Epsom Hospital Update
Epsom and St Helier agrees maternity cutbacks.
The Epsom and St Helier Trust has agreed to put plans to either close or downgrade Epsom's maternity department to public consultation. The news comes after weeks of speculation that cutbacks were imminent.
Chris Grayling said: "This is disastrous news for Epsom, and makes no sense at a time when it looks as if St Helier may lose its acute services in the very near future. We will fight against these unwanted cutbacks."
Statement from Epsom and St Helier on Maternity Consultation
Safe and Sustainable Hospital Services (S2) Update:
Trust Board Agrees Maternity Options
Background
Between January and March 2006 the trust undertook an internal review of key clinical services following concerns raised by senior trust clinicians about the long term safety and sustainability of anaesthetic and surgical rotas.
Two groups (surgery, medicine and critical care services and women and children's services) presented their findings to expert panels. The women and children's panel, chaired by Professor and Pediatrician Sir Cyril Chantler recommended that:
- All obstetric and neonatal services should be consolidated at St Helier
- Midwifery led units (MLU) should be developed at both Epsom and St Helier
- Extended Hours Paediatric Assessment units (PAU)should be set up on both sites
- Paediatric overnight in patients should be consolidated at St Helier
Sir Cyril Chantler commented:
"The future is about improving community services, and growing a flexible workforce with the right skill mix to support this. The NHS is moving to a consultant delivered service, with fewer trainees with better training, on the basis that quality comes cheap if you get it right first time. We suggest that looking for more flexible ways of using your staff should be considered before you decide you have to invest in more resources by adding extra people to the workforce".
The Trust Board endorsed the recommendations on the configuration of services in April 2006 but asked for a further work to be done exploring the long term financial and clinical viability of the expert panel's recommendations. There is considerable concern amongst the local community about the potential loss of obstetric services from Epsom, so it is essential that we exhaustively explore the potential to protect services on the Epsom site.
The Trust Board has now given its support to take two options for the reorganisation of maternity services to public consultation, subject to approval from NHS London.
The Options
Both options include an investment of around £4 million into upgrading maternity facilities, and will deliver better, safer services through:
- More senior clinical input to patient care
- Better clinical training for doctors
- Better working conditions for junior doctors
- More cost effective use of scarce NHS resources.
The first option is to consolidate obstetric and neonatal services at St Helier Hospital with development of a Midwifery Led Delivery Unit and Early Pregnancy Assessment Units on both Epsom and St Helier hospitals.
The second option is to consolidate all obstetric and neonatal in-patient services to St Helier Hospital without the development of Midwifery Led Delivery Units at Epsom.
Under both options ultrasound, antenatal, community midwifery, and Maternal Day Assessment Unit will continue on both sites. Three other options were examined, including maintaining the status quo, and were found to be clinically unviable.
More detail can be found in the Board paper available on our website at www.epsom-sthelier.nhs.uk/6_7.html
As the recommendations make clear, these changes are about clinical viability and providing safer services, with constant consultant cover. They are not part of the Trust's financial recovery plan.
The Next Steps
Formal public consultation will take place on these maternity service proposals after the Trust Board has agreed to proposals for the necessary changes to children's services and received support for public consultation on both maternity and paediatric services from NHS London.
The recommendations for paediatric services are now being finalised and will be presented to the Trust Board at its February 2, 2007 meeting.
In the meantime, we will be discussing the process for consultation with the local Overview and Scrutiny Committees and other stakeholders.
The Need for Change
Changes in medical practice, working hours and training are increasing the amount of consultant cover required for obstetric units to be clinically viable and offer the safest possible service to patients.
Providing the necessary level required at each both Epsom and St Helier would require more consultants and junior hospital doctors. But the comparatively small workload, in particular at Epsom, would not provide doctors with adequate experience to train or maintain their skills.
This issue is becoming more acute as both the new training programme for doctors driven by "Modernising Medical Careers" and the European Working Time Directive will reduce the total numbers of doctors in training and the hours available to support service provision from August 2007 and 2009 respectively.
These changes also mean that dedicated anaesthetics cover will no longer be available to support obstetric services at Epsom Hospital from August 2007.
It is also anticipated that within the next 2 years the Royal College of Obstetrics and Gynaecology will cease to recognise and accredit training posts in units where the minimum consultant presence is not met.
The need to provide this level of consultant cover on labour wards was also emphasised in the recent Healthcare Commission report into maternal deaths at Northwick Park Hospital in North West London.
To meet these challenges and provide the best service to patients we need to increase the amount of obstetric consultant cover for labour wards in line with the Royal College of Obstetrics and Gynaecology best practice guidelines.
The only way to achieve these changes is the consolidation of obstetrics services at St Helier Hospital. As the reports show, it is clinically and financially unviable to consolidate these services at Epsom Hospital.
More information about Safe and Sustainable Hospital Services
As of October 4, the changes to emergency and critical care services were fully implemented and are working well.
More information about the Safety and Sustainability Review, including the medical expert panels' reports, can be found on the Trust website at www.epsom-sthelier.nhs.uk. You can also email enquiries@epsom-sthelier.nhs.uk or call 020 8296 4973.
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