage of individuals who have used the internet over three months ago/never used prior
to data collection.
2017 2018 2019 2020
Westminster 8.5 5.4 14.1 9.3
Kensington & Chelsea and
Hammersmith & Fulham
4.4 4.2 2.9 5.9
Brent 14.4 6.6 9.8 2.6
Ealing 5.8 6.3 5.3 4.8
Harrow and Hillingdon 8.4 11.6 6.9 7.9
Hounslow and Richmond upon Thames 5.4 4.4 7.2 7.1
Figure 8
Percentage of individuals by ethnicity who use the internet.
Persons aged 16 years and over %
Used in the last 3 months Used over 3 months ago/never used
Lower
limit
Survey
estimate
Upper
limit
Lower
limit
Survey
estimate
Upper
limit
White 91.3 91.6 91.9 8.0 8.3 8.6
Mixed/multiple
ethnic background
98.2 99.2 - - 0.7 1.6
Indian 94.9 96.3 97.8 1.9 3.3 4.7
Pakistani 89.2 91.7 94.3 5.6 8.1 10.7
Bangladeshi 83.1 87.8 92.6 7.0 11.7 16.4
Chinese 95.1 97.6 - - 2.4 4.9
Other Asian
background
94.9 96.8 98.7 1.2 3.0 4.8
Black/African/
Caribbean/Black
British
93.9 95.4 96.9 3.1 4.6 6.1
Other ethnic group 96.2 97.6 99.1 0.9 2.4 3.8
Source. (ONS April 21) figure 9
The next step is to identify maternity service users within our boroughs and provide them with necessary
support to facilitate the best use of digital tools and systems. Initially, we are prioritising the availability
of Personalised Care Support Plans (PCSPs) in a range of languages and formats, including multiple
language hard copy for those experiencing digital or language exclusion.
23
The award winning Mum and baby (M&B)
www://mumandbaby.uk/ mobile application, created by NW
London LMS, is being translated into the top five languages
across our sector (Arabic, Romanian, Hindi, Somali and
Guajarati). In addition the Mum & Baby website launched in
September 2022 enabling wider access for those without hand-
held digital devices, including increased accessibility for staff in
clinical settings. Content on the website can be translated into
any language using web based translation tools.
Parts of the mobile app and website can be downloaded and
printed for those who prefer or require hard copies. The app
is Web Content Accessibility Guidelines (WCAG) compliant, which requires digital communications be
designed in a format that accommodates accessibility needs for those with cognitive limitations and
disabilities including partial sight loss, photosensitivity, hearing loss and learning disabilities.
To facilitate ease of access and improved patient experience, we are developing a pilot
interface between M&B app and Patient Know Best (PKB)/Care Information Exchange (CIE).
The CIE platform facilitates personal access of medical records and is available to the NW London
population. It will be used as the ‘front door’ to all mobile applications used and suggested across the
NW London ICS. All applicants will have the ability to log into these applications via their PKB login and
the PCSPs for pregnant women will be available for the multidisciplinary team to review. This pilot will be
implemented towards the end of 2022.
The need for high quality translation services is key to improving communication and ensures information
is safely understood during decision making and risk assessment. A planned three month pilot to use
a digital translation service tool will start in the next quarter in combination with expanding existing
translating services. This is described in section 4 intervention 2.
In early 2022, NW London Maternity units and the LMS digital team secured a budget via the Unified
Tech funding with a view to upgrading the maternity digital infrastructure across the sector. This included
maternity information systems and digital tools such as remote diabetic monitoring. This will facilitate
wider accessibility and improve data quality. The newly appointed digital transformation lead will address
each priority with an equality and equity lens.
In conjunction with Brent Council and neighbourhood services, NW London ICB performed a pilot during
the Covid-19 outbreak where they distributed mobile devices and provided advice for any problems with
internet connectivity. The focus was to support people participating in substance misuse programmes.
The pilot was well received and found to have positive effects. All of the participants engaged actively
and took part in their treatment plans. Therefore, part of future actions will be for the LMS to collaborate
with Local Authorities to investigate potential participation of maternity services in similar schemes.
Additionally, the four NW London trusts have in place an action plan to implement Maternity Continuity
of Care (MCoC) targeting those in the areas of highest deprivation, from black, Asian and minority
ethnic groups and those at greater risk of poor outcomes in pregnancy and birth. An enhanced model of
care will be available to these groups. The teams delivering MCoC will bridge communication gaps with
these communities and provide the personalised care that they need.
NW London Maternity units
and the LMS digital team
secured a budget via the Unified
Tech funding with a view to
upgrading the maternity digital
infrastructure across the sector
24
Data shows the majority of the NW London population are digitally literate, with more than 90% having
access to and use of the internet. Internet connectivity and provision is good across the boroughs.
However, pockets within the population have been identified as being at risk of being digitally excluded
and therefore action will be taken to remedy this with future interventions.
NW London ICB identified 3 priorities areas and defined objectives to ensure digital inclusion (figure 10).
Priority Areas Objectives
Digital exclusion
mapping exercise
Identify a target population of people that remains digitally excluded
in our local communities. This analysis will inform our digital clinical
pathways. Undertake analysis of those that a) have not been reached
through the various programmes and b) those that do not want to or
cannot engage
• For maternity: identify the maternity service users, support MCoC
teams to understand the needs
Digital online
Directory
Share digital Inclusion resources for front-line staff to signpost residents to
digital solutions in their local areas
Digital champion
model
Develop and implement a digital champion model – replicate model use
in Brent who has a target to recruit 500 digital champions. Develop a
Digital Training pack to increase motivation and skills development based
on needs assessment
Figure 10
The Maternity Digital Programme Delivery manager will lead on the digital agenda and be part of the
ICB Digital Inclusion steering group. Key priorities for the group include aims to sustain solutions already
implemented and find new innovations to limit and mitigate digital exclusion.
Actions
Priority 2 : Mitigate against digital exclusion
Intervention 1: Ensure
personalised care and
support plans (PCSPs)
are available in a range
of languages and
formats
Identify maternity service users facing potential digital exclusion areas
and provide the necessary support to facilitate best use of digital tools
and systems.
Share digital inclusion resources for front-line staff to signpost residents
to digital solutions in their local areas
Develop and implement a digital champion model
25
Priority 3: Ensure datasets are
complete and timely
NHS Resolution is in year four of the Clinical Negligence Scheme for trusts
(CNST). Known as The Maternity Incentive Scheme (MIS), CNST is designed
to support the delivery of safer maternity care by incentivising providers to
implement safety actions. Compliance results in a discounted clinical negligence
insurance premium for the acute provider Trust and system.
All NW London maternity services are members of the CNST and working
towards full compliance. To achieve compliance the trusts need to demonstrate
that they are achieving 10 safety actions. Safety action 2 asks providers to
demonstrate that they are submitting data to the National Maternity Services
Data Set (MSDS) to the required standard, complete and timely. To provide
evidence of compliance NHS Digital produce quarterly scorecards which are
reviewed by the NW London LMS digital sub-group. Intervention 1 relates to
analysis of NW London LMS latest (August 2022) scorecard results.
INTERVENTION 1: on maternity information systems
continuously improve the data quality of ethnic coding
and the mother’s postcode.
As part of CNST Safety Action 2 trusts are required to meet 7 criteria. The table (figure 11) below shows
the standards required including the timing for when the data should be captured.
Score Standard Where to cleanse
1 Digital Strategy in place by October 2022 In progress
2 CQIMs – Trust Boards assure themselves that at least 9 out of the
11 Clinical Quality Improvement Metrics have passed in the MSDS file
Antenatal (smoking data)
and Delivery data
3 BMI – July submission contained 90% height and weight data All records reaching
16 weeks in July
4 CSF – July submission contained 95% Complex Social Factor Booking Data
5 PCSP – July submission contained 95% antenatal personalised care
plans completed of women booked in the month.
Booking Data
6 Ethnicity – July submission contained 90% valid ethnic category for
women booked in Month. ‘Not stated’, ‘missing’ and ‘not known’ are
not valid records
Booking Data
7 MCoC • 5% of antenatal care plans in place (recorded at 29/40)
• 5% have a care professional ID and Team ID have been provided
• 70% of CoC records have a valid Care Professional Local
Identifier recorded
All those who reach
29 weeks in the reporting
month
Figure 11
Trusts need to
demonstrate that
they are achieving
10
safety
actions
26
Scorecard analysis, standard for criteria 7 ,Clinical Quality Improvement Metrics (CQIMs) based on trusts
monthly submissions via their Maternity Information systems (figure 12).
Criteria
1
Criteria
2
Criteria
3
Criteria
4
Criteria
5
Criteria
6
Criteria
7
Midwifery Continuity of
Carer (MCoC)
Criteria
7
Results
Digital
Strategy
BMI Complex
social
factor
PCSP Ethnicity COC_DQ04
Antenatal care plan
MCoC
(Midwifery
Continuity of
Carer)
CQIMs
Achieved
COC_DQ05
Named lead midwife
and team ID
COC_CareProfLID
Valid Care Professional
Local Identifier
This is the
combined
results of
COC_DQ04,
COC_DQ05
and COC_
CareProfLID
Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No COC_
DQ04
Yes/No
COC_
DQ05
Yes/No
COC_
CareProfLID
Yes/No
Yes/No Achieved
Out of 6
Criteria 2
CQIMs - Trust Boards to assure themselves that at least 9 out of 11 Clinical Quality Improvement Metrics (CQIMs)
have passed for July 2022 data
CQIM
Apgar
CQIM
Breastfeeding
CQIM
PPH
CQIM
Preterm
CQIM
Robson01
CQIM
Robson02
CQIM
Robson05
CQIM
Smoking
Booking
CQIM
Smoking
Delivery
CQIM
Tears
CQIM
VBAC
(Yes/No) (Yes/No) (Yes/No) (Yes/No) (Yes/No) (Yes/No) (Yes/No) (Yes/No) (Yes/No) (Yes/No) (Yes/No)
Figure 12
27
The table below shows the scorecards for 2021-2022, figure 13.
Organisation Name
Oct
2021
Nov
2021
Dec
2021
Jan
2022
Feb
2022
Mar
2022
Apr
2022
May
2022
London North West University
Healthcare NHS Trust (LNWUHT)
4 4 4 4 4 4 5 6
The Hillingdon Hospitals
NHS Foundation Trust (THH)
2 2 2 2 3 3 3 3
Chelsea and Westminster
Hospital NHS Foundation Trust
(CWHFT)
5 5 5 1 4 4 5 4
Imperial College Healthcare
NHS Trust (ICHT)
2 2 4 3 4 4 4 4
Figure 13
LNWUHT has been gradually improving their
data quality and submissions scoring 6 out
of 6 for May 2022. THH is in the process of
upgrading their local maternity IT system,
technicalities in this process has contributed
to consistently low scores. CWHFT is in
transition and are in the process of changing
their maternity system. They are aware of
their issues and they will be tackled with the
new system. ICHT has been scoring 3 & 4
due to broken communication between the
IT systems. Their maternity IT system supplier
is aware and has been working to resolve
the issue by the end of October 2022.
Specifically the areas that scored low for in
May are shown (figure 14).
28
Table 2. Clinical quality improvement metrics NW London trusts are scoring low
The Hillingdon
Hospitals
NHS Foundation
Trust
Criteria 2
CQIMs
Achieved
Criteria 3
BMI - July 2022 data contained height and
weight data, or a calculated Body Mass
Index (BMI), recorded by 15+0 weeks
gestation for 90% of women reaching
15+0 weeks gestation in the month
Criteria 5
PCSP - July 2022 data
contained antenatal
personalised care plan
fields completed for 95%
of women booked in the
month. (MSD101/2)
Chelsea and
Westminster
Hospital NHS
Foundation Trust
Criteria 2
CQIMs
Achieved
Criteria 7
MCoC (Midwifery Continuity of Carer)
This is the combined results of COC_
DQ04, COC_DQ05 and COC_CareProfLID
Imperial College
Healthcare
NHS Trust
Criteria 2
CQIMs
Achieved
Criteria 7
This is the combined results of COC_
DQ04, COC_DQ05 and COC_CareProfLID
Figure 14
NWL LMS has a monthly Digital and Data meeting to monitor MSDS Trusts’ submissions and review
action plan progress. Our priority is to improve maternity IT systems to ensure high quality data capture
and analysis for the national MSDS and local reporting requirements. How this will be achieved will be
described in the maternity digital strategy that is currently being developed and due for submission in
October 2022.
Actions
Priority 3: Ensure datasets are complete and timely
Intervention 1:
on maternity
information systems
continuously improve
the data quality of
ethnic coding and the
mother’s postcode
Develop and Submit NWL Maternity Digital Strategy
Enhance MSDS submission and the accuracy of the data by
implementing a new process prior the final submission.
Upgrade maternity IT systems
Regular data quality checks via LMS digital meeting
To capture data on MCoC teams, deprivation and ethnicity. Monitor
quality and progress with monthly dashboard check and MSDS
submissions
29
Priority 4:
Accelerate preventative
programmes that engage
those at greatest risk of poor
health outcomes
Priority 4a: Understand your population and
coproduce interventions
INTERVENTION 1:
Understand the local population’s maternal and perinatal
health needs (including the social determinants of health).
Methodology
Using data from Whole System Integrated Care (WSIC) data set, we know that of a total population of
2.1 million, there are currently 869,426 females of childbearing age registered with GPs in NW London
and an estimated 24000 to 28000 pregnant people in NW London in any given period. WSIC only
provides real time data, not retrospective data: data was downloaded on NW London residents who are
currently pregnant or of childbearing age between May to September 2022.
To better understand change over time, an analysis of pregnancy and birth data over a ten-year time
frame was commissioned by the Applied Research Collaboration (ARC) NW London www.arc-nwl.
nihr.ac.uk/home to establish trends in pregnancy and birth across the NW London sector. With the
capabilities available from WSIC combined with data provided by ARC, a health needs analysis was
undertaken. At the time this analysis was undertaken, in May 2022, WSIC recorded 24,597 pregnant
people in NW London. This does not account for people using maternity services in NW London who are
not registered with GPs in NW London. Where data has come from alternative sources, this has clearly
been stated.
Pregnancies & birth rate
Since 2010, there has been a progressive decrease in pregnancy rates in NW London. Peak pregnancies
in NW London were 37,424 in 2010, but this figure dropped to 27,409 by 2021.
Outer boroughs in NW London make up the largest proportion of pregnancies and live births, a trend
that remains the same across the past decade. In 2021, the outer boroughs of Hillingdon, Harrow, Brent,
Ealing, and Hounslow made up 78.6% of the total pregnancies and 81.8% of live births, whereas inner
boroughs Westminster, Hammersmith and Fulham, Kensington and Chelsea make up 21.4% of the total
pregnancies and 18.2% of live births in NW London (figure 17 and 18).
30
0
20,000
30,000
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
10,000
Brent
Ealing
Hammersmith and Fulham
Harrow
Hillingdon
Hounslow
Kensington and Chelsea
Westminster
Year
Count
The downward trend in pregnancy and birth is not unexpected. The heat maps show where pregnancy and
birth rates are concentrated (figure 18). Maternity and children services need to map and address the changing
pregnancy and birth rates of the population it serves to ensure that there is adequate provision of services.
Figure 18
Figure 17 Count of pregnancies annually North West London 2010 to 2021
Rate of
pregnancies per
1,000 population
by ward of
residence
Proportion of total
NWL pregnancies
by ward of
residence
2020-212018-19
31
Ethnicity & diversity
The population of NW London is ethnically diverse. The map below shows population numbers in each
borough with percentage of black, Asian and minority ethnic (figure 19).
Figure 19 Source: North West London Health and Care Partnership
At present, the largest single cohort of pregnancies in NW London is to women of white ethnicity,
accounting for 42.9% of total pregnancies. The second-largest cohort is made up of women of Asian
and Asian British ethnicity, with 32.7%.
In total, minority ethnic pregnant women accounted for
56.3% of all pregnancies in the sector. The borough of Brent
has the highest proportion of ethnic minorities. NW London
is more ethnically diverse than the UK in general, with 22%
recorded as Asian or Asian British, 9% as mixed ethnicity,
6% as black or black British, 26% white, 36% unknown,
and 1% other (Bottle et al, 2020 bmcmedinformdecismak.
biomedcentral.com/articles/10.1186/s12911-020-1082-7).
The UK population is 87% white, 4% Asian or Asian British
and 3% black or black.
Apart from Hillingdon, Harrow, and Hounslow, the single largest cohort of pregnancies in NW London in
2018-19 and 2020-21 was to pregnant people of white ethnicity as the graphs below show
(figure 21). Pregnant people from white ethnic categories had 63.4% of pregnancies in Hammersmith
and Fulham, 60% in Kensington and Chelsea, 53.4% in Westminster, 39.4% in Ealing, and 36.1% in
Brent. In Harrow, Hounslow, and Hillingdon, Asian or Asian British pregnant people make up the largest
group at 42.7%, 42.4%, and 41.2%, respectively.
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