Andrew Demetriades, Acute Sustainability Programme Joint Programme Director Sutton, Merton and Surrey Downs Clinical Commissioning Groups.

Daniel Elkeles, Chief Executive, Epsom & St. Helier University Hospitals NHS Trust.

The Panel welcomed the Chief Executive of Epsom & St Helier University Hopsitals NHS Trust (ESHUHT), Mr. Daniel Elkeles, and the Acute Sustainability Programme Joint Programme Director Sutton, Merton and Surrey Downs Clinical Commissioning Groups, Mr. Andrew Demetriades, and received a presentation on the programme for Improving Healthcare Together.

There was an acknowledgement of the progress made on the business case, with the 3 Clinical Commissioning Groups (CCGs) (Surrey Downs, Merton and Sutton) having worked closely with Epsom & St Helier.

It was acknowledged that there was a need to retain access to major acute services.  However, in providing this critical care, the only way to do so was by bringing them into one site.  The current system was “too fragile” to keep going.  Notwithstanding this, there remained a commitment to providing district hospital services through “planned and specialist care” at Epsom and St. Helier.

The current position remained that approval was required by the regulators before an options paper could go out to public consultation.  A draft, making the case for change, had been submitted to NHS England at the end of last year.  It had not been made public for several reasons, one key reason being that the business case was now required to ‘go through’ several tests in regards to clinical workforce and clinical standards, and financial viability/sustainability.

Several questions were raised by councillors in respect of the number of additional bed spaces being made available through the proposed model, the anticipated (and significant rise) in population in relation to funding, sale of the Trust’s land, staffing of the hospitals, location of, and access/travel time as impacted by the location of critical care on one site.

In response to these questions by Mr. Elkeles and Mr. Demetriades, it was noted that:

·                     It was confirmed that 40 additional beds would be provided over the next 4 years.  However, this was not an appropriate measure of need due to the changes in the way elective surgery was now carried out with more people being able to be cared for at home.

·                     The current model meant not having the workforce to cover the two sites: at present, there was one middle grade doctor available after 10pm, which could lead to significant waits in A&E.  If the workforce was located on one site, the Trust could meet the 24/7 staff requirements as set by NHSE.  The location of the major acute services on each of the proposed sites had been confirmed as feasible, deliverable and buildable.

·                     It was acknowledged that funding and estates were a “huge hurdle”.  There was an underlying deficit in running two acute sites.  As stated, there were a number tests in respect of affordability that needed to be ‘passed’ by the regulators in respect of the sustainability of the proposal being made as well as the availability of capital funding.  This was a two-stage process overseen by NHSE and a National Oversight Committee.

·                     ESHUHT was not the only Trust bidding for capital funding.  There had been a huge number of bids for capital from various NHS Trusts.  7 schemes had been shortlisted with ESHUHT being one in making its case for a new £500m hospital.  It was unclear as to ESHUHT’s position on the shortlist or when confirmation would be received as to whether the bid had been successful.  A letter had also been written to Surrey County Council and other authorities seeking any interest in investment.

·                     In respect of sale of land, a public announcement would be made on Friday, 15 March 2019.  The site in question housed no provision of clinical care, and had no viability for future critical care use.  It was also accepted that sale of land should not simply ‘pay off debt’, but be reinvested into developing the Trust’s existing sites.  Work being undertaken was primarily in long-term investment, such as 32 new consultation rooms in outpatients.

·                     The Trust had been successful in securing repayment for treatment from some oversees patients.

·                     Structural changes were currently underway at Epsom to ensure patient experience and clinical provision could be improved and aligned to wards. Children’s play facilities were provided in each consulting room.

·                     Ambulance providers were looking at conveyance times at different times of the day and considering net inflow and outflow.  This piece of work would be completed by the end of May 2019 and was looking at a sustainable system across all of the 3 CCG areas for which there were currently circa 750,000 residents.

·                     Access would form part of the IIA (Integrated Impact Assessment) which would be considering positive and negative impacts across the CCG areas, including the impact on those in protected characteristic groups.  The IIA was not to determine what option was selected, but was evidence to support any decision made.

·                     There was now a bus route (81) that ran directly between both sites

·                     It was confirmed that of all 6 major acute services would be on one site under the proposal with clinical evidence for better outcomes for patients.  The location of acute services on one site would mitigate the scope for presenting with a need at the ‘incorrect’ site.  Currently, this could be confusing.  A directory of services was available to GP’s and the CCG continued to publicise this.

·                     Public consultation could possibly be undertaken in autumn.  To date most people had expressed a willingness to travel a little further to receive better quality care.  It was hoped that this would be supported by the outcome of any formal public consultation.  The trade-off in losing an acute facility in one location would be an additional 3 miles travel to a site that could result in a better, potentially lifesaving, patient outcome.