Consultation on proposed changes at St Helier Hospital

Karen Worthington, a local GP and part of Merton Clinical Commissioning Group and James Blythe, Managing Director Merton and Wandsworth CCGs, gave a presentation on the proposals for the future of critical care services at the Trust. The presentation is an appendix to this report. 

The Government has allocated £500m to improve buildings and build a new Specialist Emergency Care hospital (SECH). Under the proposals 85% services stay at Epsom and St Helier sites and a minimum of £80m will be spent on improving the existing buildings. Emergency services do not currently meet national standards and CQC rate them as needs improvement. There is also problem with recruiting sufficient staff. The current buildings not fit for purpose and expensive to maintain which creates an ongoing problem with finances

The new clinical model would mean at least two District Hospitals (Urgent Treatment Centre; Outpatient services; Diagnostic services; Planned Care procedures; Hospital Rehab/recovery) and one Specialist Emergency Care Hospital (Emergency Department; Acute Medicine; Emergency Surgery; Critical Care; Births; Inpatient Paediatrics). There are three options for the new SECH site:

Epsom, St Helier, or Sutton (next to the Royal Marsden). Sutton is the preferred site for the CCGs as it has the smallest increase in average travel times, would be easiest and quickest to build; and based on the Government assessment formulae provides the best value for money.

Modelling shows a slight increase in beds is needed, most would be at Epsom, St Helier and Sutton but some would need to be provided at other hospitals including St Georges, Croydon, Kingston or the Surrey hospitals to mitigate increase pressure on those hospitals. There would be little time difference in Ambulance and Car travel to the single SECH site, but there will be increases in Public Transport journey times for some people. The NHS would need to work with transport providers to mitigate this before the facility opens.

All three options are possible and no decision has been made so responses to the consultation are encouraged before it closes on 1 April 2020.

A resident asked if there was a meeting in Mitcham on 5 March. There is a listening event on 5 March at Chak89 from 6.30pm. Details of all events can be found on the Improving Healthcare Together website.

A resident asked if land opposite St Helier could be used in a land swap to speed up the option of building at that site. If that is a viable option then please feedback in consultation, however that still would not solve issues around travel times and impact on other sites.

A resident asked if this was in effect a Sutton Council decision. The decision will be taken by the local NHS decision, but will be subject to the usual planning application process.

A resident said there was information missing from consultation namely that 62% of St Helier beds would be lost; any new beds will be in Croydon/St Georges; that the proposals meant moving services from deprived area to an affluent area but there is a correlation with A&E attendance in higher deprivation areas. As a result, the plan should be to keep both hospitals and invest at both sites. James responded that the number of beds will increase but depending on option, some will need to go elsewhere – 50 in the case of preferred option of Sutton. Deprivation analysis is available in the Integrated Impact Analysis includes all the details that inform the decision and many of the  patients in most deprived areas in Merton already go to St Georges. The £500m investment is in capital funds so will not help to get new staff, and there is shortage in specialist staff regardless of funding.

A resident asked about the location for planned surgery that is not day surgery. Karen explained that this would depend on the assessment of risk with low risk at District Hospitals, and higher risk at the SECH. They will clarify this for future presentations.

A resident asked if the £80m for the old sites would be for each or both. The money will be spent across the two sites, which will bring both sites up to standard. A resident asked about the need for single bed rooms, these are needed for both infection control and privacy/dignity.

A resident said that the Sutton site was no good for Mitcham residents to get to. James replied that most patients attending A&E would do so by ambulance, whilst driving to the UTC at St Helier will still be an option for most residents.

There is a need to do more to divert patients from A&E; and needs effective triage at St Georges. Merton CCG has expanded out of hours GP appointments, and in the A&E they send patients to the UTC. There is a need to improve the triage at St Georges so they have been putting more resources in, including more GPs.

Walk-in centres have all been abolished they were largely duplicating GPs. UTCs do the same but a lot more as have diagnostics and other infrastructure.

A resident asked why plans included new car parks at Epsom and St Helier sites. There is still demand for car parks but will follow up on modelling those two sites.

A resident asked about bed blocking. James said there is very strong partnership with Merton Council, as a result the number of delayed discharges is really low compared to past.