Campaigners sceptical on future of hospitals as major NHS review prepares to publish next report

GP groups, who now hold the purse strings for all NHS care, have been looking around Epsom, St Helier, St George’s, Kingston and Croydon, to try and improve things but also to save money and stave off a looming NHS financial crisis.

An ‘issues paper’ is expected toward the end of June, according to the organisation running the review on behalf of GPs.

Last time around, A&Es and maternity units were under threat of closure as part of plans to tackle a rising demand for healthcare, a shortage of specialist staff, and a predicted shortfall of £210m in the region’s budgets over the next five years.

The next stage of the review was revealed last week by Daniel Elkeles, the chief executive of St Helier and Epsom Hospitals.

Campaigners immediately raised their fears, despite the review being careful to avoid leading to the impression of an inevitable closure or downgrading.

Sandra Ash, of campaigning groups Keep Our St Helier Hospital (KOSHH) and the National Health Action Party for Sutton and Cheam, said: "We are not surprised.

"We didn't believe the threat had gone away.

"Daniel Elkeles is still saying put the placards away. If they're already planning the closure of Epsom and St Helier it's time to get the placards out."

Colin Crilly, KOSHH spokesman, said: "They always try to reassure the public that it’s necessary, that there are constraints, the need for care in the community and they are trying to get the best for the public. 

"They just rehash the old names and slogans."

And Dave Ash, also of the National Health Action Party, said: "We have been warning for some time of the danger that BSBV, or something of a different name with similar intentions would be coming back soon."

THE STORY SO FAR

Almost immediately after the Better Services Better Value (BSBV) review was scrapped last February under political pressure, a new organisation, South West London Collaborative Commissioning (SWLCC), was formed.

February 2014: Multi-million pound hospital review by NHS BSBV scrapped

At the time, Paul Burstow, then MP for Sutton and Cheam, said: "My concern is on one hand they are reassuring the public they have dropped BSBV's plans and at the same time they say they are going to use BSBV's methods.

"Given they were heavily flawed - would they reach the same flawed conclusion?"

SWLCC published its "case for change" last May to again raise the issues of ‘clinical and financial challenges’ facing the NHS. 

May 2014: NHS unveils new five-year strategy for healthcare in southwest London

It said hospital care was expensive and could often be delivered better in a GP surgery or other community setting.

Some of the changes have already been made.

An ‘issues paper’ was expected toward June, according to a SWLCC news release on May 22, but is not expected to jump to the stark conclusions reached by BSBV.

A spokeswoman denied its work was a "successor to BSBV" but said SWLCC had replaced BSBV.

She said: "The NHS faces a number of challenges in the years ahead and the six CCGs have been working together with NHS England on a long-term plan to overcome these challenges and to improve the quality of our services.

"We are working with local hospitals, NHS trusts, GPs and others to plan the implementation of our strategy and what it could mean in practice for each part of the local NHS."

She added: "Of course, if our discussions lead to proposals for major service change, then we would carry out a full public consultation before making any changes."

March 2015: Kingston Hospital faces £15m budget cut and is forced into deficit by 'extreme pressure' from government austerity

PROTECTING EPSOM AND ST HELIER

Fears for Epsom and St Helier were raised again when a leading GP declined to support Epsom and St Helier’s plans.

March 2015: Dr Chris Elliott: "I cannot support that statement because we are not in a position to say whether that is the right thing or wrong thing at the present time."

Mr Elkeles revealed the latest iteration of the long-running and politically controversial review was back on in an interview about his desire to get Epsom and St Helier out of the ‘firing line’ by improving their buildings.

He said: "We are trying to put a new proposal on the table which is right for the half a million people who use our services.

"Something exciting, new, which will provide amazing healthcare so when Better Services Better Value comes round again in the autumn, which is when it will, it can’t just do what it did last time because there’s a new thing on the table that they haven’t considered.”

He said the "underpinning analysis" of having just three hospitals in south west London was still the case.

Epsom and St Helier will consider its options to improve its estate, including a leaked idea of building a single 800-bed hospital on a site, probably in St Helier.

Mr Elkeles had said: "The reason why Epsom and St Helier get discounted in the BSBV approach is because St Helier is falling down and people don’t care about Epsom.  It’s not in London.

"The underpinning analysis which says the right answer is having three [hospitals in south west London] hasn’t really gone away.

"Unless you come out with an answer for the four geographies [in south west London] this isn’t going to work.

"We need to arrive at an answer for south west London that does involve keeping four hospitals.  Inevitably that does mean Epsom and St Helier has to change because we’ve got two."

WHO ARE SWLCCG?

The six purse-holding Clinical Commissioning Groups employ 18 full-time and 4 part-time NHS staff and the programme is currently supported by two full-time and seven part-time interim contractors, according to SWLCCG’s website.

They include a business manager role, four communications workers, and a small finance team.

Consultancy firms currently providing ‘external consultancy support’ include PricewaterhouseCoopers and 2020 Delivery, a company headed by Sir Ian Carruthers, a fomer chief executive of NHS South of England before it was axed, and the previous acting chief executive of the NHS.

SWLCCG pre-empts any questions as to how much the consultants are being paid on a day rate by saying: “In terms of what we pay individual contractors, the government guidance is that care must be taken to ensure that no information is released which would allow the suppliers’ internal pricing structure to be deduced and so prejudice their commercial interests.

"Information should otherwise be released.

"The release of the day rates of our interim contractors would in practice reveal the internal pricing structure of the individual contractors concerned...

"The information is therefore exempt from disclosure under section 43(2) of the Freedom of Information Act."

"JUDGE ME ON MY ACTIONS"

"Judge me on my actions", was the message from the hospitals’ chief executive - who believes people cannot compare his task at Epsom and St Helier with the work he completed to reshape NHS services in north west London.

Daniel Elkeles, who started at the hospital trust in January, said he appreciated the "emotional connection" people have with the hospitals and, as an Ashtead resident, felt he was "part of the community that wants great healthcare".

He said: "I applied for the job because I live locally.

"I passionately want my family to be able to access great healthcare locally and I thought I want to be part of creating the best NHS we can have locally."

As a former director of strategy for NHS North West London - where the Shaping a Healthier Future programme resulted in the loss of A&Es at Hammersmith Hospital and Central Middlesex Hospital - some health campaigners have raised concerns that Mr Elkeles is a NHS bureaucrat called in to cut hospitals' acute services.

Dave Ash of the National Health Action Party said: "Why would one send an axeman to cut the grass?"

But Mr Elkeles said: "The issues we are facing at Epsom and St Helier and the ones south west London and Surrey have are very different from the north west London issues that we had. 

"A direct comparison is not appropriate.

"But I would say judge me on my actions at Epsom and St Helier.

"Since I have been here in January we have been really clear now what our strategy is.

"Epsom and St Helier is not now the problem in south west London because it's performance has got so much better, the money has got so much better.

"We are in a place where we can actually look to the future as opposed to just looking to the next few months."