The Epsom Guardian’s editor Sean Duggan examines whether the Better Services Better Value process to reconfigure hospitals in the area is losing the confidence of the public.

When it was launched the Better Services Better Value (BSBV) review promised to be a model of local decision-making in action about that most vital of issues – the fate of local hospitals.

But after spending millions of pounds of taxpayers money, with plenty more to come, many people are coming to a very different conclusion.

Thousands of residents in south-west London and Surrey have had their confidence in the process shattered by a series of decisions which appear to shift the goalposts whenever the objections of medical experts, or the public, seriously challenge what is being proposed.

Examples range from the Royal College of Nursing saying its members were almost entirely ignored during the drawing up of the options, to Surrey Downs clinical commissioning group (SDCCG) being forced to do a humiliating U-turn on its agreed voting process just minutes before a massive public meeting.

Then it emerged that hospitals and the seven CCGs have been told to agree all public statements in advance with the BSBV press team, and directors at the five hospitals have been given pre-written letters to sign expressing their support for the process and saying that its proposals will increase public safety.

When we broke those stories last week the BSBV press team explained there really is not a BSBV team and that key decisions are all agreed by the GPs and hospitals. Silly us.

Little surprise then that one angry reader wrote in describing the BSBV process as reminiscent of the way things are done in authoritarian regimes such as Iran or Russia. Others have used other terms such as “a big fix”, “Pravda”, and “a stitch-up”.

Increasingly, the cherished BSBV consultation process, and the much-vaunted “GP led” commissioning groups, seem like glove puppets being manipulated by much more powerful, but faceless, forces.

There is a strong suspicion that senior NHS bureaucrats decided long ago what outcomes they want in south west London and Epsom and will do whatever it takes to ensure those outcomes are reached.

But maybe people are just being paranoid. Maybe the process really has been fair and open so far. Maybe this is all about providing the best possible hospital services and not about saving money.

Maybe we have nothing to fear should the proposed options go out to public consultation because, should swathes of residents across south west London object, they will be ditched and acceptable ones drawn up?

Decide for yourself by looking back over the track record so far:

  • The Royal College of Nursing issues a statement this week confirming its members feel their views have not been properly taken into account: “If this process is to proceed as intended it is essential that there is proper clinical engagement with all those working on the front line in south-west London.”

  • The leader of Merton Council speaks out last week against BSBV’s plan to run the 14-week public consultation over the summer holidays when, of course, thousands of people will be away.  

  • Hospitals and GP commissioning groups are issued with a media protocol stating that all their public statements about the proposals must be “discussed and agreed in advance” with the BSBV press team.
    It says: “We would not want to be seen to ‘gag’ clinicians, especially as BSBV is a clinically-led programme.” (Note the wording. Not that they would not want to gag clinicians, but would not want “to be seen to ‘ be gagging them.)
  • Hospital medical directors are given pre-written letters to sign, which state that there “has been wide-ranging active involvement of clinicians and clinician support for the programme’s aims and processes” and that they support the case for change and back the BSBV proposals going to public consultation.
  • SDCCG governing body is forced to abort plans to vote on whether the proposals should go to public consultation. The decision, made on legal advice provided by BSBV it subsequently emerged, is taken at an emergency meeting just before its board meeting on May 17, to the disbelief of 700 residents who had turned up to witness the vote.

  • At the May 17 meeting SDCCG gives evidence to the public that includes serious inaccuracies such as the claim that changes to maternity are required by Royal College guidelines. Epsom currently conforms fully to all Royal College guidelines in maternity.

  • After many months of costly study and debate BSBV, GPs and hospitals, management consultancy company employed by BSBV, 2020 Delivery, sends an email in mid May to clinicians asking for basic information about Epsom Hospital – including information on paediatric and consultant activity and bed numbers.

  • A booklet created by 2020 Delivery on its website portrays a very cynical and dismissive view of any opposition from hospitals and MPs. It says hospitals will always try to block reconfiguration because they “lose activity” so their “financial position gets worse” – but makes no mention of the fact that staff might possibly have valid worries about patient care.
    And the only reason it gives why MPs are likely to oppose the loss of services at their local hospital is to stop “Save our hospital” candidates beating them in an election.

  • Clinicians at Epsom Hospital publish an open letter saying the “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.
    “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.”

  • Members of the governing body of the SDCCG come under intense personal pressure to go along with the proposals. One of them says privately he was “counting on Chris Grayling” to stop them.

  • SDCCG decides to appoint to its governing body as secondary care representative a consultant from St George’s, and not one from Epsom.

  • The Better Services Better Value team announces that its preferred clinical option is to have three acute centres before it even begins holding meetings about the process in Surrey.