Surgeons tell NHS they oppose Epsom Hospital downgrade

They have taken the extraordinary step because they said they wanted the public to be aware that the Better Service, Better Value (BSBV) process "is not supported by the majority of local doctors".

They argue that Epsom Hospital provides high quality services for local residents and if BSBV proposals, unveiled last week, are approved it would lead to the "destruction of the fully integrated acute and community services in paediatrics and obstetrics."

Services would be relocated to south west London hospitals, especially St George's which is already struggling to cope with its current workload.

And they outline an alternative plan they have been working on which links the hospital to Surrey not London and which they describe as "a strong plan and one that will work well for our local residents".

The open letter in full:

We write as group of Hospital Consultants and General Practitioners who have worked in the Epsom area for most of our professional lives.

We are extremely concerned that the future of Epsom General Hospital (EGH) is currently threatened by a process called “Better Service, Better Value” (BSBV).

The BSBV review has proposed major changes to local hospital services, subject to public consultation. 

We believe the public should be aware that this process is not supported by the majority of local doctors and there are serious concerns regarding both the safety and the likely impact of these proposed changes.

If these changes are enacted, the reality will be weaker services for local residents at increased cost to local commissioners.

We are extremely concerned that the delays involved in transporting ill patients to distant hospitals will increase clinical risk; that patients will find it difficult to access much needed services and that the elderly and families with children will find that the travelling times and costs are prohibitive.

These plans have been hurried in respect of EGH’s involvement with a conspicuous failure to provide any robust evidence of benefit to local people or to accurately model the implications for healthcare in Surrey.

EGH’s place is undoubtedly as a Surrey hospital working with other Surrey Trusts.  However the BSBV plan would irrevocably bind EGH and local residents to reliance on South West London Hospitals.  Many of South West London Hospital face challenges. 

In particular, St. George’s Hospital struggles to provide a full range of highly specialised (tertiary) services to this sector whilst also providing secondary care to its local population. 

BSBV would simply transform it into a bigger, over-full, District General Hospital with even greater problems.

As clinicians we understand that the NHS faces financial and logistical challenges locally as well as nationally. 

However, working in partnership with GPs, other Surrey Hospitals and specialist units such as St. George’s Hospital, EGH has continued to develop high quality care closer to home for our local population. 

As a result:

• Mortality rate is amongst the lowest in the UK.  We are in the top 25% hospitals for recovery from heart attack and stroke.
• Quality of patient experience is amongst the highest in the south of England.
• Though our maternity unit is small, our system ensures we have one of the lowest perinatal mortality and maternal morbidity rates.
• A & E times are amongst the shortest in the region and we can manage acute medical emergencies such as stroke, heart attack, chest disease and diabetic crises.  Many of these cases are managed in our high dependency and intensive care units which were recently renovated.
• A recent assessment of Epsom A and E by the London Standards for Emergency Healthcare placed our acute services second best across all of  London.
• EGH is on target to achieve financial balance by 2014-2015.

BSBV proposes to close maternity, paediatrics and A & E at EGH and deliver these acute services at Tooting, Croydon and Kingston. 

Our Consultants and Nurses would be moved to work in these Hospitals, returning to EGH to run out-patient clinics only. 

This would lead to the destruction of the currently fully integrated acute and community services in both Paediatrics and Obstetrics with a further reduction in local services. 

The A & E at EGH would become a walk-in centre, mainly staffed by GP’s.  People who are seriously ill would need to be transferred to other hospitals or would be taken directly.

But there is an alternative.  We have worked with others to create a Surrey plan which will:

• Modernise the A & E to recognise the changing needs of urgent care
• Continue to provide a truly integrated children’s service and strong maternity cover
• Provide Consultant cover on rotation to support specialist services 24/7
• Bring new services onto the site to recognise the changing requirements to integrate hospital and community care.
• Integrate EGH services more fully with the wider group of Surrey hospitals.
• Move gradually to a ‘campus site’, building on the best that the NHS, Private Providers and Voluntary Organisations can bring to Epsom.
• Encouraging new diagnostic facilities to use EGH as their base.

This is a strong plan and one that will work well for our local residents.  It is supported by our MP, Chris Grayling.

The NHS will change markedly in the next two years and without robust hospital services in Epsom the NHS in North and East Surrey will struggle to deliver hospital-based healthcare for local residents.  We would ask you to do all you can to challenge the assumptions of BSBV and assert your right to ask for an alternative plan that delivers real choice and quality locally. 

We ask you to reject the BSBV proposals and consider our plan.

We ask members of the public to support us and make their opinion known before it is too late:

• Write to Chris Grayling at the Houses of Parliament.
• Let your GP know your views.
• Write to Dr. Clare Fuller, Chair of NHS Surrey Downs at Cedar Court, Guildford Road, Fetcham, Leatherhead, Surrey, KT22 9AE
• Attend the public meetings scheduled to consider these changes.

With thanks and best wishes,

Yours sincerely (in alphabetical order):

Brendan Affley        
Consultant Stroke Physician

Adam Carter
Consultant Paediatrician    

Andrew Cobb       
Consultant Orthopaedic Surgeon        

Joan Desborough      
Consultant Anaesthetist

Peter Deveson
General Practitioner

Aoifa Evans
General Practitioner

Hilary Floyd
General Practitioner

Dean Harris
General Practitioner     

Mashkur Khan       
Consultant Physician 

Nigel Mckee,
General Practitioner

Nina Newton
General Practitioner      

Janet Nicholls
Consultant Paediatrician     

Sandeep Pande
General practitioner

Hassan Shehata     
Consultant Obstetrician

Jeremy Stephenson
General Practitioner

Peter Stott,
General practitioner

Paul Toomey
Consultant Surgeon

Goska Trubshaw
General Practitioner

Roy Twyman
Consultant Orthopaedic Surgeon

Lee Wadey
Consultant Paediatrician

Lee Wormley
General Practitioner