Agenda item

Updates regarding:

·         Variants of concern and the likely impact on admission rates, and the continuing progress made in service recovery at Epsom General Hospital on its return to business as usual.

·         The Improving Healthcare Together programme of work, and the progress being made in relation to clinical services not indicated in the original consultation, and plans for resident engagement.

·         The refurbishment and investment programme at Epsom General Hospital.

Speaker: Daniel Elkeles – CEO, Epsom and St Helier University Hospitals Trust

Updates regarding:

·                     Variants of concern and the likely impact on admission rates, and the continuing progress made in service recovery at Epsom General Hospital on its return to business as usual.

·                     The Improving Healthcare Together programme of work, and the progress being made in relation to clinical services not indicated in the original consultation and plans for resident engagement.

·                     The refurbishment and investment programme at Epsom General Hospital.

The Panel received an update from Dr James Marsh on the current impact of Covid-19, the variant of concern and how the pandemic continues to impact on the hospital’s recovery.

Dr Marsh advised on the following:

·                     The delta variant is prevalent in the Borough and is a cause for concern, especially in respect of the unvaccinated population. All cases of Covid-19 however will continue to be treated the same, and swabs taken to determine the variant. 

·                     The data provided is for all 5 acute hospitals throughout South-West London and it is recognised that recovery is reliant on all acute hospitals working together. Data will therefore encompass Epsom, St Helier, Kingston, Croydon, and St George’s

·                     In January 280 beds at Epsom and St Helier were occupied and the South West London Elective Orthopaedic Centre converted to address this need.

·                     Currently the 7-day incident rate per 100,000 across London and South West London has increased by 50% in the last week. Prior to this it was between 25% and 50% per week.

·                     Rates in South West London 115 per 100,000, with 198 in E&E is higher

·                     Vaccination data shows 80% of the adult population in Epsom and Ewell has received one dose and 58% have received the second dose

·                     As of 1st July 2021, we have 9 patients in in-patients’ beds (1 in Epsom and 8 in St Helier), and 1 person in ICU. These figures are not dissimilar across all of South-West London with 6 patients in total being cared for in ICU.

·                     With community transmission as high as it is, the admission rates are evidence that the vaccination programme is having a positive impact. 

·                     There has been a change in the demographics for in-patient care has shifted. At the height of the pandemic, those admitted were mostly those aged over 60-years old. Since May 2021 however the collective data across South West London, including Epsom, shows that most admission are in those under the age of 40-years old.

·                     In respect of vaccination, of the 100 sequential admissions since May 2021, 69 had not received their vaccination, 14 had received a single dose, 1 had received two doses but under 14-days apart, and 11 had received both doses more than 14-days apart.  

·                     Long-Covid remains a concern and the Long-Covid service remains available. The trust also continues to follow-up on those patients who have left hospital; these are primarily seen by the respiratory team.

·                     87% of the workforce have received their 1st dose of medication. 65% have received their second dose.

·                     In respect of delayed treatments, in March 2021 there was a peak of just over 1000 patients who had been waiting for treatment for over a year. By the end of May 2021 this stood at 354 patients, as of 30th June 2021 this stood at 285 patients waiting 52-weeks. Of these 104 were waiting for elective surgery, 181 are currently on outpatient with the most pressure on orthopaedic, gynaecology, cardiology, and gastroenterology

Dr Marsh handed over for Mr. Trevor Fitzgerald.

The Panel received a presentation from Trevor Fitzgerald.

Mr Fitzgerald advised the Panel that the Trust has been working on the business case for the Building Future Your Hospitals Programme; this follows the decision made in July 2020, for a new acute hospital to be built in Sutton of which the Trust now has ownership.

The business case has included the design of the build and working alongside the London Borough of Sutton in securing the planning application, including a multi-story care park. Resident engagement has also been undertaken.

The Trust attended a national investment committee in May 2021 and have secured ongoing support and a £25 million investment for a new electronic patient record system to be implemented, for the reunification of the renal hospital subject to the necessary engagement and was further supported to secure specialist/detailed planning work required for the provision of cancer surgery. Continuation of the business case was granted with further support around building design.

Building design has been subject to modification due to the ongoing learning from Covid-19. The Trust has sought to increase the number of single rooms from 50% to 72%, and has considered the need for segregation, both staff and departments.

The timelines are to submit the planning application by the Autumn of 2021, and commence in the new build by January 2023, with completion in 2026. This would allow for further investment in the Epsom and St Helier sites during 2027/2028.

In respect of the renal care services the proposal is for a new £80 million in-patient facility at St George’s for specialist renal care. This facility would serve approximately 5% of renal patients in South West London, with 95% of patients still being cared for at respective sites. The new centre will improve clinical care provide a sustainable workforce, and lead to better research and training.

Mr. Fitzpatrick gave an update on the Building Your Future Hospitals and emphasised the capital investment on the Epsom site and the retention of 85% of services at the site.

 The Trust has recently installed a new energy centre and has also been successful in in securing funding for improving the facilities for emergency and urgent care, allowing segregation in the waiting rooms and therefore improving infection control.

 In respect of addressing the backlog of treatments for planned care, the Trust has introduced a second CT and MRI scanner to the site, along with a new high voltage electrical supply to help run the equipment. The have also just completed a 6th theatre at the elective orthopaedic centre. The Trust is also working to move the Cottage Hospital to the Langley building. This is a £11-million investment that will be completed by a bridge link, joining the two buildings.

A Councillor asked about the increasing Covid infection rate and asked whether there is a particular area or demographic that is contributing to the increase.

Dr Marsh advised he cannot be specific in respect of geographical, however the increase in incidents is largely seen in teenage children and young adults. This is due to socialisation and the return to school and university and the delay in vaccination in these age groups.  

A Councillor asked about segregation and asked whether the Trust has the flexibility to increase such areas where required. The Councillor also asked about whether there are additional plans for a covered pathway in the area towards the Woodcote Green, on route to the orthopaedic centre.

Dr Marsh advised that in designing the hospital, they have built in resilience. They have increased the proportion of side rooms as to isolate infectious patients. They have also been working in different ways and closing various access routes to keep infectious and non-infectious (often admitted for planned care) separate. There is a clear expectation that if you are being admitted for surgery, or are an outpatient, we are expected to ensure separation. For outpatients, this was achieved primarily through virtual appointments with 35-40% seen using this method.

Mr. Fitzpatrick advised the Panel that the Trust are working to better navigate entrances and exits. They are trying to reduce the number available as such they are focusing on the entrance via the Dorking Road and there is a walkway being installed that will lead directly to the Woodcote wing. There will also be access to the Wells Wing, and access to emergency care. For the rear of the site, they will use the Orthopaedic centre as a main entrance.

A Councillor asked if the Trust are having any emergency or urgent care at Epsom and St Helier.

Dr Marsh confirmed that there will be urgent treatment centre at both Epsom and St Helier. Older patients requiring inpatient care will largely be seen at Epsom and St Helier. The sickest patients will be seen at A&E at the new hospital in Sutton.

A Councillor asked about the bus service from Croydon and Sutton is going to be increased, however asked about bus routes for surrounding areas as to make sure the new hospital sites are accessible to them. 

Mr Fitzpatrick advised they have set up a transport and travel working groups to review and look at these challenges, covering Merton, Sutton and Surrey Boroughs. The Trust are also relying on information from other voluntary groups such as Healthwatch and Age Concern.

There has also been a consultation undertaken with Transport for London to improve public transport links for Merton and Sutton and they await the outcome. The Trust has also been doing a lot of work with the voluntary sector in respect of voluntary drivers and can also rely on their own transport service that currently moves between 600-900 patients each day. The Trust also runs the H1 bus service looking at how this can be expanded.

Dr Marsh advised on access to the renal centre, and declared he is a renal physician. Dr Marsh confirmed none of the current services will change in respect of services being embedded on the local sites to retain access.

A Councillor advised that the Mayor of London is still going ahead with the £5.50 charge for driving into Belmont and asked what was being done about this.

Mr. Fitzpatrick advised this will be picked up by the working group with them looking at how this can be managed and mitigated.

A Councillor asked if the H1 bus service is still available.

Mr. Fitzpatrick confirmed it was still running and that there had been a recent change in moving from a contract delivering this, to this now being overseen by the Trust.