Epsom Hospital Update
Chris Grayling's Submission Over the Future of Epsom Hospital
In overall terms, the concept of local care centres is an interesting one, and based on the responses I have received to date, more than 70% are interested in pursuing the idea. People who responded to me were much more divided over the ability of the primary care sector to play the active role that you envisage for them - there is a definite sense that local doctors are already too busy. Based on conversations I have had with local GPs, I share this view. Although some - like Tim Richardson - are clearly very enthusiastic about the approach, not all share his views.
However I do have some doubts, and will certainly be looking for answers to these in the next stage of consultation. Most particularly I am yet to be convinced that the overall cost of managing these services will be less over several sites than it is over two. Assuming that overall activity levels will not fall, the danger is that multiple sites will increase rather than decrease overheads.
This also applies to the staffing issue around local care centres. I have listened carefully to the arguments about this - for example over how new X-Ray technology will make it possible to spread radiography services over several sites without being hit by the shortage of radiographers. However I think you will need to answer in much more detail questions about staffing levels and opening hours - for example, how will it be possible to provide round-the-clock cover at local care centres? Or will the centres only be open during the day - in which case, what are the implications for A&E outside normal hours?
I am extremely uneasy about the financial aspects of the plans. As I mentioned to you when we met, I have yet to receive a convincing answer about the financing of the transition period - when the two hospitals and the local care centres are operating in parallel. My fear is that as you move services out of the two hospitals, you will undermine the financial foundations of the acute centres - meaning a rushed and unplanned move towards a single site rather than a measured process. Effectively you end up with a number of years when - at best - both hospitals feel, in places, like the Marie Celeste and when the budgets to pay for site overheads are inadequate.
I remain totally committed to the maintenance of acute services in Epsom as do 97% of the people who have responded to me so far. As I have said to you, if the Trust is to secure backing for a strategy which aims for a single hospital site, the only logical location must be Epsom. This is for several reasons.
Firstly, the area covered by the Trust stretches from Wimbledon to Dorking. Epsom is roughly in the middle of this area. Given the strategy of providing lower level services through the local care centres, and acute back-up at a single major hospital, that hospital needs to be located in a location where it can provide back-up to Cobham and Leatherhead as well as other sites further north.
Epsom is the only place in the Trust's area which enjoys accessible public transport links to the whole area. It has rail and bus routes to Wimbledon, Carshalton, Sutton, Dorking, Leatherhead and Cobham.
Both the St Helier and Sutton sites are relatively close to other major acute hospitals at Kingston, St George's and Mayday. Epsom is set significantly further away from another major acute hospital.
You will also remember that the documentation put together during the Investing in Excellence Review found that there is a larger population living within 20 minutes drive of Epsom than of the St Helier site.
The Trust also needs to bear in mind the potential implications on its revenue flows of a decision to move acute services out of Epsom. It is interesting that in the responses I am sending to you, the alternative preferences for hospitals throw up an unexpected factor. As expected, people in the South of the Trust area tend to express an interest in going to Guildford or East Surrey, if Epsom is not there. But there is a considerable body of opinion further north that looks to Kingston as its alternative rather than St Helier.
It would seem logical therefore that an assessment should be made in the next stage of the work of the potential impact of the changes on Kingston as well as the other hospitals in Surrey.
Finally, there is strong support for maintaining some specific services in Epsom.
An overwhelming majority - 98% - want A&E to stay in Epsom, and 84% want to keep a maternity unit. More than 70% also want orthopaedics and paediatrics.
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