Epsom Hospital Update
This is the text of a document that Chris has submitted to the NHS calling for the construction of a major new hospital at Epsom. Please have a look at the plans, and let Chris know what you think - either using the feedback section on this site, or by email to graylingc@parliament.uk.
Campaign Relaunched with Major Hospital Proposal
Most people in our area are aware of the review being carried out by the NHS into the future of healthcare in our area. The current plan is to devolve many of the services currently provided by the two District General Hospitals to a network of local care centres and eventually to amalgamate acute hospital services on a single site.
This proposal does not seek to prejudge the final decision on that issue. Whatever the final decision, it will be a difficult step to take. But if the single site option is selected, there is an overwhelming case for the final site chosen to be Epsom. That has not always been clear in the debates and discussions in the past few years. This document aims to set that right.
In the event that the NHS decides to proceed with the single hospital option, this document sets out costed plans for the development of such a hospital on the Epsom site. This option would cost the NHS approximately £100 million, around £150 million less than building an entirely new hospital elsewhere, and would site the acute centre at the geographical centre of the area served by the Epsom and St Helier Trust. Epsom is also the site that, based on the Government's own figures, is the most accessible to the greatest number of patients and is the only option that has direct public transport links to all of the area covered by the Trust.
The NHS's own estimates of what would be required from a new hospital are that it would need approximately 700 beds, and would cost £200-250 million.
These plans and costings have been drawn up by a team of architects and quantity surveyors, on behalf of The Denbies Trust, who have detailed knowledge of, and have worked on, the Epsom Hospital site. They show how it is possible to expand Epsom to 700 acute beds plus an additional 40 non-acute beds to alleviate bed-blocking using the current footprint of the site and at a cost of under £100 million - whilst leaving flexibility available for further development and expansion should the local community and the NHS decide it is needed in future.
The plans also show how it is possible to incorporate the completion of the outstanding staff accommodation blocks, to be provided by St Kilda Trust, within the overall scheme.
The costings include provision for construction, on-site services to meet the needs of a larger hospital, additional parking and local highway improvements to cater for public transport and the increased traffic using the site. The development up to a level of 700 acute beds would not affect the new Regional Orthopaedic Centre, and would also leave in place on the site approximately 40 additional intermediate beds for the elderly and mentally ill.
The plans also do not include the development of a new building along the Dorking Road frontage, which received indicative planning consent in the 1990s and could be added if required at an extra cost of approximately £5m
These plans are intended to be indicative, rather than prescriptive. I recognise that the final configuration of services and beds on the site would need to be the subject of detailed work. However these plans do clearly indicate the potential of the Epsom site. The extensions can also be built without affecting the services provided at either Epsom or St Helier.
It is for the NHS to resolve the future configuration of services. However if the final decision is to have a single acute centre, the financial case for Epsom is overwhelming. The cost of meeting the PFI repayments on the extra £150 million would be at least £15 million a year, money that should be spent on providing better services through the primary care sector.
Nor is this document intended to take a view on the future of St Helier Hospital. However it is worth noting that the savings generated by siting the acute centre at Epsom would allow the NHS to build in addition one of the most advanced community hospitals in Europe at St Helier and still save £100 million on the cost of building a totally new hospital in the area.
The NHS has said consistently throughout this exercise that the location of services should not matter - it is quality that is important. That quality can be achieved at Epsom, and at a price that is vastly better value to the NHS than a new build elsewhere.
My challenge to the management teams working on this review for the NHS is to make sure they do not miss this opportunity.
Chris Grayling
MP for Epsom and Ewell
July 2003
What do we know about what the NHS needs in our area?
There is strong support among the medical profession locally for a change to the configuration of services. Although there are differences in emphasis between the hospital doctors and consultants, whose concerns lie around the difficulty on running services on two sites, and GPs who want more done in community hospitals and the primary care sector, most seem agreed that they want a single hospital.
NHS management are also concerned that they may not be able to continue running all services on two sites, particularly once the European Working Time Directive is introduced in 2004. Already some activities - such as overnight surgery - are set to be brought together on one site.
The goal of the local NHS trusts is to meet these pressures by moving services such as minor-injuries out of the two hospitals and into local care centres in the network of community hospitals in our area. Following the initial discussion period that ended in March, it seems clear that this strategy is being pursued strongly. Indeed it is likely that firm decisions will be taken sooner rather than later. The South West London Strategic Health Authority wants to see the situation resolved this year.
The shape of services under consideration by the Epsom and St Helier Trust would appear to consist of the following.
A single 700 bed hospital to replace Epsom and St Helier. The Trust has been careful not to state a site preference, but it has only three options - St Helier, Sutton or Epsom. This hospital would deal with more serious cases.
Local Care Centres, probably in Dorking, Leatherhead, Cobham, Epsom, Sutton, Wimbledon and Carshalton. These would provide minor surgery, etc.
Intermediate beds, located either at the local care centres or elsewhere, providing short term minor surgery beds or convalescent beds designed to reduce the impact of bed blocking.
No decisions have yet been taken about hospital locations. However we do know that senior NHS Managers recognise that the St Helier site needs to be totally renewed - that the existing buildings need to be knocked down.
Although there are some buildings at Sutton, it is not currently an acute site, and so any new hospital built there would essentially be brand new.
The Epsom site is more mixed. It has some new buildings, some perfectly serviceable older buildings and some that are dated and need to be replaced.
So the Epsom and St Helier Trust seems to have a choice between a totally new build at Sutton or St Helier, or a partial new build at Epsom.
The cost of building new hospitals
Estimates for the cost of building a totally new hospital locally have ranged from £200 to £330 million - depending on the size. However the current thinking of the Epsom and St Helier management is that they need a hospital with approximately 700 beds, and that this will cost around £200-£250 million.
Published evidence from other hospital projects in the South East suggests that it is likely that the cost of the project will be around £250m
One of the most significant 'new hospital' projects of recent years is the University College London Hospital on Euston Road. The new building was provisionally due to cost £250m but is now scheduled to be completed, with 725 beds, at a cost of between £404m and £422m. The new site will group together an Acute Assessment Unit, a Diagnostic and Care Unit, a Critical Care Unit, and an Adolescent Unit, with the A&E and Acute services ready by 2005 and full completion in 2008.
The Paddington Health Campus proposal is another current example. It involves a plan to house a new St Mary's Hospital, a new Royal Brompton and Harefield Hospital, and is now on the way to receiving the green light to start the process of choosing a private building partner. This 'combined site' will have around 900 beds, with an expected cost of £360m.
The newly opened 'Princess Royal University Hospital' in Bromley holds 500 beds and cost around £155m - in line proportionately with the Trust's current estimates for a larger hospital in the Epsom and St Helier area.
How we achieve this at Epsom for a fraction of the cost
These plans outline proposals to form a 740 bed hospital at Epsom for a total cost of under £100 million. They add more than 20,000 square metres of additional capacity to the hospital, all constructed in the central footprint of the site. They involve replacing all the older buildings inside this footprint except the Wells wing, which remains in good order.
The plans involve the construction of a five-storey extension to the rear of the current hospital, linking the rear of the Denbies wing to the south side of the Wells wing.
In addition they provide for the replacement of the current one and two storey buildings on the north side of the site, situated around the main public entrance to the hospital, with a four storey building.
The Langley wing would remain in place with its existing capacity for the elderly and mentally ill. The 40 or so elderly beds in this wing would, under the plan, be retained for intermediate care to alleviate bed-blocking.
The plans also involve a review of the service buildings on the site, the construction of a new one way road system around the site with north and south exits, a multi-storey car park that would significantly increase the availability of parking on the site, and make financial provision for junction improvements on the Dorking Road.
We have also provided the space for the construction (by St Kilda Trust) of the three outstanding accommodation blocks for staff on the site, in line with planning consents obtained during the 1990s.
This section contains additional details about each of these elements of the plans, ground plans and elevations of the proposed development, and outline costings for the proposal.
The overall site
The plan shows the overall footprint of the proposed development. The two substantial extensions are shown at the north and south sides of the side, surrounded by a new internal one way road providing improved access and traffic flows around the site.
In addition, the plan envisages the construction of a new Staff and Services building to the southwest of the site. This would contain many facilities currently located in the Wells wing, thus releasing additional space for clinical purposes.
The multi-storey car park adjoining the sports ground at the northeast end of the site has been designed to the existing plans which received outline planning consent in the 1990s, but with the addition of a lower ground floor. This would provide a total of 750 parking places, almost 550 over and above those already available on the site. Given the intention to reduce the amount of minor treatment carried out on the site, this should be an appropriate level of expansion to cover the needs of a major acute hospital.
The development replaces some current one and two storey buildings on the site, and assumes the demolition of the elderly Woodcote wing.
Where existing buildings have been demolished, it has been assumed that the clinical teams currently in those areas will receive replacement floor space in the new buildings.
The existing administrative buildings and the 1970s built Langley wing to the west of the site would remain in position. The plans assume that the beds in the Langley wing would remain in place for elderly and mental health patients, and are not included in the overall 700 bed total for the acute side of the hospital.
Equally, the plans do not include the current use of the upper floors of the Denbies wing and the top floor of the maternity block for the Regional Orthopaedic Unit, which is assumed to remain a separate, standalone entity.
The front extension
The existing buildings at the front (north) of the hospital, which are either one or two-storey would be demolished in their entirety, and replaced with a new four storey building in the same style as the Denbies wing. At the centre of this new building would be an atrium which would contain a canteen and cafeteria area and related services, and would also provide an internal light well to the surrounding building.
The height of this building is consistent with existing buildings and consents on the site.
The space assumptions around this building are that it would provide 16,000 square metres in total capacity, of which a maximum of around 6,000 square metres would be needed to provide new accommodation for the activities already sited in that building.
In reality many of those services would move into the cottage hospitals, and so we envisage additional clinical space being made available as a result.
The east flank of the front extension would link up to the existing Bradbury wing thus providing an impressive, prominent eastern elevation.
The rear extension
The five-storey rear (south) extension links the existing Denbies wing to the south side of the Wells wing. It provides an additional 8,750 square metres of space over five floors.
It would be constructed in the same style as the Denbies wing and, continued in the new building at the front, would mean that this building style would apply to almost all the hospital.
It has been assumed that half of the ground floor and half of one of the other floors will be required to extend A&E and for the construction of operating theatres and other clinical facilities.
The Wells wing
The plan would involve considerable internal change to the Wells wing to create additional clinical space. The changes are as follows:
- The creation of an atrium cafeteria at the front of the hospital would release the space currently used for this purpose in the Wells wing.
- The kitchens would be transferred to the front extension or to the new Staff and Services building.
- Areas used for storage would also be transferred to the new buildings, as would the lecture theatre and rooms.
In total this should release 2½ floors of the Wells wing, to be used to create two additional wards, additional operating theatres and extra clinical space on the ground floor.
The New Staff and Services building
The new Staff and Services building will be an industrial unit on the southwest side of the site. It will be three storey at the end where it is closer to the central buildings of the hospital, and would drop to two storey closer to the hospital boundary to avoid causing a height problem for neighbours.
The plan envisages that it would hold kitchens, storage areas, support services and training areas for staff.
Accommodation
Accommodation blocks would be based on the recently constructed Woodcote Lodge.
A total of around 80 additional flats would be created in the three blocks.
Costings
The estimates for the proposed development are based on the new wings being of similar design and specification to the Denbies wing.
| Floor | Area (m²) | Cost per m² | Total | |
| New Wings | ||||
| Front Extension | 16,000 | @ | £2,500 | £40,000,000 |
| Rear Extension | 8,750 | @ | £2,500 | £21,875,000 |
| Hospital Fit-out | 24,750 | @ | £500 | £12,375,000 |
| Wells wing Fit-out | 6,800 | @ | £1,000 | £6,800,000 |
| Wells wing external rehabilitation | £1,000,000 | |||
| Services Building | 2,600 | @ | £1,500 | £3,900,000 |
| Services | ||||
| De-centralised plant | £2,000,000 | |||
| Roads & Parking | ||||
| Car Park | For 750 cars | £7,000,000 | ||
| Access Road | Create one-way system and junction improvements | £1,500,000 | ||
| TOTAL | £96,450,000 | |||
Other factors that point to Epsom
Epsom's other key advantage is transport. The area covered by the Trust runs from Wimbledon to Dorking. Epsom is central in this area, and is the only place that can offer direct public transport links to the key communities that the Trust serves, Wimbledon, Mitcham, Morden, Sutton, Carshalton, Banstead, Ewell, Stoneleigh, Epsom, Ashtead, Cobham, Leatherhead and Dorking.
In each of these cases there is a direct public transport link by either bus or train to Epsom.
Sutton cannot offer direct links to Cobham, Stoneleigh or Ewell.
St Helier does not have direct links to Banstead, Ewell, Stoneleigh, Ashtead, Leatherhead, Cobham or Dorking.
Epsom also offers the most convenient road access to the greatest number of people.
Research work carried out by the consultancy firm SECTA to the Epsom and St Helier Trust in 2001 and now available in the House of Commons Library shows that the populations resident within travel time boundaries from the its three sites were as follows:
| Hospital | Population resident within: | ||||
| 4 mins | 8 mins | 12 mins | 16 mins | 20 mins | |
| Epsom | 13,335 | 54,702 | 138,160 | 293,400 | 496,250 |
| St Helier | 5,547 | 25,254 | 61,559 | 38,756 | 252,469 |
| Sutton | 8,184 | 44,574 | 100,289 | 223,463 | 402,879 |
These figures clearly reinforce the overwhelming financial case for Epsom.
The other factor which will have to be noted in the consideration of the issues is the current location of other acute centres. At present, there are additional acute hospitals in Kingston, on the border between Tooting and Merton (St George's), on the northwest side of Croydon, at the Mayday, at Redhill and at Guildford. In a selection between the three potential sites, Epsom offers the most central location to ensure the best spread of acute services - again adding reinforcement to the strong financial case.
Note on construction
These development plans can be completed without significantly affecting the ongoing work of Epsom Hospital.
There are a number of ways in which this can take place. But put most simply it is possible for the rear extension to be constructed first, and then the services currently sited in the front extension to be resited in the rear to allow demolition to begin.
Once both areas are complete, a process of full reorganisation can be carried out in order to complete the move of the full range of acute services onto the site.
Services
It is proposed that the development is undertaken with de-centralised plant to serve individual departments/areas to enable the phasing of the works, whilst maintaining the existing services to other remaining areas of the Hospital.
A detailed document setting out the requirements for services in the new development has been prepared separately.
Appendix
Schedule of Bed numbers in the proposed Epsom hospital.
| Current | |
| Location | Beds |
| Wells wing | 150 |
| Maternity wing | 30 |
| Additional | |
| Front Extension | 250 |
| Rear extension | 200 |
| Wells wing | 70 |
| TOTAL | 700 |
