Epsom Hospital

Maternity service saved at last:

On 4 March 2009 Epsom and St Helier NHS Trust announced at a public meeting in Epsom Town Hall that they are no longer considering closing Epsom’s maternity service. The women’s and children’s service is safe.

The Trust told me that although the original plan was to centralise the Trust’s maternity services at St Helier, it has learnt that Mole Valley residents do not want to go to St Helier. Finally the Trust has listened to my campaign and the many other voices that for so long have been telling them this. I am absolutely thrilled. It really does prove that local campaigning can work. I would like to express my huge thanks to all those who have supported my campaign.

At the Town Hall meeting, Antony Tiernan, Director of Communications for the Trust, also announced that the Trust intends to make a major investment into Epsom Hospital. His colleague said that the Hospital needs “modernising and investing in”. In addition to new maternity staff being recruited (anaesthetists, consultants, midwives), a significant investment is going to be made into the Hospital as a whole. Over the next 6 months a ‘vision’ will be developed for the future of Epsom Hospital.

Mr Tiernan did not give a figure of how much money the major investment would be, so a few days later I telephoned him to find out more details and to confirm the maternity service is safe – after it being under threat for so long I wanted to be absolutely certain it will remain.

He told me that he anticipates that the investment in Epsom will be between £80m and £100m, but that he cannot commit to an exact figure as that depends on what the ‘vision’ requires, and the vision will be formed over the coming months. The Trust will then apply for the funds. So the monies have not yet been secured, but Mr Tiernan seemed confident they would be. I asked him what the Trust expects to spend the money on. He said some new build and some re-build, but he cannot commit to anything at this stage.

I asked him about the maternity service. He assured me that it is now definitely safe and that new staff will be recruited. I asked if the ‘vision’ could include cutting back other services instead, he said that it would not.

I am incredibly pleased that Surrey PCT and the Trust have finally seen sense and listened to the views of local people. My thanks again to all of you who supported my campaign.

My meeting with the CEO of the Trust on 30/01/09:

I organised a meeting with Samantha Jones the Chief Executive Officer of Epsom and St Helier NHS Trust (the Trust) in order to lobby her directly.

I emphasised to her the scale of opposition amongst local people to cuts to Epsom Hospital illustrated by the hundreds of signatures that my petition had received.

I also probed her on the issue of a possible de-merger of Epsom from St Helier and how seriously the Trust are considering this. She said that it is being seriously considered, and emphasised that due to the small size of Epsom Hospital it will not be possible for it to be a stand-alone District General Hospital. She accepted that being merged with a hospital that comes under a different strategic health authority makes things “complicated” – South East Coast is responsible for Surrey PCT (which commissions most of Epsom’s services) whereas NHS London is responsible for Sutton and Merton PCT (which commissions St Helier).

I asked her about the Partnerships option that was being investigated, namely to share staff with other near-by hospitals to ease the strain on Epsom. She said that St Helier has a clear need for this and the PCT are very much looking into the option of St Georges Hospital in Tooting sharing staff with St Helier . In terms of Epsom, she said that the need is less pressing, but that they are talking to other hospitals.

She said the recruitment difficulties the Trust has, are not due to a lack of finance to pay for new staff, they are the result of a national shortage of staff available to recruit. Nonetheless as I pointed out to her, had the Trust not considered closing some of Epsom services, and for such a long time, it is likely more potential staff would be applying to work at Epsom.

Ms Jones told me she feels that Epsom needs to be building its relationship with Surrey hospitals. She gave the example of how currently pregnant women with diabetes or with twins are sent to St Helier to give birth, when they could be sent to the Royal Surrey in Guildford instead. I was very pleased to hear that she now recognises local people’s desire, where the medical treatment is the same, to go to Surrey hospitals rather than St Helier. I and others have been pushing for some-time for greater links to be made with Surrey hospitals, so this is good news.

Finally we briefly discussed the Trust’s fight against infection rates. There has been a decrease of almost 50% of the Trust’s C Difficle cases and a two thirds reduction of MRSA cases, which is obviously excellent news.

Nonetheless, it seems incredible to me that many of Britain’s hospitals in the 21 st century, after so much investment from the Government, are failing the most basic of rules in the book – cleanliness. Over recent years the Government has wasted a considerable amount of NHS money on re-branding, consultants and middle management, whilst many hospitals are simply unclean, and many are threatened with closure.

‘Assuring Access’ event on 26/01/09:

I attended another of Surrey Primary Care Trust’s ‘Assuring Access’ consultation events on 26 January. The aim of the event was to look at the priorities the previous ‘Assuring Access’ events had identified, and for the PCT to report on how it is going to respond to them, through its commissioning intentions. It was announced at the end of September that the PCT wishes to commission the maternity service at Epsom, but its intentions in respect of the other services were not publicly announced until this ‘Assuring Access’ event.

In the morning a presentation was given that listed the priorities the previous ‘Assuring Access’ events had identified, and the PCT’s commissioning responses. Then questions were taken. Unplanned care (eg A&E, unplanned trips to your GP etc) is one of the priorities that the previous sessions identified. The PCT reported that it wants to ensure that only the appropriate people attend A&E (ie people who’s needs cannot be better met by a different service such as a GP surgery or pharmacy). I agree with this aim but the PCT needs to do more to make it possible for local people. At previous events clinicians made clear that a significant proportion of people who come to A&E could be treated by different services (eg by their GP/ pharmacy etc), thereby reducing the strain on A&E.

However, I expect that often the reason people go to A&E in these circumstances is because they feel they need to be assessed/treated urgently and their GP surgery or local pharmacy is not open at the time they need it, or they are unsure if that is the appropriate place for them to go. I am pleased that the PCT recognised that increasing the opening hours of GP surgeries was a priority identified at previous ‘Assuring Access’ events. The PCT responded by reporting that 63% of practices in Surrey offer extended opening hours. This needs to be increased.

Another priority is for there to be a review of the clinical networks that Epsom Hospital has with other hospitals for strokes, hearts and trauma. This means a review of which hospitals Epsom sends its stroke/heart/emergency surgery patients to. We were told by the presenter who was reporting the priorities to us “You felt very strongly that Epsom Hospital should be linked to Surrey hospitals rather than London ones.” I was pleased to hear the PCT officially recognising this. Where a service can be provided by a Surrey hospital equally well, the people of Mole Valley should not be sent to St Helier simply because it is the sister hospital of Epsom.

However if, as is the case with certain types of injuries, the best possible treatment is provided by a London hospital and not a Surrey one, patients should of course be sent to the London one. An obvious example being the Royal Marsden for cancer treatment. Epsom’s trauma patients (eg car crash victims / people with multiple injuries) are usually sent to the Royal Surrey in Guildford. Patients needing emergency surgery are sent to St Helier.

It was also announced that the PCT are reviewing their mental health / alcohol strategy. Mental health is something that often gets neglected, and alcohol related problems increasingly important with binge drinking being such a serious national problem. So I was pleased to hear the PCT’s approach to these is going to be reviewed.

We were told the PCT has given itself a target to reach by 2012/13 in respect of ‘End of Life’, ie increase the number of terminally ill people who can die in their own home if they so chose, rather than in hospital. Apparently the current level is just 16%.

During the questions session, one of the attendees asked the representatives of the PCT about the possible de-merger of Epsom Hospital from St Helier Hospital. The PCT emphasised that this issue is for Epsom and St Helier NHS Trust (‘the Trust’) to decide, not the PCT. The ‘Local Needs, Local Health’ consultation that the Trust are running is, I am pleased to say, considering a de-merger of Epsom from St Helier as one possible option for its future. However, as somebody said it is not a question of whether Epsom should be a stand alone hospital, it is a question of which hospital it should be joined with / most linked with, and that change must of course be an improvement to be worthwhile.

We were told at the end of the consultation day that it was likely to be the last ‘Assuring Access’ event. A report on the views expressed will be submitted to the Programme Board.

'Assuring Access' events on 22/10/08 and 24/10/08:

On Wednesday 22 October I attended a consultation event that is part of the recently commenced ‘Assuring Access – Co-mapping future services for Epsom and Ewell ’ consultation. The full day event took place at Ewell Court House.

The consultation events that I have attended in regards to the women’s and children’s services, have been run by Epsom and St Helier NHS Trust (‘the Trust’). In contrast, ‘Assuring Access’ is being run by Surrey Primary Care Trust (PCT). Surrey PCT commissions most of the services that Epsom Hospital provides, so to a large extent it holds the purse strings.

The event was about the future of the ‘unplanned care’ that is provided in Epsom and Ewell , such as the A&E service.

The attendees at the consultation event were a mixture of public representatives and clinicians, which made the discussions particularly interesting. It was very helpful to hear the views of doctors who refer patients to Epsom Hospital , of paediatricians and nurses who work there, and of the experiences and opinions of paramedics.

Split into groups, we discussed how the current strain on Epsom’s unplanned care services could be decreased. We discussed more pharmacies being open 24 hours a day, social workers and district nurses (out in the community) being available 24 hours a day, more district nurses being recruited, and GP surgeries having longer opening hours. The latter is something that the Lib Dems have been campaigning for for a long time, and I feel particularly passionate about. It is obviously very inconvenient for most working people, when GP surgeries do not open in the evenings or on Saturdays. If we are to encourage people to look after their health surely surgeries should be open at these times.

Another suggestion discussed for reducing the strain on A&E, was having an assessment centre at the front of it to assess attendees before they begin their wait for A&E. This would determine early on, whether the attendee needs to attend A&E, or if in fact it would be better for them to attend their GP surgery or a pharmacy for example. After our group discussions, each group reported their views to the gentleman who was running the consultation event.

I and others in my group questioned some of the statistics that the PCT had provided us with in a pack. Instead of stating the total number of people that attend Epsom’s A&E each year, the pack stated just the number of people from selectedGP surgeries that attend it. This gave a misleading figure of 13,000 attendees, when in fact approximately 48,000 people use Epsom’s A&E each year I am told. The response I received to my complaint that the statistics were incomplete, was that the selected practices are being used as a sample. I argued that it is difficult to give our views on a situation when we are not provided with the full picture.

I also pointed out that the statistics do not mention the likely future increase in the size of the local population. Considering a significant amount of housing is due to be built in the area, it is crucial that population forecasts are taken into account when assessing the need for Epsom’s A&E. For example, it was claimed by the medical director of St Helier Hospital , that there is not enough demand for an emergency surgery service to be at Epsom. The emergency surgery element of Epsom’s A&E was closed a couple of years ago, but Epsom’s remaining A&E services are used by thousands of people every year. Statistics regarding the current number and likely future number of users of Epsom’s services, are obviously critical in assessing what services Epsom Hospital needs to provide.

During the lunch break of the consultation event, I spoke to Mr Sadler, the director who had resigned from the Board of Directors of Epsom and St Helier NHS Trust, and who I had met with during September. Mr Sadler expressed grave concerns about the future of Epsom’s A&E. He strongly believes that the service should remain, and that it should include an emergency surgery service as it used to.

I found the consultation day very useful. It enabled me to express my views and concerns to Surrey PCT about the fate of Epsom’s unplanned care, and it was very interesting to hear the views of the doctors and other staff who work for the hospital and actually see what is happening on the ground.

On Friday 24 th October I attended the ‘Assuring Access’ consultation event on ‘planned care’. ‘Planned care’ encompasses ‘primary care’ such as appointments at GP surgeries, as well as planned surgery at the hospital. Unfortunately I was unable to stay long at the event as I was moving into my new home that day.

My views on the PCT's decision – 1/10/08 :

Surrey Primary Care Trust has announced that it wishes to continue to commission maternity services at Epsom Hospital . This is a major victory for local campaigners who have worked hard to keep up the pressure for maternity services to remain at Epsom.

I am very pleased with the PCT’s decision. It means that funding is available for maternity services to continue to be provided at Epsom. However, the fight is not over yet. The fate of Epsom’s maternity services shall ultimately be decided by the Trust, following its ongoing review of womens and childrens services, and the Trust has not yet made a decision. We must continue our campaign to protect this important local service.

Good news from Surrey Primary Care Trust – 29/9/08 :

“PCT Board confirms intentions for future of maternity services at Epsom

Last week, Surrey PCT’s Board gave an early indication of its desire to commission maternity services at Epsom Hospital . The board made the decision after taking into account all the latest evidence and best practice, including the recommendations made by the Independent Reconfiguration Panel on the proposals for maternity services at East Sussex Hospitals NHS Trust and the most recent guidance from the Royal College of Obstetricians and Gynaecologists on the future of small maternity units.

Surrey PCT Chief Executive, Chris Butler commented: “This is the right decision for Surrey ’s residents. The fine detail of our commissioning plans needs to be worked through but all the evidence, including the views from the community, says this has to be the right way forward.”

Samantha Jones , Chief Executive of Epsom and St Helier University Hospitals NHS Trust, added: "We are really pleased that the board of Surrey Primary Care Trust has declared its desire to commission maternity services from Epsom Hospital for the people of Epsom and beyond. We look forward to receiving the finer detail of their commissioning intentions, including the standards they expect us to meet, so that we can give them detailed service plans which are viable both clinically and financially."

Further work to inform full commissioning intentions for maternity is being taken forward through the co-mapping process.”

My meeting with Mike Sadler on 23/9/08:

Following the controversial resignation of Mike Sadler from his role as non-executive director of Epsom and St Helier NHS Trust Board, I took my colleague’s excellent advice and arranged a meeting with Mr Sadler. My aim was to discover more detail about why he resigned, and his views on: Adrian White’s offer, a possible de-merger of the Trust’s hospitals, and the threats to Epsom’s women’s and children’s services.

Our meeting took place over dinner at one of my favourite restaurants, which made it particularly enjoyable. Mr Sadler gave me a lot of information and his views which were extremely interesting and helpful to hear.

Adrian White’s purchase offer:

Adrian White has offered to purchase the whole of the Epsom Hospital building for £30 million, and to invest a further £80 million in it. Mr Sadler told me that Mr White wants to create “an outstanding health care service here” providing the same services as are currently provided, but with the addition of a specialist cardiac unit. He said “I happen to think it’s a very good idea.”

Mr White would build and own the cardiac unit, just as he would own the rest of the hospital, but he would contract out the running of the cardiac unit to a private, probably American, company. He would contract out the other services that the hospital provides largely to the NHS, but probably to private companies as well. So Mr White would contract/lease out the hospital’s services, ie pay providers to deliver them, and those providers would be a mixture of the NHS and private companies. Mr White would own the hospital as a charity, so he would not make a profit from it. However, the private companies providing services would of course be profit-making.

I wanted to be absolutely certain that patients would not have to pay to access the privately provided/run services. Mr Sadler said that part of the contract with any private (profit-making) company would be that they would offer their services to NHS patients at the national agreed rate that the Government sets (i.e. PbR rates). The expectation would be that the private provider would be at least as efficient as an NHS provider.

So NHS patients would not be charged to access the services, even the services provided by private companies. Of course, to have all of the ‘bells and whistles’ of being a private patient rather than an NHS patient, means private patients would be charged.

Most of the hospital’s services are and would continue to be, funded by the Primary Care Trust (PCT). The GPs are effectively private organisations providing services for the PCT. Every time a GP refers a patient to Epsom Hospital , the GP surgery pays the hospital for treating the patient via Surrey PCT. Under ‘Patient Choice’, the funder of the hospital’s service providers, whether NHS or private providers, would still be the GP surgeries working for the PCT. Patients would not be charged.

Mr Sadler explained that Mr White funded and owns the specialist orthopaedic centre building that is attached to Epsom Hospital . He said the South West Elective Orthopoedic Centre (SWLEOC) is the biggest and best orthopaedic centre in the country, and has zero levels of MRSA . Mr White also provided funding for Epsom’s maternity unit, and was the Chair of the Trust’s Board of Directors during the 1990s.

Mr Sadler said “It was over two years ago now that Mr White made his offer to purchase and invest in Epsom Hospital . Yet it is amazing that the Trust has refused to seriously engage in any discussions about how they could make the proposed investment happen.” I asked Mr Sadler why he believes the Trust have delayed so much in investigating the offer, considering its need for funding. He said “I think they’re scared. They feel out of their depth, unconfident about their ability to negotiate with Adrian . But more importantly, they are afraid that accepting his offer would be seen as admitting that the NHS cannot manage to run the hospital itself.”

As Epsom Hospital is run by ‘Epsom and St Helier NHS Trust’, and St Helier Hospital is in Greater London, the Trust is governed by NHS London. This means that to accept Mr White’s offer, the Trust would require the approval of NHS London. Mr Sadler believes that NHS London is fearful of entering a public-private partnership at Epsom, such as that which Mr White’s offer would create.

He informed me that the Trust’s Executive Committee has alone dealt with Mr White’s offer, the Committee has prohibited the Trust’s Board of Directors, which Mr Sadler was on, from accessing information about the offer.

He believes the Trust should accept Mr White’s offer to purchase and invest in the hospital. He said “I know the Trust has no plan about how to save its threatened services. Mr White’s proposal is the best thing on offer.” He told me the proposal includes saving the women’s and children’s services.

In terms of my view on Adrian White’s offer, I am campaigning for a way forward for Epsom Hospital that allows the NHS to provide all the services our people need without any outside help. But as this issue drags on through committee after committee there is a real danger of our losing this crucial battle. All options that provide much-needed high quality services where we need them and without any charges to NHS patients must now receive serious consideration.

Better Healthcare Closer to Home (BHCH):

This is the title of one of the many projects/consultations that the Trust has embarked on, in its assessment of what services it should continue to provide. I asked Mr Sadler his views on the project.

He highlighted that much earlier in BHCH, three years ago now, it was decided that a new hospital would be built in Sutton, and Epsom and St Helier would both be downgraded. For political reasons, this plan was scrapped.

Now the Trust are hoping to obtain £220 million of funding from the Department of Health, and intend to spend approximately £140 million of it on St Helier . St Helier Hospital is an old run down building and desperately in need of investment, but Mr Sadler is concerned that Epsom Hospital is being neglected. He says “Whilst St Helier is getting on and spending the money it hopes to (though has not yet) got from the Government, there are no clear proposals for saving and improving Epsom’s services.”

He continued “More importantly, with £140 million for just the first phase of the refurbishment of St Helier , it is likely that the Trust will spend ALL its allowable capital resources simply on sorting out St Helier , leaving absolutely nothing for refurbishing and developing Epsom. Even worse, they would be using the value of the services supplied at Epsom to justify the extra expenditure at St Helier . Meanwhile Epsom is run down and the Denbies proposal gathers dust!!”

Whether ‘Epsom and St Helier NHS Trust’ should de-merge:

I asked Mr Sadler if he is in favour of a de-merger of Epsom Hospital from St Helier Hospital , as the two are currently run jointly by ‘Epsom and St Helier NHS Trust’. In my view, it may well be that Epsom Hospital would benefit from a de-merger from St Helier , but this would depend on the plan for Epsom’s future. A de-merger could be an improvement because, as explained above, due to St Helier Hospital being based in London , the Trust that runs Epsom and St Helier , is governed by NHS London. As Epsom Hospital is in Surrey , it is not at the top of the priority list of NHS London. So Epsom gets neglected.

Furthermore, the needs of Epsom are very different to those of St Helier in Carshalton. Carshalton has a much more urban, more densely populated catchment area. It also, unlike Epsom, has various other major hospitals near to it, such as Mayday and St Georges Hospital.

It is possible a de-merger would result in Epsom’s needs being focused on more. But this depends on what other hospital it is merged with, if it is merged with another at all, the detail of the de-merger/merger, and the plan for its future.

Mr Sadler told me he is in favour of a de-merger, but only if “there is a proposal for the future, and Epsom is not thrown out into the cold.” He believes that NHS London and the Trust’s CEO are in favour of a de-merger, so one is likely to happen eventually.

The women’s and children’s services at Epsom Hospital:

Mr Sadler strongly believes that these should remain at Epsom. As a member of the Trust’s Board of Directors, he had objected to the consultation on the fate of these services being delegated to 6 committees that are run by management consultants.

He believes that the Trust wants to close Epsom’s women’s and children’s services. This would mean that patients would have to go as far as St Helier for a delivery ward and inpatient children’s ward. Check-ups for pregnant women would be done in GP surgeries.

I asked Mr Sadler his views on the ‘Partnerships Option’ that the Trust is considering. This option would involve sharing staff with other local hospitals in order to meet the health and safety guidelines on the number of staff in women’s and children’s services. The Trust currently says that the main reason they are considering closing the services is that the guidelines are currently not met. Talks are being held with Kingston Hospital to investigate the feasibility of pursuing the ‘Partnerships Option’ with them.

Interestingly, Mr Sadler’s view was that entering a partnership with Kingston Hospital would not be wise, as like St Helier , it is governed by NHS London. He believes it could create similar problems as we have now, such as Epsom being neglected. Instead, he thinks that a partnership with Guildford ’s The Royal Surrey Hospital might work. He told me, “We’ve got to look to the future. If Epsom is going to survive it has got to join up with a hospital.”

He explained that like Epsom, most hospitals in the area have difficulty recruiting midwives because of the high cost of living. However, Epsom has a particular difficulty in attracting new staff. This is for two reasons. The first is the threats to Epsom’s services. Obviously midwives aren’t attracted to apply for a job at Epsom when the women’s and children’s services may be closed in a year’s time. The second reason is that the Trust is making only a minimal effort to recruit new staff for Epsom. Mr Sadler explained that it has not even advertised the vacancies in the local newspaper. He believes that the Trust’s lack of effort is because it is considering closing Epsom’s women’s and children’s services. Historically, the Trust has run recruitment campaigns in the old Commonwealth countries (Nigeria, Phillipines, Malaysia) offering accommodation and employment for needed nurses and midwives. This is clearly needed now.

He believes that the Trust is using the health and safety guidelines (of the Royal College of Obstetricians) and the European Working Time Directive as an excuse for considering the closures. He says that Epsom’s maternity unit is already very safe. It has one of the best mortality rates in the country.

Epsom falls short of the The Royal College’s guidelines in terms of number of midwives, but the guidelines are for maternity units that deal with more than 2,500 births each year, which Epsom does not. Mr Sadler believes that Epsom’s maternity unit does need more midwives, but that the Trust could acquire these if it actively tried to recruit them. He believes there is a sufficient number of consultants.

Mr Sadler’s resignation:

For a long time he had been asking the Trust to provide him with details of the maternity unit’s income and expenditure, but that they would not. He raised it with the Chair of the Trust Board, John Davey, on 7 different occasions, until eventually, in April 2008 financial details were produced at a public meeting. The figures showed that Epsom’s women’s and children’s services were losing £1.5 million a year, and St Helier ’s were losing £2 million a year. But, Mr Sadler told me, the figures were incorrect. They did not include the income earned by the gynaecology department, which for Epsom was approximately £2.5 million a year. There was something distinctly wrong about the Revenue figures for the two hospitals. St Helier apparently had over double the income of Epsom, yet they only delivered 40% more babies and yet they were both on the same PbR rate card for pricing. Also the costs allocated to the two hospital’s maternity units did not seem sensible. For example, pathology charges were higher at Epsom despite the hospital having 40% fewer mothers and babies to check!

Mr Sadler put other questions to John Davey, but they did not receive answers. At a Strategy Committee meeting on 30 June 2008 , he told Mr Davey that if he did not answer his questions he would consider resigning. Answers were not given, so he resigned.

Despite his disillusionment with the Trust, Mr Sadler was keen to highlight that the Trust’s performance has improved over the last 3 years. However, he has serious concerns about the future of Epsom’s services.

St Helier Hospital:

Disillusioned Trust non-executive director resigns – 20/8/08:

Michael Sadler, a non-executive director on the Epsom and St Helier Trust Board, has resigned from his role, because of the continuing delays in reforming the hospitals, and the lack of powers that the Board has with which to do so.

In his letter of resignation to the Trust Board’s chairman he wrote: “Our board seems to spend an amazing amount of time examining the detail and trivia of our trust’s activities while studiously avoiding any discussion of the matters of strategic importance.”

In relation to the Trust’s ongoing review and consultation on the fate of its womens and childrens service, Mr Sadler told the Standard newspaper: “We are in chaos on this project. We have six teams of management consultants all for the women and childrens review.”

Update – 2/8/08:

On 2nd July Epsom and St Helier NHS Trust announced that it will launch a review called Local Needs, Local Health of the structural organisation of the Trust’s hospitals. This will run in tandem with the ongoing review of womens and childrens services that has been in motion for some time.

The review of womens and childrens services is continuing to consider closing the delivery ward and inpatient childrens service which is at Epsom Hospital , and merging them with those at St Helier Hospital in Carshalton.

Firm proposals for the future of the services are due to be announced by the Trust in September, but it is expected that this will be delayed as the Trust are in the process of holding meetings with other local hospitals, to investigate the feasibility of the ‘Partnerships Option’.

From attending ‘stakeholder consultation meetings’ that the Trust has held, it has become clear that at the crux of the threat to Epsom’s services is a difficulty in attracting potential employees to work for the hospital. Ironically, this difficulty is likely to be the result of the uncertainty surrounding the future of the hospital’s services.

The Partnerships Option is a possible means of sharing staff with other local hospitals such as Kingston , which has a very large maternity unit, in order to rectify Epsom’s staff shortage, and potentially retain the threatened services at Epsom.

Adrian White of Denbies has previously indicated that he is interested in investing in Epsom Hospital . Very little detail about this possible option has been made public, but formal discussions are due to take place between Mr White and the Trust during August.

Press release from Epsom and St Helier NHS Trust - 2/7/08:

“Epsom and St Helier University Hospitals NHS Trust has today announced plans to review the way that it is configured with a view to establishing whether there is a better way of running the hospitals so that it can further improve the service it provides to local people.

The review, which is called Local Needs, Local Health, is an extension of the Trust’s clinical strategy, launched in January, and will look at all possible options for the future shape of the Trust. The main reasons for undertaking the review, which will involve the Trust’s doctors, nurses and other staff from the outset, are:

- To see if there is a better way for the Trust to meet the diverse health needs of the populations of Sutton, Merton, Epsom and the surrounding areas;

- To see if there is a better way for the Trust meet the demands placed on it by the primary care trusts that commission its services, in particular:

- For patients to be able to access services locally;

- To meet the increasingly high standards of care expected by a number of professional bodies, for instance within A&E, women and children’s services, anaesthetics and critical care;

- Its ability to deliver services within the finite resources available.

- To see if there is a better way for the Trust to meet the challenges posed by:

- The need to reduce the number of hours staff can work under the European Working Time Directive;

- Its ability to recruit certain types of clinicians;

- Patient Choice , the national NHS initiative which gives patients a choice of where they receive treatment.

With the involvement of Trust’s clinical and non clinical staff, Local Needs, LocalHealth is expected to put forward and assess a range of potential options for the future. These could include, amongst others:

- remaining with the status quo;

- the hospitals doing more in partnership with other trusts/hospitals;

- establishing the feasibility of Epsom and St Helier hospitals de-merging to become stand alone entities.

Samantha Jones , Chief Executive, said: “We are committed to ensuring that the people of Epsom, Sutton, Merton and surrounding areas have easy access to safe high quality care in a clean and welcoming environment.

“The NHS is going through a period of unparalleled change and we must maximise the benefits this is delivering, whilst meeting the many challenges it poses. On top of this, the primary care trusts are placing increased demands on us to meet new higher standards and to keep services local, but within finite resources.

“Local Needs, Local Health will allow us, with the support and involvement of our doctors, nurses and other staff, to look at doing things differently. By using innovative solutions, we can meet the challenges we face, whilst continuing to deliver safe and high quality services that are easily accessible for local people.

“Local Needs, Local Health is not about service change, but about seeing if there is a better way to run our hospitals. The review is an extension of the Trust’s current clinical strategy, which aims to develop St Helier and Epsom as local hospitals in line with current national guidance. All possible options for the way we are shaped in the future will need to viable clinically and financially.

“We recognise that there has been, for many years, a level of uncertainty for staff, patients and local people surrounding the future of our hospitals. We are confident that Local Needs, Local Health will allow us to end this speculation once and for all, therefore delivering certainty to the local community and staff.

“We are committed to keeping our patients, local people, staff, volunteers and other stakeholders fully briefed and up-to-date with the Local Needs, Local Health review. We will run an open and transparent process with appropriate engagement and consultation.”

Local Needs, Local Health will be jointly led by the Trust and NHS London, its strategic health authority. The review is also supported by, and will involve close working with, Sutton and Merton Primary Care Trust (SMPCT), Surrey Primary Care Trust ( SPCT ) and South East Coast Strategic Health Authority.

To make sure Local Needs, Local Health delivers the best possible outcome for the people of Epsom, Sutton, Merton and the surrounding areas, it will interface with a number of local healthcare strategic reviews, including:

- Better Healthcare Closer to Home (led by SMPCT);

- Surrey Fit for the Future (led by SPCT );

- Women and children’s services review (led by the Trust, SMPCT and SPCT ).

Local Needs, Local Health will also link into national developments within the NHS, including the NHS Next Stage review (Our NHS, our future) and Healthcare for London.

Local Health, Local Needs will be managed within a formal project governance structure. Further details about the review, including timescales, will be published by the end of August.”

Consultation event - 8/5/08:

I was eventually granted a place at the consultation meeting that was held in Sutton on 22nd April in relation to the future of the women and children's services.

Three options were outlined for the Trust's delivery wards and inpatient children's services:

Dr Ruth Charlton (Divisional Director of the Trust's Family Care) said during her presentation that "the status quo cannot be maintained beyond August 2009". This relates to the European Working Time Directive preventing junior doctors from working more than 48 hours per week.

The main reason the Trust give for considering closing Epsom's delivery ward and inpatient children's service is that although the services are safe, they do not meet the guidance of the Directive, and the recommendations of the Royal College of Anaesthetists and the Royal College of Obstetrics and Gynaecology. Dr Martin Wake said during his presentation "At the nitty gritty this is about staff".

Mole Valley's population is growing. We need Epsom Hospital to access more staff so that it can retain its services that local people need.

At the meeting I asked Sam Jones, the Trust's CEO, whether she accepted that the fact that the travel time from Mole Valley to St Helier is longer than 20 minutes, could pose a threat to women who are trying to reach the delivery ward urgently. The Darzi report states that a journey of longer than 20 minutes may have an adverse effect.

When I asked Ms Jones this question at the March Trust Board meeting she had avoided answering it by telling me it would be answered at this consultation. In fact, she passed my question to a colleague to answer who apologised for not having information about travel times as promised.

I was later told by the colleague that the 20 minutes travel time relates to blue light journeys, ie transfers between hospitals when the woman is already in labour, rather than travel from the home to hospital before the woman is in labour. But of course, as I responded, the journey from the home could be a blue light one, the woman could be in labour, in which case the journey should not be longer than 20 minutes. I was promised that detailed information about travel times would be provided at the next consultation meeting.

Following the meeting I telephoned the Trust's Director of Communications and asked for more detail about the 'Partnerships' option. He informed me that the Chief Executive Officers of: Epsom & St. Helier NHS Trust, Surrey Primary Care Trust, and Sutton and Merton Primary Care Trust are going to liase with other local Trusts to explore the option of sharing staff, in order to meet the guidance of the Directive and Royal Colleges.

I explained to the Director of Communications that I want to know details about this proposal when they are developed, but that I am pleased to hear that the Trust are exploring potential ways of preserving the services at Epsom. I shall keep you posted!

My petition opposing the threats to Epsom Hospital can be found on the counters of various shops in Leatherhead, so please do sign it. If you would be willing to collect signatures for me please send me an email (alice@alicehumphreys.com) or call me (07985 678276) and I will send you a petition sheet. I would be hugely grateful! I shall soon distribute the petition to other parts of Mole Valley.

Denis Loretto (Mole Valley Lib Dems' Executive Committee member and former Chair) and I outside the Sutton venue of the 22nd April consultation event:

Update - 11/4/04:

During our protest last month Sam Jones, the Chief Executive Officer of the Trust, handed me a leaflet advertising the 'pre-engagement' consultation meeting that is to be held on 22nd April.

The leaflet requires people to request from the Trust an invitation to the meeting if they wish to attend it. However, the Trust have refused myself and others invitations! When I emailed my request on 31st March, the Trust responded by claiming that there are no spaces left at the meeting for members of the public to attend! It said that if I wanted to attend I would be put on a reserve list.

I emailed Sam Jones the following:

"Dear Sam

As you can see below, I have been informed that there are no longer places at the engagement event on the 22nd and that I therefore cannot attend.

Please explain why a larger venue cannot be used in order to accomodate the people who wish to attend, such as myself?

The aim of the meeting, according to the leaflet you handed me on 7th March, is to "make sure local people and patients are able to feed into the review and make their views known". If this is genuinely the aim of the meeting, why are you not accomodating all those who wish to attend?

Alice Humphreys
(Prospective Parliamentary Candidate for Mole Valley Liberal Democrats)"

I received a standard letter of reply, reiterating that I can be on the reserve list, and stating that more spaces may become available.

As I said in my press release, according to the leaflet advertising the meeting, the purpose of the meeting is to ensure local people are able to make their views known. How can we do this if we are not allowed to attend?"

It seems the Trust have organised the 'pre-engagement' meeting with the aim of as few people attending as possible. They arranged that it take place during working hours, we must request an invitation before we can order a ticket, and we are not informed of the location of the meeting until we are granted a ticket. Now people are being refused admission altogether! Are the Trust genuinely interested in consulting on the fate of our services or are they just going through the motions to comply with their requirement to 'consult'?

I have decided to organise a petition in Mole Valley opposing the threats to Epsom's delivery ward and inpatient childrens services. Please let me know if you would be willing to try to get some signatories. I can post you a sheet or two. I would be really grateful for your help!

Our protest - 18/3/08:

Protest

Many thanks to those who attended our protest on 7th March outside Epsom Hospital, and the Trust's Board meeting that followed. We met at 8.45am for the protest in the wind and rain, so I was particularly impressed with those that attended. Many cars driving past showed their support by beeping their horns, and the Chief Executive Officer of the Trust and her Director of Communications came out and spoke to us, informing us of the 'pre-engagement' consultation event that is to be held in April.

Board meeting

After the protest we attended the Board meeting, along with many mothers and Epsom and Ewell's Chris Grayling MP who has done an impressive amount of campaigning on this issue. No major decisions were made at the Board meeting in relation to women's and children's services, but we were informed that St Helier Hospital is actively recruiting midwives and that the Trust has recently recruited two.

The Finance Director reported that although the Trust made a loss last year "Our income is ahead of our budgeted income" which was positive news. It begs the question why the Trust is considering closing services when its finances are becoming more and more healthy.

It was announced at the meeting that Ruth Harrison has stood down from her role as manager of the review of the Trust's women's and children's services. This followed press reports that linked her previous employment in Buckinghamshire to the review at the Trust. Ms Harrison is to be replaced by Nick Relph.

At the end of the Board meeting there was an opportunity for members of the public to ask questions. I told the Board: "It takes at least twice as long to get from my family's home in Leatherhead to St Helier than to Epsom. Crucially, the journey to St Helier takes more than 20 minutes. Do you accept that this extra time, whether it is spent in an ambulance or car, could have a detrimental effect on the safety of deliveries, particularly considering that the Darzi report says that a transfer taking more than 20 minutes may have an adverse effect?" The Chief Executive Officer simply answered that travel times will be discussed during the consultation.

Consultation

Professor Ian John Lewis has been appointed the Independent Clinical Chair of the review. He will direct the review, and make proposals through the Project Board to Epsom and St Helier NHS Trust, Sutton and Merton Primary Care Trust, and Surrey Primary Care Trust. Although his review relates only to the women's and children's services at Epsom and St Helier hospitals, any changes proposed by the review require the agreement of all three trust boards. There will be a public consultation on any such proposals before the three trust boards are asked to make a decision on them.

Before the public consultation begins a 'pre-engagement' process is taking place, following which proposals for the public consultation will be formed. The 'pre-engagement process' involves meetings with clinical staff at the hospitals, and meetings with invited members of the public.

On Tuesday 22nd April a meeting with the public will be held in Sutton from 10am-2pm. If you wish to attend, you must request an invitation by emailing shelley.court@epsom-sthelier.nhs.uk, or by calling 020 8296 2406. I urge you to do so if you are available. It is an opportunity to get your voice heard.

Introduction – 24/2/08:

Epsom Hospital is considering closing the delivery ward in its maternity unit, and its inpatient children’s service. These services would be concentrated at St Helier Hospital in Carshalton. A public consultation on the matter will soon begin.

The reason given for the possible change

Epsom and St. Helier NHS Trust claims that although Epsom’s services are currently safe, they do not meet the recommended standards of the Royal College of Anaesthetists and the Royal College of Obstetrics and Gynaecology. John Davey, the Chairman of the Trust’s Board, has said that this is the main reason for the Trust considering the merger.

Meeting with John Davey

I am very concerned about the threat and have been working with the local campaign group ‘Hope for Women and Children’ who oppose the possible merger. I have also spoken to the Trust’s Divisional Director for Womens’ and Childrens’ Services.

I had a meeting with John Davey and explained to him my views. He informed me that the Trust is in the process of recruiting more staff to help meet the recommended standards. I explained that safety is of paramount importance, and that the Trust could and should continue to recruit more staff in the long-term. By doing this, the safety standards would be met and the services could remain at Epsom. Some consultants at the Hospital have produced a Financial Plan that shows that this is financially viable for the Trust.

The disadvantages of merging the services in question

The population that Epsom Hospital serves is going to increase over the next few years. Many new homes are being built in the area. Local people need these services at Epsom now more than ever. It is madness that the Trust are considering forcing us to travel to St Helier for them. According to Multimap, it takes 9 minutes to travel by car from my family’s home in Leatherhead to Epsom Hospital. Yet it takes more than twice as long, 21 minutes, to travel to St Helier in Carshalton. If a woman was in labour, trying to get to a delivery ward, those minutes would be crucial. In terms of the children's services, it would be inconvenient for parents to have to travel to Carshalton if their child was in St Helier’s inpatient paediatric unit, rather than in Epsom’s.

Protest

I am joining the campaign to fight the threatened change and would like as many people as possible, no matter what their political affiliation, to attend the next Trust Board meeting on Friday 7th March at Epsom Hospital.

We can sit in the public gallery and ask questions at the end. You need not stay for the whole meeting. Just the presence of many residents at the beginning will send a message to the Board. We will have a peaceful demonstration outside the Hospital between 8.45am and 9.15am, then attend the Board meeting at 9.30am. Please meet at the entrance to the Hospital’s car park. Please come. It is really important that we show the Board that we do not want these services removed from Epsom.