A medical director of the controversial healthcare review proposing frontline closures at Epsom and St Helier hospitals has said around the clock back-up services to A&E departments is “critical”.

Dr Marilyn Plant, joint medical director for the Better Services Better Value (BSBV) review, said emergency departments on their own cannot provide all that is needed.

As care becomes much more specialised she said a number of surgical sub-specialities are increasingly concentrated on fewer hospital sites.

That means there are not enough surgeons with appropriate skills to safely staff emergency general surgical rotas everywhere.

Dr Plant said the response has been to concentrate services in fewer, busier units.

She said: “We have considered very carefully how to make sure that all our patients can have access to all the services that may be required in an emergency.

“It is clear that many of these need to be grouped together to make the best possible use of scarce resources and rare skills.

“For instance, we have recognised that women giving birth sometimes need the skills of an emergency surgical team, which are different to those of an obstetrician, and so we have recommended that our consultant delivered maternity care should also be provided on a major acute hospital site, alongside emergency surgery and intensive care.”

The BSBV review, is proposing the closure of A&E, maternity and children’s services at Epsom and St Helier hospitals.

The review has been highly controversial and  demonstrations have taken place across south west London and north Surrey.

There have been large protests and criticism from residents, politicians and even clinicians involved in the review.