The Health and Care Overview and Scrutiny Committee met to discuss the potential closure of intrapartum services at two community hospitals, and to review the System Operational Plan for 2025-26. The committee approved a memorandum of understanding regarding substantial variations to health services, and agreed to a work programme for future meetings.

Intrapartum Services Review

Jenny Brown, Lead Midwife for Maternity Transformation at Staffordshire and Stoke-on-Trent ICB, opened the discussion by explaining that the public consultation on the suspension of birthing services at the Samuel Johnson Community Hospital in Lichfield¹ and the County Hospital in Stafford began on 12 May and would run until 3 August. The services were originally suspended in March 2020 due to staffing issues during the COVID-19 pandemic.

Ms Brown emphasised that antenatal and postnatal care would continue at both hospitals, regardless of the outcome of the consultation. She also noted that midwifery-led care would still be available at the Royal Stoke University Hospitals and Queen's Hospital Burton. Home births, which were reinstated in 2024, are also on the rise.

Councillor Ann Edgeller raised concerns about the increasing population in the Stafford area and asked whether this would be taken into consideration. Ms Brown confirmed that birth rate projections, a national tool for calculating midwifery staffing levels, would be used. However, she noted a steady decrease in birth rates nationally, alongside an increase in the complexity of births.

Councillor Colin Greatorex said that the experience mothers receive at smaller hospitals is very different to larger hospitals, and that this is not reflected in the figures. He gave an example of his experience at Queen's Hospital in Burton, where there were not enough midwives available. He said that the prenatal midwives at Samuel Johnson were the same people delivering the babies, which gave mothers more comfort, confidence and familiarity.

Sarah Noble, Director of Midwifery at UHDB, responded that the trust always takes into consideration the safety of mother and baby, and a good experience. She said that the number of women eligible for freestanding-led birth, alongside-led birth, and home birth is dropping, and that this changes the number of women that would be eligible to use these services.

Councillor Tracey Dougherty asked when the consultation would finish, whether the committee would have further input before a decision was made, and what the situation was regarding midwife training. Tracy Hsu in, Director of Corporate Governance for the Staffordshire and Stoke and Trant Integrated Care Board, clarified that the consultation would finish on 3 August, after which the feedback would be independently analysed and a report published. The report would then be used to inform a decision-making business case, which would be presented to the ICB board at a public meeting.

Councillor Matthew Wallens raised concerns about the cost of travelling to alternative maternity services for those without their own transport. He asked whether the panel agreed that local maternity services would be great for people, especially in the current cost of living crisis. Ms Brown responded that the ICB wanted to keep care as close to home as possible, but had to ensure that it was equitable for all women, and clinically and financially viable.

Councillor Jill Hood shared negative experiences she had heard from women who had given birth at the UHNM, including stories of a lack of staff and missed complications. She urged the panel to publicise the consultation more widely.

Councillor Steven Norman said that the report indicated that reinstating services at Samuel Johnson was not a viable option. He also questioned the need for a national inquiry into maternity services, given previous reports on the issue. Ms Brown responded that an optional appraisal in 2023 reviewed seven proposals, and that reinstating freestanding midwifery birthing units was not considered viable due to low numbers of eligible women.

Councillor Wallens asked what the alternative was for people who could not get to other hospitals, and said that Litchfield is a city and should have local services. Ms Noble responded that the safest place for women with medical complications to give birth was in a consultant-led unit, and that there are midwifery-led services at Queen's Hospital in Burton. She also said that home birth is considered the safest option for low-risk women with second or subsequent pregnancies.

Councillor Neil Parton asked whether there was any other way for people to access information about the consultation, given that not everyone is computer literate. Ms Brown responded that paper copies were available, and that the communications team was reaching out to specific groups, especially those with language barriers.

Councillor Wayne Luca asked what would happen when the remaining units reached capacity. Ms Noble responded that the ICB was constantly reviewing the situation, but that birth numbers were currently decreasing. She added that there was ongoing work to bring more antenatal services into the community.

Vice Chair Charlotte Kelly raised concerns about the equipment needed to support births, and asked how this would be dealt with in a finite space. Ms Noble responded that the freestanding midwifery-led unit had been closed since COVID-19, and that this had not significantly impacted acute services.

System Operational Plan 2025-2026

Claire Finn, Interim Chief Finance Officer, presented the System Operational Plan for 2025-2026. She said that the plan incorporated national and local priorities, and focused on delivering the three strategic shifts linked to the 10-year forward plan: moving care into the community, maximising the use of digital technology, and shifting from treatment to prevention.

Ms Finn acknowledged that it would be a tough financial year, despite a 4% uplift. The plan assumes receipt of £95 million in deficit support funding, and requires savings of £306 million. She added that ICBs would need to reduce running costs by 50% by the end of quarter three, and that the target running cost of the ICB would move to £18.76 per head of population.

Ms Finn highlighted a range of programmes of work to transform care, including investments in neighbourhood programmes, virtual wards, community diagnostic centres, shared care records, and smoking, alcohol and addiction services. She also noted that the ICB was aiming to achieve 100% mental health support teams, expanding crisis text lines and talk-in therapy services, and investing in community adult forensic teams. Despite these investments, out of area placements for mental health services were continuing to rise.

Councillor Norman asked why the slides had not been provided in advance of the meeting, and requested a glossary of terms used by the ICB. Ms Finn apologised for the font size on the slides, and said that a glossary would be circulated.

Councillor Wallens raised concerns about planned reductions in expenditure on section 117 aftercare² and delays to planned investment for mental health services, as well as the removal of independent sector services for diagnosing and managing ADHD³. He asked how the ICB could assure that these changes would be properly managed, and whether it would accept accountability if suicide rates increased as a result.

Ms Finn responded that the NHS had a target to increase investment in mental health services by 4%, and that the ICB was focusing its investment on community services. She added that the ICB was working in partnership with local authorities to review section 117 care packages, to ensure that they were appropriate and that resources were being used efficiently.

Councillor Luca asked about plans for the mental health unit next to Sir Robert Peel Hospital, which has been closed for years. Ms Finn responded that a decision had been made to close the George Bryan Centre after it was destroyed by fire in 2019, and that the money had been reinvested in community services.

Councillor Greatorex said that the operational plans did not demonstrate how the savings of £306 million and the reduction of 1098 whole time equivalent staff would be achieved. He added that there were six bullet points where there was non-compliance or things going the wrong way. Ms Finn responded that the focus was on reducing the corporate workforce, and that workforce plans had been developed to ensure that constitutional standards could be delivered.

Councillor Hood said that the wording of the consultation gave the impression that it was only about the County Hospital in Stafford and the Samuel Johnson Community Hospital in Litchfield. She also raised concerns about the impact of cuts on hospitals with the largest number of beds. Ms Finn responded that the consultation was about the freestanding midwifery birthing units, and that no decision had been made at this point.

Councillor Dougherty asked how many of the surplus midwives would receive placements if the units were closed, given the NHS's need to save £300 million in the next year. Ms Finn responded that the number of midwives needed was calculated on the number of births and the complexity of the women, and that it would not be affected by where the women birthed.

Councillor Wallens asked whether the ICB had consulted with trade unions about the 800 job losses. Ms Finn responded that there were national and local conversations with trade unions, and that any redundancies would be subject to employment law.

Councillor Luca asked what the number of job losses would be in mental health. Ms Finn responded that she did not have the exact breakdown, but that the focus was on reducing the corporate workforce and agency staff.

Councillor Dougherty asked how the loss of 800 jobs would have a positive impact on services. Ms Finn responded that the focus was on reducing the corporate workforce and agency staff, and that substantive staffing models would provide the right care for patients.

Councillor Bentley asked whether the ICB would be able to manage without agency staff, and said that the ICB was cutting funding for voluntary and community services while relying on them more. Ms Finn responded that the ICB was investing in the voluntary sector, and that there was one element where they did not decide to invest.

Councillor Samuels asked what the most critical point of failure was. Ms Finn responded that the one thing that could not fail was quality of care.

Vice Chair Kelly asked how the ICB was ensuring that there would not be a delay in people receiving their current help for mental health issues when the new services came into play. Ms Finn responded that the ICB had a health and care senate, which was full of experts in their particular field, and that they oversaw anything that the ICB was doing to make sure that the services they were putting in place were safe.

Councillor Norman shared an anecdote about a case where a letter was not sent from the consultant or received by the GP for a year, and said that this was an example of inefficiency that needed to be sorted out. Ms Finn responded that this should not happen, and that she could be contacted if there was a particular issue.

Councillor Luca asked about plans to save on prescriptions. Ms Finn responded that the ICB was looking to switch to generic drugs where possible, and to reduce usage and wastage.

Councillor Hood said that the pace of the work was rapid, and that this was not appropriate when dealing with people and delivering timely, dignified care. She added that performance data clearly showed operational strain, and that the proposals were not workable. Ms Finn responded that the ICB had a national directive, and that it had to respond to it rapidly in order to make its submission.

Vice Chair Kelly asked how the ICB was ensuring that there would not be a delay in people receiving their current help for mental health issues when the new process was coming into play. Ms Finn responded that the ICB had a health and care senate, which was full of experts in their particular field, and that they oversaw anything that the ICB was doing to make sure that the services they were putting in place were safe.

Memorandum of Understanding

Zach, an officer, presented a report on the memorandum of understanding and substantial variation for development of health services. He said that the report had been developed alongside Stoke-on-Trent City Council and the ICB, and that it was relatively self-explanatory. The recommendation was that the committee approve the memorandum of understanding and endorse the report to progress to the full council.

Councillor Norman asked how the committee would get reports back on substantial issues involving Stoke and Staffordshire. Zach responded that there would be two meetings: one to go through what the consultation looked like, and another to review and respond to the consultation. He added that there was then the opportunity for the issue to come back to committee.

Councillor Greatorex asked about the political balance of the committee, and how it would be chaired. Zach responded that the membership would be determined as per the political balance, and that the chairman would be nominated by the committee.

Councillor Samuels asked whether the reason given for not consulting had to be taken as read. Zach responded that the committee could direct the ICB to some extent.

The committee approved the memorandum of understanding and endorsed the report to progress to the full council.

Work Programme Report

Zach presented the work programme report of the committee.

Councillor Anya asked why there was nothing about obesity on the work programme. Zach responded that he would take that back and have another look at it.

Councillor Bentley asked about the withdrawal of funding for Moreland's home link. Zach responded that there was a report on the voluntary sector funding, and that this would be the update.

Councillor Grayson suggested that mental health and SEND be prioritised for January. Zach responded that there was a little bit of crossover with mental health and SEND with the Safeguarding and Education Committee, and that the chairs would be considering how they wanted to go through and process.

Councillor Norman asked whether anything on the work programme was only on the work programme because it affected more than one district or borough. Zach responded that he did not know.

The committee agreed to the work programme, with the exception of the points that needed to be looked into.