The vision for Epsom Hospital following its exit from the controversial healthcare review aiming to axe its acute services was discussed with councillors on Monday.

Dr Claire Fuller, chairman of Surrey Downs Clinical Commissioning Group (SDCCG), Epsom and St Helier hospital trust’s chief executive Matthew Hopkins and its chief operating officer, Jackie Sullivan, addressed Epsom Council’s health liaison panel.

Dr Fuller explained that in deciding to walk out on the Better Services Better Value (BSBV) review - after a secret ballot of Surrey Downs' GPs showed they overwhelming opposed proposals to remove Epsom’s A&E, maternity and children’s units - the CCG became the first one in the country to listen to its membership in such a way.

She said it is now focused on driving up clinical standards at the hospital through more integrated care, community services and monitoring at primary care level - to keep people out of hospital.

'BSBV was not right for our population'

Dr Fuller said: "We felt that BSBV was not the right vehicle for our population.  We have a high proportion of elderly people and we need to be able to admit these patients locally, to have people in hospital for a short time as possible and work closely with community providers.

"You can't have that if they're sent to Tooting."

She added: "We are going to support Epsom Hospital.  Our relationship with the hospital is the closest it’s ever been."

The GP said SDCCG wants to up the number of hours consultants spend in hospitals, increase the number of "community beds" at Epsom Hospital, and improve urgent care so patients are seen by more senior members of staff where necessary.

She said Epsom Hospital will need to work more closely with GPs and acute doctors and nurses to offer a seamless service where patients "don't necessarily know the difference" between the types of professionals who are treating them, only that they are the most appropriate ones.

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Dr Fuller said: "We need a different mix of people in A&E alongside the other staff and it's about making sure that you're being seen by the right people there."

She added: "Our strategy is trying to keep people as well as we can.  

"If you do get into hospital, we need to make sure we have the community teams going into the hospital so their relationships with patients start early."

'There may now be a way to get ourselves out of the red and into the black'

Mr Hopkins provided the panel with year-to-date figures for Epsom and St Helier trust’s deficit which currently stands at £3.9m - £48,000 behind its projected sum. 

But the trust is £5.7m ahead in its projected income, at £206.8m.

When asked about how complications surrounding St Helier’s continued inclusion in the BSBV review would be resolved and whether the two hospitals would de-merge, Mr Hopkins said it was difficult to speculate.

He said: "In relative terms we are actually doing rather well.

"We believe if we continue with the way we have run the organisation and see an improvement each year, there might now be a path to get ourselves out of the red and into the black.

"It takes a process of persuasion to those who were very clear they don’t see a future for these hospitals in the long-term.  There needs to be a degree of dialogue and discussion.

"We are in the process of discussions on what the long-term future might be. 

"If we are in a situation where there are significant proposals for change at St Helier we will have to think about what they will mean about services at Epsom Hospital.

"It's difficult to speculate at this stage because the six South West London CCGs need to consider the variables and decide on the best causes of action.

"But the question is not ‘who will Epsom Hospital partner with?’ but 'do people support the existing partnership'?"

Winter pressure

Ms Sullivan spoke about how Epsom Hospital would cope with winter pressure, having already experienced a "particularly challenging" summer.

She said: "We have had most of the escalation beds, which are usually used during the winter, open all year.

"The only way we are going to meet the A&E challenge is to look at the way we do things, work closer with the community and consider how we deliver our services."

Ms Sullivan said that some of the measures looking to be introduced include extending matrons' working hours to 8pm on both sites and piloting an ambulatory care unit at Epsom where patients would be assessed, treated and discharged without needing to be admitted.

She said that the trust has already put more funding into having discharge doctors available at weekends and placing additional doctors and nurses into A&E to cope with paediatric cases.

Movement of services from Sutton Hospital

Plans for the movement of services from Sutton Hospital to Epsom and St Helier were also discussed.

Ms Sullivan said 22 per cent of Sutton Hospital's activity would remain on-site following discussions with GPs, but 21 per cent would move to Epsom - including some day surgery, urology and lithotripsy.  Opthamology outpatients will move to both sites, although laser eye treatment will be conducted at St Helier.

She said: "It's about moving the services, not closing them to improve the quality of the care for patients and making the trust more financially and clinically sustainable."


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