Proposals to change NHS services in South London are one step closer to a public consultation after a vote by Sutton Clinical Commissioning Group. One of the proposals would see Croydon University Hospital downgraded to a “local hospital”, meaning replacement of its accident and emergency unit with an urgent care centre.
The board met on May 9 in Cheam and took questions from members of the public, many of whom were local residents specifically concerned about the potential downgrading of St Helier and Epsom. The first two options recommended by the Better Services, Better Value review process would see both hospitals’ services downgraded.
The meeting was full, and those who could not get in leaned in at the windows. There were heated interjections when board members made the case for proposed changes.
The CCG were keen to emphasise that there were no budget cuts, and that services would be redistributed rather than closed, although the wider review process acknowledges that changes are being sought partly in response to increased financial pressure.
On a day that increased pressure on A&E departments made the headlines, members of Sutton CCG indicated there would be a greater focus on healthcare services provided outside of hospital in order to tackle this pressure. More health visitors would be trained, and there would be more investment in GP and community services.
The point was made repeatedly that “no change is not an option”.
Dr Marilyn Plant, the joint medical director of Better Services, Better Value, said: “We can’t go on as we are. The Health Service is broken and needs to be fixed.”
She argued that patients could be better treated if they were taken to specialist units spread over a greater area, rather than being taken to local hospitals, even though a longer journey time may be involved. She was jeered at several points during her presentation.
Questions from members of the public challenged the board over the quality of the evidence and data used to come to their decision, and the impact of the proposed changes on people in the area, especially in terms of journey times to hospital and the availability of emergency and maternity services at the hospitals.
There was significant opposition at the meeting to the planned changes, and two Liberal Democrat MPs were present to fight the corner of their constituents.
Brake said that the performance of the Epsom and St Helier NHS Trust was “markedly better than its neighbours”. He also presented a dossier of comments from local people about why they want to save their local hospital.
If all seven clinical commissioning groups involved vote in favour, then the public consultation process will begin in June.
Clinical commissioning groups are bodies which make decisions about the delivery of NHS services in England. They are composed primarily of GP practices, and every practice in England belongs to a CCG. They are responsible for about 60% of the NHS budget.
This vote is the latest step in a long process. The Better Services, Better Value review has recommended the consolidation of NHS services across five hospitals – namely, Croydon, Kingston, St George’s, St Helier and Epsom. If the proposed changes go ahead, the implementation would begin from April 2014.
The proposals include replacing the five accident and emergency units with three units, and downgrading the other two hospitals to urgent care centres. It would also involve changes to maternity and children’s services, potentially meaning that two of the hospitals could have stand-alone midwife-led units.
Three options have been presented, and were ranked by Sutton CCG in order of preference:
The first, preferred option would both see Croydon, St George’s and Kingston remain as major acute hospitals, with St Helier being downgraded to a local hospital, and Epsom being downgraded to a local hospital with an elective centre. This means that both hospitals would have urgent care centres rather than accident and emergency units. An “elective centre” means the inclusion of an intensive care unit and medical procedures such as endoscopy and lithotripsy.
The second option is similar, but St Helier would have the elective centre, and Epsom would be a local hospital.
The third option would mean that St Helier would be a major acute hospital and Croydon would be downgraded to a local hospital. This option is the least preferred partly because it would be the most expensive, and because the loss of emergency services in Croydon would mean an increased flow of activity to King’s College Hospital in Camberwell.
The difference between an urgent care centre and an emergency department is that the latter would deal with life-threatening situations, while the former would not.