Epsom and St Helier 2020-2030: Potential plans for healthcare reformation in our area unveiled
We had a very interesting presentation at our Neighbourhood Forum meetings on 27th and 28th September from Daniel Elkeles, Chief Executive of Epsom & St Helier NHS Trust and his team about the Trust’s plans for the future. Our sessions were two of the numerous events that Epsom & St Helier management have attended as part of their initial consultation on how the community would like them to move forward with providing significantly improved health care facilities in our area.
How do they propose offering better facilities for patients?
Currently they are planning to spend over £70m (£17m already spent) improving their buildings (mainly at St Helier). This includes replacing windows and cladding the outside to make the building watertight, improvements to kitchens and much more. However, in their view, this will not enable them to provide the best service for their most at risk patients for whom better, more modern facilities are needed.
For this they propose creating a single Acute Care Unit that would care for their most at risk patients namely:
Inpatient paediatrics (children who need to stay overnight)
Babies born in hospital
Major A&E (patients who are acutely unwell needing complex clinical assessment and procedures like resuscitation)
Critical Care (the highest dependence care a hospital can offer)
Complex emergency medicine (patients who need services like high-dependency care and coronary care)
Emergency surgery and trauma
Would this mean Epsom or St Helier hospitals closing?
Far from closing, both Epsom and St Helier Hospitals are having large sums of money spent on them and form the cornerstone of future health service delivery. Both will retain their walk-in A&E facilities; as now, ambulance teams will triage patients at the point of pick up and decide where best to take them. This may be to Epsom, St Helier, the new Acute Care Unit (wherever that is located) or possibly St Georges in Tooting.
It is not decided yet, but it is unlikely that the new ACU will have walk-in facilities other than for Paediatrics.
According to their forecasts, the Acute Care facilities would only be needed by 15% of their patients, the remaining 85% would continue to be treated at the existing facilities at St Helier Hospital and Epsom Hospital.
However, because of the longer stays needed by those patients needing acute care facilities, these acute care patients would require a greater percentage of beds, around 50% of the total.
Currently there are over 600 beds at St Helier and under 400 at Epsom, giving a total of around 1000. It is not intended that this total number would change, but would be re-allocated to be 200 beds at St Helier for non-acute patients, 300 beds at Epsom for non-acute patients and 500 beds in the new Acute Care Unit, wherever that is located.
Where might the new Acute Care Unit be located?
We were told that there is land available for a brand new Acute Care Unit at either of the two current hospitals or alternatively at the old Sutton Hospital site in Belmont. If the unit were to go to St Helier that would become a 700 bed hospital, if it were to go to Epsom that would become an 800 bed hospital. If it were to go to the Sutton Hospital site, that would have 500 beds and St Helier and Epsom would have 200 and 300 beds respectively
At this point in time the Trust is building a business case to obtain funding of £300 - £400m to create a single Acute Care Unit on one of their sites. This would complement the existing services that would continue to be provided to 85% of their patients from St Helier and Epsom hospitals. No decision has been made about which site the Acute Care Centre might be located at, and the focus is to get government approval for the spend. Input from residents about the preferred location for the unit will form the basis of a new consultation probably next year once firmer funding arrangements have been agreed.
What do we think?
With this in mind, the Trust have asked the following questions (in red italics). Our comments and proposed position on these questions is given below each question.
Q1 Do you agree with our aim to provide as much care as possible from our existing hospital sites at St Helier and Epsom and do this by working more closely with the other local health and care providers?
Our Response: Yes. This is much more preferable than closing either of the existing hospitals which had been proposed previously.
Q2 Do you think we have made the case that we will improve patient care by bringing together our services for our sickest or most at-risk patients on a new specialist acute facility on one site?
Our Response: In an ideal world both hospitals would be enhanced to have their own Acute Care Unit. However, we appreciate that funds are unlikely to be available to provide two Acute Care Units in our area. We have waited many years for a “state of the art” hospital in our area and demanding two at this time would probably result in us getting none. Also the Trust is already having difficulty recruiting sufficient qualified staff to run the units that it does have. Concentrating their staff in one unit would mean it would be able to offer experienced staff for longer hours of cover and reduce the agency staff bill by over £1m per month.
At our meeting on the 28th September, Dr James Marsh, the Trust’s Joint Medical Director, told us that he had personally polled many senior clinical staff and they were all of the view that a better patient service could be provided from one centre rather than from two.
Q3 We have set out several scenarios on how we can do this. In all scenarios 85% of patients will continue to be treated at Epsom or St Helier as now. Do you think we should consider any other scenarios?
Our Response: In none of our meetings was an alternative suggested other than the option mentioned above of enhancing both hospitals. So “No”.
It is therefore our proposal to support the Trust in their proposal to press ahead with their business case for a single Acute Care Unit. There have been so many attempts for over 25 years to make a step function improvement in our health care facilities. It is vital that this initiative succeeds and we have confidence in the Trust’s current management team that they can make this happen. We would welcome your feedback.
This, of course, leads to the difficult question which will arrive next as to where the ACU should be located. All of the politicians want the facility on their own patch. Chris Grayling thinks the Trust should be split up and Epsom Hospital expanded in its own right. Tom Brake supports the ACU at St Helier while local MP Paul Scully is supportive of retaining services at St Helier with the possibility of the ACU at Belmont.
What if the Acute Care Unit is located at Belmont?
For the future, our position is that it would be good for our area to have a local state of the art hospital. Being an Acute Care facility, patient arrivals and departures will be much lower volumes than a unit specialising in, say, outpatient care. However, that doesn’t reduce the concerns about the impact of the unit on the surrounding neighbourhood.
We are assured by the Trust management that 10% of the capital funding they hope to obtain would be expected to be spent on infrastructure improvements.
IF the Acute Care Unit is to go to the Sutton Hospital site in Belmont, then improvements we must ensure are provided as a minimum must include:
Provision of sufficient and affordable parking onsite
A plan put in place to ensure that on-street parking in the surrounding roads is not seen as an attractive alternative
The road network around the site must be enhanced both at a macro and a micro level to ensure that emergency services can reach the site and to ensure that there is no detrimental effect for local residents.
Public transport improvements will be needed to ease travel throughout the hospital’s catchment area and in particular between Belmont and Epsom and Belmont and St Helier.
We must demand that all such improvements are in place before the facility is opened.
Is there room on the Sutton Hospital site?
The diagram below shows how the old Sutton Hospital site has been split into different land parcels. The new secondary school will occupy just the small northern section of the site (1.6 hectares) basically what was the ornamental lawns and the front of the old hospital building plus the visitors car park. The temporary school that will be used while the main school is being built will be located in Cumbrian House, an existing building behind the Malvern Centre.
All of the land shown green has already been purchased by the London Borough of Sutton and it is planned that they will purchase all of the remaining land parcels with the possible exception of the land shown yellow. This is roughly where the Acute Care Unit could be located. Although only a relatively small area, the building could be 3 storeys high rising to 7 storeys high at the east of the site. This is broadly in line with the design guidelines for the London Cancer Hub which suggests a “pyramid” style of development i.e. low round the edges but higher in the centre.
All action on the Sutton hospital site
Discussions on whether or not a new hospital might appear in Belmont are likely to run for several years.
In the immediate future (in some cases NOW), a number of projects are already under way. Several members have contacted us, confused about what is going on and whether what they have heard of are either / or develpments. Be assured none of the projects below are alternatives; they are ALL happening now or in the near future.
Construction for the new school for which planning approval was eventually granted on the 31st August. We are part of a working group that has been set up to consider the impact of the development on the area round the school during the construction phase and eventually when the school opens. We are still awaiting news on the proposals for the redesign of the junction of Cotswold Road and Chiltern Road with Brighton Road. We have been told this will be available for the Council’s Local Committee meeting on 7th December.
Modifications to Cumbrian House to make it suitable as temporary accommodation for the new school will be started probably later this year once the planning application has been heard by the Planning Committee (probably in November).
The Institute of Cancer Research started a 20 week programme last month to carry out the earthworks needed for them to build their new research laboratories on the land to the south of Chiltern Road. We have asked that no heavy lorries leave the site via Cotswold Road to the north and instead head south down Sutton Lane towards Banstead. We have ensured that Pelton Road and Downs Road are specifically forbidden. If you see any lorries from the site on any of the forbidden roads please let me know.
In preparation for the build of the Maggie Centre at the rear of the Royal Marsden Hospital, a new rear access road is being constructed. This runs straight from the existing Cotswold Road entrance towards the ICR, through where the old swimming pool was located (now demolished).