Epsom Hospital Update
MPs Challenge NHS over finances.
Four local MPs, including Epsom and Ewell MP Chris Grayling, have challenged the NHS over the financial structure of the reconfiguration project for Epsom and St Helier Hospitals. In a joint letter to the South West London Strategic Health Authority, they said that the NHS had still to provide answers about how the project would be paid for - and warned that other services might have to be cut if the NHS builds a brand new hospital rather than rebuilding Epsom for the future.
"There are massive unanswered questions," said Chris Grayling. " We are worried that the final decision will be taken about the site without adequate thought having gone into the financial implications of the plan for the whole health service in the area. We believe that the NHS cannot afford a £300m new hospital in Sutton, and that Epsom represents a better and cheaper option."
This is the letter sent by the MPs.
Julie Dent
Chief Executive
South West London Strategic Health Authority
41-47 Hartfield Road
Wimbledon, SW19 3RG
4th February 2004
Dear Julie
We are writing to raise with you some very specific concerns about the review process deciding the future configuration of hospital services in the Epsom and St Helier area.
The Review Group, of which you are Chairman, has already submitted its first stage document for this process, the Strategic Outline Case, to the Government for approval. You will clearly know that this set out four options for the future, with a clear recommendation that one of them - a single acute hospital and a network of 5-6 local care centres should go ahead. It placed an estimated cost of £342 million for the new investments, and although it didn't specify figures for each individual element, it appears that the estimated figures are £300m for the acute centre and approximately £7m per local care centre.
However, although the document follows the PFI textbook, the process has a number of major potential flaws which remain unaddressed either publicly or privately and which will affect the viability of the scheme.
1. Affordability. The SOC indicates that after all savings from site and staff rationalisation are taken into account, the preferred option will increase annual costs to the Epsom and St Helier Trust by £20m. The Trust is currently in deficit, as are the local PCTs. No one in the NHS has been able to come up with a credible explanation about where this additional funding will come from. Inevitably, if the project goes ahead, it will mean that other services will lose out, and may be cut. This poses real concerns for the future, for example, of local Mental Health Services and Community-based services.
2. The Local Care Centre model. No detailed work has yet been done on what these would look like and no one in senior positions in the exercise has yet to be able to provide any of us with much detail about them. So the £7m figure is very indicative. However the only local example where it is possible to build a sense of what the new centres might look like is at Farnham, where a new centre has recently been opened at a cost of £23m. Although this was an entirely new build, and on some of the sites there are already suitable buildings in place, the gap in cost is so striking that additional work should be done to demonstrate the affordability of the current model. At present, the funding outline in the SOC seems totally inadequate.
3. Patient Choice. In the next two years, a major change will take place to the financing of the NHS. Under Patient Choice, patients will have more opportunity to move around the NHS, particularly when they have been on a waiting list for some time. Most senior NHS Managers that we have spoken to privately admit that they do not yet know the financial implications of this. It would seem extremely rash for the Epsom and St Helier Trust to press ahead with a high cost alternative to its current services without being able to demonstrate the implications of Patient Choice for the affordability of the project.
As you will recall, the proposals submitted to you last year demonstrated that it is possible to convert Epsom into a 700 bed acute centre for a much lower cost than a totally new build. Given the differences between the cost of the different site options, it is illogical and indeed arguably totally inappropriate for the NHS to select its sites when so much crucial information remains unavailable. We appreciate that the project has so far followed normal procedures, but the fundamental issues still remain.
We would strongly urge you not to press ahead with a decision on your preferred sites until you can clearly demonstrate the affordability and viability of the scheme, with particular reference to the issues outlined above.
It is worth noting that when a similar discussion took place about the future configuration of services between East Surrey and Crawley hospitals, that the option of a new build at Pease Pottage proved unviable for financial reasons.
We intend to make these concerns public and look forward to your comments.
With best wishes
Sir Paul Beresford, MP for Mole Valley
Crispin Blunt, MP for Reigate
Chris Grayling, MP for Epsom and Ewell
Ian Taylor, MP for Esher and Walton
