St Helier under threat - again

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StH Hospital Senior management at St Helier hospital are continuing with their long-standing plans to close St Helier as a fully-functioning hospital. 

Plans to strip St Helier of its A&E and maternity unit, while building a general hospital on the Sutton site, will make St Helier just a site for out-patients and an urgent care centre - thereby closing St Helier as a functioning General hospital.

You can read the recent correspondence to and from Mr Daniel Elkeles, Chief Executive of Epsom and St Helier University Hospitals NHS Trust below. 


From: Daniel Elkeles [mailto:Daniel.Elkeles@esth.nhs.uk] Sent: 27 April 2016 14:25 To: MCDONAGH, Siobhain <siobhain.mcdonagh.mp@parliament.uk> Subject: Next Steps for Epsom and St Helier Estates Review

Dear Siobhain,

I am writing to update you on the progress we have made with our Estates Review and outline our next steps in this process. We are now getting to the stage where options are emerging and before we put them in the public domain I would value the opportunity to talk to you about them and get your steer on how to best engage our local communities.

Just to remind you of the context, as you know we are developing our estates strategy for 2020 - 2030 as it is clear our buildings will not be fit for the purpose of delivering safe healthcare beyond 2020. We expect that the CQC report on their inspection of our hospitals, when it is published at the end of May, will make explicit reference to the poor state of our estate.

We engaged extensively with our communities and key stakeholders in 2015 and A summary of feedback was presented to our board at its public meeting on 9 October 2015: https://www.epsom-sthelier.nhs.uk/download.cfm?doc=docm93jijm4n4246.pdf&ver=8691 With a further Estates Engagement Update Report presented to our board on 12 February 2016: https://www.epsom-sthelier.nhs.uk/download.cfm?doc=docm93jijm4n4836.pdf&ver=10449

This work helped us to make the case for new facilities, and in February our commissioners and regulators gave us the go-ahead to develop a Strategic Outline Case to help us understand our options and evaluate them. We held further engagement events with staff and with our communities in March, identifying the key criteria against which options should be evaluated, which have fed into the development of the Strategic Outline Case. Over 200 people took part in this and gave us over 600 different ideas to consider.

It is clear from this feedback that a one-site, so called “super hospital” will not be a viable option for us
as local access to a great many of our services is a key criteria for our communities. Therefore, we are currently working up options which ALL involve retaining a considerable volume of activity at both the St Helier and Epsom sites. I can share with you the emergent list but it includes urgent care, elderly care, planned care surgery, outpatients and diagnostics. These are all the services that best enable us to work with our local communities to deliver preventative and proactive care for our patients that is focussed on keeping them well.


However, there is a clear quality argument that centralising our acute services for the sickest patients on one of our sites will enable us to provide a higher standard of care in a purpose built facility. We believe that there are four potential options, where we locate acute services on one site, whilst retaining most of our services on the Epsom and St Helier campuses. The options that we believe may be viable are:
a. A new build around the St Helier site for acute services with services remaining at Epsom
b. A rebuild of the Epsom site for the acute services with services remaining at St Helier
c. A new build on our estate at Sutton Hospital with services remaining at both Epsom and St Helier
d. A new build in partnership with the Royal Marsden on their site in Sutton for the acute services with services remaining at both Epsom and St Helier

We are planning to engage with both our staff and our communities in May during the period between the Mayoral election and the beginning of purdah for the EU Referendum, and we hope to give as many people as possible the opportunity to assess these options against the criteria which were identified at our events in March. Prior to our public engagement, I would appreciate the opportunity to discuss these options with you in more detail, and take your steer as to how best to engage with your communities.

Yours sincerely
Daniel 



From: Daniel Elkeles [mailto:Daniel.Elkeles@esth.nhs.uk] Sent: 28 April 2016 13:44 To: MCDONAGH, Siobhain <siobhain.mcdonagh.mp@parliament.uk> Subject: Further update on Epsom and St Helier Estates Review

Dear Siobhain,

Yesterday I wrote to you to outline our proposed next steps in engaging our communities about the potential options for securing modern hospital facilities for our patients. Following this letter, it has become clear that the engagement work should wait until the current national planning process to implement the NHS Five Year Forward View has reached its conclusion. Both South West London and Surrey Heartlands areas are producing Sustainability and Transformation Plans and our estates strategy must align with that important work and cannot pre-empt it.

We will, however, be aiming to complete the actual analysis that we have commissioned for our estate as it will provide a useful input into the Sustainability and Transformation Plans. I would like to apologise for any anxiety my email yesterday may have caused you. I am, as always, available to discuss this further if you would find that helpful.

Yours sincerely Daniel 



Text received from Daniel Elkeles to Siobhain McDonagh, May 3rd

Just to follow up the phone call. Your initial reaction that there isn’t time to do proper engagement between the purdahs was felt to be correct.

And up the line want to land clearly the message that we want four acute sites in SWL before starting the engagement which is what the planning submission for the end of June will say. 

So nothing will happen initiated by the hospital until July other than my continued lobbying for £hundreds of millions so we can get the hospital estate that we can all be proud of. Hope that clarifies. If not, please do phone back. Daniel 



From: Daniel Elkeles [mailto:Daniel.Elkeles@esth.nhs.uk]  Sent: 10 May 2016 12:35 To: COLGAN, Dee <dee.colgan@parliament.uk> Subject: Letter for Siobhain 

10 May 2016 

Dear Siobhain,

It is disappointing to see that Jerome Neil is quoting you as saying that I notified you that we were launching a consultation into closing the St Helier Hospital. I want to make it crystal clear that we are not.

As you know we are working on our estates strategy to identify options to replace our decaying estate. Our buildings are now in the 10 worst for critical infrastructure backlog maintenance in England, 43% of our clinical space is deemed not suitable to provide patient care and we have half the number of single rooms we should have to provide an infection free environment. This means we are spending more than £5m a year more than we should do on keeping our buildings safe. This is money we should be spending on patient care. 

To make the initial case for the hundreds of millions pounds we need to secure to replace our buildings we have to engage people in the development of potential scenarios. In the letter I sent you last week I made it clear that in all the scenarios the Trust has looked at to date, we were looking to maintain hospital services at both St Helier and Epsom hospitals. 

I also explained to you in my follow up email of 28 April that I have been advised that the engagement of our communities on potential future scenarios should wait until the current national planning process to implement the NHS Five Year Forward View has reached its conclusion. As explained in our letter last week, the NHS in both South West London and Surrey Heartlands is working with its local authorities on a long term plan for local services. All NHS regions across the country are required to do this. The five-year plan is called the ‘sustainability and transformation plan’ (STP). This work is being jointly carried out by local clinical commissioning groups (CCGs), hospitals, community health services and mental health trusts, with the support of local councils and members of the public. We will build on work already taking place in south west London and Surrey Downs and we will be looking at all aspects of local health services – hospitals, primary care, mental health and community services. 

Both South West London and Surrey Heartlands areas are producing Sustainability and Transformation Plans and our estates strategy must align with that important work. It cannot pre-empt it.

We have spent the last year providing certainty to our staff on the future. As a result we have increased the number of clinical staff by almost 350. This has meant our vacancy rate has halved and our agency nurse spend had reduced by 70%. I and our whole Trust Board are committed to now securing the money to invest in appropriate buildings to enable us to treat your constituents and all the other communities we serve in a fit for purpose environment. I hope that you can join us in our work to secure the investment that our local NHS so badly needs. 

I hope it will be possible for me to attend the meeting on Monday 16 May referred to in the attached letter, to answer any questions that are raised. I wonder if it would also be helpful for us to meet on the St Helier site, along with local commissioners, to discuss these issues in more detail?

Best wishes 

Yours sincerely

Daniel Elkeles Chief Executive 



From: MCDONAGH, Siobhain Sent: 12 May 2016 17:50 To: 'Daniel.Elkeles@esth.nhs.uk' <Daniel.Elkeles@esth.nhs.uk> Subject: RE: Further update on Epsom and St Helier Estates Review 

Dear Mr Elkeles,

I am disappointed by your letter which I regard as both disingenuous and dishonest. 

Your most recent letter regarding the current proposals for the St Helier site makes no mention of your email to me of April 27th in which you proposed to consult on developing a new acute hospital on one of four sites, with only one of those sites being St Helier.

To quote your email: 

‘…there is a clear quality argument that centralising our acute services for the sickest patients on one of our sites will enable us to provide a higher standard of care in a purpose built facility. 

We believe that there are four potential options, where we locate acute services on one site, whilst retaining most of our services on the Epsom and St Helier campuses. The options that we believe may be viable are:
a. A new build around the St Helier site for acute services with services remaining at Epsom
b. A rebuild of the Epsom site for the acute services with services remaining at St Helier
c. A new build on our estate at Sutton Hospital with services remaining at both Epsom and St Helier
d. A new build in partnership with the Royal Marsden on their site in Sutton for the acute services with services remaining at both Epsom and St Helier…’


Your email suggested that these options would be under consultation between May 6th and the beginning of the purdah period of the EU referendum, a period of less than four weeks, culminating in a public meeting on May 21st. 

And not only did you send me this in an email, you may recall that we also discussed this all over the phone.

Clearly other people within the NHS share my view that this is an unrealistic and reckless timetable - hence your withdrawing the proposals the following day, and then suggesting that the consultation would instead begin in July. 

These proposals are almost identical to those presented during the ‘Better Healthcare Closer To Home’ consultation which took place in 2005. The current proposed consultation is the third that we have had since I became an MP in 1997. I estimate that the current cost of consultations alone has been in excess of £30m. Continuing the same consultation is a waste of public money and it cannot be right to keep doing the same thing until you wear the public down. I am therefore asking the Public Accounts Committee to investigate appropriate use of public money in repeated consultations. 

Since taking up your post as Chief Executive of Epsom and St Helier Trust it has been increasingly clear to me that your main purpose is to close St Helier as a fully functioning general hospital, leaving minimal services, such as outpatient appointments and an urgent care center, but removing the A&E, maternity units, renal unit, major surgery, and over 230 beds. I have no doubt that you wish to keep minimal services on the St Helier site to pacify those who oppose the closure of St Helier as a fully-functioning general hospital. 

Indeed as you will recall during the General Election, you secretly employed consultants to undertake these plans – this only came to light as a result of a BBC journalist overhearing a telephone conversation from the consultants. 

I understand that you believe that you can secure the half-a-billion-pound capital funding for a new hospital as a result of the reduction in running costs that a new site would provide. Should this fund be available, I do not understand why this could not be used to build a new hospital on or opposite the current St Helier site. I would also kindly like to see the back paper work to show that half-a-billion pounds is indeed available, such as a letter from Government confirming this is the case.

You are most welcome to attend the meeting on Monday, and to make your case. But please be aware that I remain absolutely determined to ensure a hospital including A&E and Maternity Unit is maintained at St Helier, and I will not be browbeaten by yourself, or intimidated by the unequal access we have to sufficient funds to argue our respective cases. 

As the elected representative of the constituents of Mitcham & Morden, who rely on St Helier and who are in the most need of healthcare of any community within the Epsom & St Helier Trust catchment area, I reserve the right to keep my constituents fully aware of your proposals. 

Yours sincerely,
Siobhain McDonagh MP



From: MCDONAGH, Siobhain Sent: 13 May 2016 16:31 To: daniel.elkeles@esth.nhs.uk Subject: FW: Further update on Epsom and St Helier Estates Review

Dear Daniel

Just to confirm that we would very much welcome your attendance at Monday’s meeting.

Thanks,

Siobhain 




On 13 May 2016, at 17:40, Daniel Elkeles <Daniel.Elkeles@esth.nhs.uk> wrote:

Dear Siobhain,

Thank you for your letter of 13 May 2016.

I think it is a great shame that we find ourselves at loggerheads. I think we are both trying to do the best that we can for the people that we serve. You for the residents of Mitcham and Morden and I for the 500,000 people who use our hospitals and for our 5000 staff. Just like you my family and I are residents of the area as well and I have a great desire to ensure that Epsom and St Helier University Hospitals NHS Trust thrive as they are my families local hospitals too. As I have explained to you on many occasions, the poor state of our buildings is a major barrier to doing that. As an organisation we are determined to improve the facilities - and therefore the standard of care that we offer.

As you refer to in your letter, it will be necessary for us to raise a substantial amount of capital to achieve the necessary improvements to our buildings and facilities. It would be helpful to have your support in doing that, for the good of all the communities that we serve. In order that we can ascertain whether or not that funding will be forthcoming it is vital that we complete our Strategic Outline Case. As part of that work it is only appropriate as you suggest that we consider the viability of building a new hospital at the St Helier site.

I believe I have been open and transparent with you and have been very clear that we are a long way off any consultation on the provision of our services. We do, however, believe it is vital to keep our communities informed and have ongoing discussions about our services and what they might look like in the future and we intend to do that whenever possible. There is a vast difference between “consulting” on options (which infers that we have reached the advanced stage of developing proposals that require formal consultation) and discussing potential scenarios with the communities that we serve. For the avoidance of doubt, we do not envisage a consultation taking place during 2016, though we will continue to talk to people and gather their views.

Furthermore, all of this work will need to complement the national planning process to implement the NHS Five Year Forward View. The NHS in both South West London and Surrey Heartlands are working with their local authorities on a long term plan for local services - all NHS regions across the country are required to do this, and each region is producing a five-year plan called the Sustainability and Transformation Plan (STP). In order to ensure that our estates review complements the STP vision, any further engagement on our estate will wait until this process has been completed.

My view is that you should proceed with your meeting on Monday, but in order that we can discuss all of the issues in a constructive way, and that I can show you the scale of the facility challenges that we face, I think it would be useful to meet at St Helier Hospital after the St Helier by-election. I’d be grateful if you could let me know when this is convenient for you.

I hope that you have a good weekend.
Daniel 




 From: MCDONAGH, Siobhain Sent: 16 May 2016 10:54 To: Daniel Elkeles <Daniel.Elkeles@esth.nhs.uk> Subject: Re: Further update on Epsom and St Helier Estates Review 

Thank you for your email. I would be very grateful if you could clarify whether you will be attending tonight's meeting?

For the record you emailed me on April 27th informing that you intended to "engage" on site preferences on a new acute hospital on St Helier, Epsom or Sutton sites between the end of the Mayoral elections and the start of purdah on the EU Referendum with a major consultation event on May 21st. This was followed by your calling me and explaining the same. 

On April 28th you emailed and texted me to say that you had reconsidered and agreed the timescale was too tight. A consultation/engagement would begin in July after South West London and Surrey Heartlands had submitted its Sustainability and Transformation Plan. Now, who knows? Your plans rarely appear to last more than 24 hours.


I remain convinced that your ambition is to strip St Helier of its A&E and maternity unit. Building a general hospital on the Sutton site and leaving St Helier a site for out patients and an urgent care centre thereby closing St Helier as a functioning General hospital. Please be assured that I will do all I can to work with local residents to prevent St Helier closing. Siobhain

Ps please could you confirm whether you will be attending tonight's meeting. As I am sure you will recall it was you who wrote to me asking if you could attend.

Siobhain McDonagh 



From: Daniel Elkeles [mailto:Daniel.Elkeles@esth.nhs.uk] Sent: 16 May 2016 14:02 To: MCDONAGH, Siobhain <siobhain.mcdonagh.mp@parliament.uk> Subject: RE: Further update on Epsom and St Helier Estates Review

 

Dear Siobhain
 
Thank you for your response. When I wrote to you last week saying that I hoped to be able to attend the meeting tonight, I had not anticipated the  extent that the hospital would become the centre piece of
the by-election campaign.  As a public body we should not participate in active engagement during election campaigns and so I believe that we should wait until after the by-election in order that you and I can have a constructive discussion and I can show you the scale of the buildings challenges that we face. 

I, and our whole Trust Board are committed to ensuring that we work with our communities to deliver the best possible care from the best possible facilities, and intend to continue those discussions after the
Sustainability and Transformation plans are submitted at the end of June.  As I have made clear, we are a long way off any formal ‘consultation’ process which we will only get to when the NHS has accepted the case for investment in our buildings. As I have also said, your help in making that case would be greatly appreciated.

Daniel

 


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