Essential insight into England’s biggest health economy, by Ben Clover

London-Surrey borders

It was always an odd choice, having an international cancer specialist running community services in an outer London borough.

But with last week’s announcement that The Royal Marsden would stop managing the £18m a year community services contract in Sutton next year, something new can take shape.

Of course, organisations everywhere are working on integrating services (the public are always a bit surprised they are not already) but south west London has a fair amount of variety going on.

I have written before about the 10 year contract between the mental health provider, community and hospital trust, primary care and the council for over 65s in Croydon, just over the border from Sutton.

Over another border, Central London Community Healthcare Trust recently won the work for Merton. The trust’s name is increasingly inaccurate if it wins work further afield from its roots in Westminster, Kensington and Hammersmith.

The services in Sutton will be hosted by Epsom and St Helier University Hospitals Trust from next year but will be called Sutton Health and Care Provider Alliance.

This aims to replicate the success the trust has seen in Epsom, where Epsom Health and Social Care works with Surrey County Council, community services provider Central Surrey Healthcare and 20 GP practices. The team’s job is to keep older people out of accident and emergency and reduce length of stay for patients who have already gone through it.

Length of stay for elderly patients has already fallen by one day, according to local sources. The Epsom team will have a budget of £17m and employ 300 people when it is fully operational. It uses the primary care EMIS IT system, with the main expense being more licenses.

Awarding the Sutton contract to the trust seems like an important step to integrating that borough in the manner of Epsom.

Capital money?

It would be refreshing for ESTH’s boundary straddling to have a positive effect.

Its position across the London-Surrey divide has traditionally meant it was answerable to many more layers of bureaucracy than organisations on one side or the other.

This and a long running (15 years plus) debate on whether/how to downgrade/close/refurbish one or both of its acute sites have hobbled the trust almost as much as the high cost of running two sites.

But there may be hope on the horizon on the reconfiguration front.

The trust has been running an extensive public engagement campaign and the £100m plus needed to replace old facilities at St Helier Hospital is looking more possible, HSJ understands.

It is worth pointing out that for a long time, ESTH was in or around the bottom decile in London for access and finance. Its performance figures are now significantly better and on A&E it was, for a while, in the top five nationally – a real achievement.

Its latest Care Quality Commission report, published on Monday, left it rated requires improvement and made reference to the difficulties its estates caused it (point of detail: St Helier’s boilers are older than the NHS itself).

Will it get a solution?

To understate things, the trust’s position on the boundary of several marginal parliamentary seats has made things more difficult. But perhaps the right people have been persuaded.

Hospital trust taking over community contract after specialist drops out