Andrew Demetriades, Joint Programme Director, will in attendance and update the Panel on the establishment of a commissioner led programme to review and develop the clinical case for change and potential solutions identified in the work undertaken to date by the hospital trust.
Mr. Andrew Demetriades, Joint Programme Director for the Acute Sustainability Programme established by Surrey Downs, Sutton and Merton Clinical Commissioning Groups, addressed the Panel.
Epsom and St. Helier University Hospitals NHS Trust faced significant challenges in terms of the sustainability of its buildings and how its acute services were organised. The Trust recently set out its own views on these challenges and how to respond to them, running a public engagement exercise and producing a Strategic Outline Case for investment in its acute services. The key challenges going forward were threefold: clinical, financial and estates. In particular, Mr. Demetriades highlighted the challenge faced in relation to the Trust’s estates.
The decision to change service arrangements locally could only be taken by the three CCGs and the Acute Sustainability Programme would be looking in detail at the challenges faced by the Trust and how the CCGs could best ensure that the hospitals continued to deliver quality, safe and sustainable services for the area going forward.
There was a complex regulatory process that needed to be followed, particularly in terms of financing any proposals, but the importance of engaging more widely in the potential future configuration of services was recognised. The Trust had set out its preferred scenario of consolidating its major acute services onto a single site either at Epsom, St. Helier or on the Sutton Hospital Site where a new build would be required. In the Sutton scenario, land had been retained by the Trust in order that a new facility could be co-located on with the Marsden site. Should the Sutton site not be the way forward, the land would be sold to the London Borough of Sutton for housing purposes.
The programme would consider the best overall clinical model going forward in terms of the configuration of Major Acute services as well as other local health and care services. Major Acute services were identified as Emergency Department, Acute Medicine, Paediatrics, Emergency General Surgery, Obstetrics and Intensive Care. Any changes to the configuration of services needed to have clinical support based on good evidence but Mr. Demetriades stressed that the CCGs had reaffirmed their commitment to the requirement for two hospitals.
In order to achieve this, it was important that the governance process was sound. An independently chaired Programme Board had been established with commissioner, provider and regulator representation. The Board would provide strategic oversight of the programme and make recommendations to the Committees in Common.
Mr. Demetriades outlined the programme’s journey so far, in particular highlighting that testing of the clinical model and case for change had begun and a dedicated Stakeholder Reference Group was about to be established to help shape the programme. The indicative programme timeline envisaged the programme being delivered through 5 phases, working on the assumption that a formal consultation would be required. The programme was currently in the phase of reconfirming the case for change and reviewing the clinical service models & impacts these may have, in particular whether deprivation might have an impact on access to services. It was currently envisaged that the earliest any decision on public consultation was likely to be in the autumn of 2018 and there was a significant amount of work to be undertaken between now and then.
It was pointed out that costly and aborted review exercises had been undertaken in the past and queried whether anything would come of the current exercise. Mr. Demetriades stated that there was no guarantee but all parties were united in trying to find a solution to the challenges faced, not the least access to capital funding. In terms of the cost of the review exercise, in order to secure significant investment, the proportion of spend needed to arrive at a high quality and robust case was a consideration. The programme would call on as much resource across the three CCGs as possible to progress this but some external advisory assistance would be required.
Mr. Elkeles stressed that no decision had been taken regarding the location of consolidated services but that the status quo was not an option. However, any solution was contingent on capital funding being made available. There was a limited amount of funding available and the Trust was lobbying hard to ensure that this was in place. In the meantime, services at Epsom were not being run down and significant sums had been invested in services on the site. In terms of funding the scheme itself, the source of the borrowing was not the issue, it all counted as government debt and part of NHS capital and therefore government buy-in to the project was necessary. The Trust supported the approach of more care at home but there was still a need for acute facilities.
In respect of staffing, Mr. Elkeles stated that the Trust had made a step change improvement but that £1m was still spent a month on temporary staff in the acute services because there were not sufficient clinicians either here or from abroad to cover the establisment and this was not clinically sustainable. One of the reasons the Trust was doing relatively well was because staff were motivated to do well because of positive vision of future of acute services with sustainable rotas and teams and job satisfaction. The biggest risk to getting to that end point was the financing and it was vital that the focus was on securing this.