Surrey Downs Clinical Commissioning Group (SDCCG) said it is pressing ahead with plans to revolutionise primary care and integrated services at Epsom Hospital - despite the uncertainty which continues to hang over it.
In an exclusive interview with the Epsom Guardian, Miles Freeman, chief officer of SDCCG, said it is difficult to set out a vision for Epsom Hospital because it is still part of Epsom and St Helier Hospital trust.
But, he insisted, the CCG wants to boost the area's out-of-hospital provision and provide more integrated care on the Epsom hospital site itself.
He acknowledged the situation is complicated by the fact St Helier still part of the BSBV process, but said it does not have the time to wait and see what will happen with the review.
Mr Freeman said: "We’re looking for a system where there isn’t a strong dividing line between primary and community care and hospital care - where clinicians can follow the patients at different points at their journey.
"We haven’t got the right configuration of services which means we’re over-reliant on hospital care.
"Given we’ve got a rapidly ageing population, we’re going to need the bed stock at Epsom but we’re going to need more services in the community."
Mr Freeman believes the Epsom hospital site must be better utilised by increasing the number of its beds which have a "community ethos alongside proper full-blown acute beds".
These "community beds" would support patients almost ready to go home from hospital - with the emphasis being on independence, an activities and dining room, and rehabilitation.
Mr Freeman said there also needs to be an emphasis on turning "emergency admissions into planned care".
That would involve more experienced consultants admitting patients to hospital and more proactive primary care - greater surveillance of elderly people with high-risk factors and chronic diseases by their GPs, for example.
He added: "We’ve got a good deal of buy-in from the trust and they’re working with us to try to revolutionise care on the Epsom site."
Earlier this month, SDCCG walked out on the controversial Better Services Better Value (BSBV) review which was recommending that Epsom lose its A&E, children’s and maternity units.
To the delight of residents, campaigners, MPs and councillors, the CCG made the shock move after its GPs overwhelming rejected the review’s proposals in a secret online ballot.
Epsom Hospital is now removed from the NHS BSBV review
Mr Freeman has worked in NHS commissioning since 2002 and previously worked as a residential social worker with young offenders.
He said the CCG had recommended its GPs vote against the proposals because they were right for the Surrey Downs population.
He said: "The benefits of specialisation has largely already been achieved at Epsom - major trauma is going to St George’s, emergency surgery is going to St Helier.
"But the effects of the BSBV model would be no medical admissions would be going directly into Epsom, they would have to be pre-screened somewhere else first.
"That meant that, given our population, and the much higher number of over-85s and over-75s emergency elderly admissions we have compared to South West London, we wouldn’t really be able to deal with that population’s care effectively.
"Those in that population don’t need high-tech scanners, they are unlikely to have gunshot wounds, they are rarely victims of stabbings - it’s a different type of care that’s required.
"Once you move that group of people away from where their community services, social services and support networks are, it’s really, really hard to get them out of hospital quickly."
But, Mr Freeman said the proposals scored "very highly" with SDCCG on their ablity to implement the desired clinical standards, but lower on deliverability.
He added: "We saw enormous risk to the service while you have that uncertainty before a downgrade.
"But it still wasn’t the model we particularly wanted to start with."
Mr Freeman denied that "any kind of deal" was struck between SDCCG and BSBV involving the latter asking the CCG to withdraw from the process.
He said SDCCG are planning to go ahead with its plans for Epsom Hospital, but if new BSBV recommendations for St Helier to lose its A&E, children's and maternity departments were to go to public consultation, it would be looking to de-merge the hospitals.
Mr Freeman said: "That will have an inevitable knock-on effect on Epsom Hospital and, at that stage, if that went to consultation, we would be looking at options for a de-merger and a merger within Surrey hospitals."
Mr Freeman said SDCCG will continue to have a voice within any discussions which take place between BSBV and St Helier and that he does not understand the "business case" for moving Epsom’s pioneering Elective Orthopaedic Centre (EOC) from the site - an option which was mooted before Epsom joined the BSBV review last year.
He also acknowledged that this is not the end of the uncertainty: "Some of the services at Epsom are relatively small and somewhat precarious and standards will change.
"The GPs didn’t vote for no change.
"I anticipate over the next few years we will discussing what’s the best mix of services on the Epsom site with the public."
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