Exclusive: London STP considers cutting number of acute sites to three

Leaked documents seen by HSJ also reveal potential plans to centralise cancer services from St George’s University Hospitals Foundation Trust, Epsom and St Helier University Hospitals Trust and the Royal Marsden FT on to one shared site.

South west London currently has acute services on five main sites: Croydon, Epsom, St Helier, Kingston and St George’s. A version of the STP from June says: “Evidence for south west London suggests that continuing to provide acute services on five sites is unsustainable”. STP stakeholders will analyse “the viability and sustainability of five, four and three site models for the future”.

Any estate freed up by reducing the number of sites could be used by other services such as primary, community or frail elderly care, the document says.

The plans do not include details about a reconfiguration to three sites, but say moving to four sites could “deliver improvements in the position around the clinical workforce” and improve financial sustainability. The document says a four site solution would need “significant capital” to address estate issues across the patch.

As part of plans to address the number of acute sites, the document says: “Options for the future of the Epsom and St Helier University Hospitals Trust estate need to be considered as a priority.”

Four proposals for estates already being considered by the trust: building a new acute hospital on either the St Helier or Epsom sites; building a new acute hospital in Sutton; or building a new acute hospital co-located with the Sutton Royal Marsden Hospital site.

The latter option would include a new cancer centre for south west London and redistribute all other acute activity to existing sites across the patch.

Analysis by the STP suggests it would cost £236m to replace one wing of the St Helier hospital site with a new building but classes this as the “do minimum” scenario.

In 2011, the Better Services, Better Value programme was launched to review acute services across Epsom, St Helier, St George’s, Kingston and Croydon hospitals. The programme recommended that services at St Helier hospital be downgraded and only three hospitals in the group retain maternity and emergency services. The programme was abandoned by commissioners in 2014.

The draft STP also addresses the need to reconfigure the provision of specialised services.

Options being considered include centralising cancer surgeries from four sites to one shared site, and creating a single specialist unit for all high risk pregnancies. This option cites findings from the national maternity review, which said there was no clinical benefit from the London quality standard of having consultant obstetricians present for 168 hours per week.

A review into specialised services across the patch is ongoing. Led by NHS England, initial findings are expected this month and final conclusions in December.

Other plans included in the STP document are the creation of primary care hubs across the patch; setting up locality teams to align with GP lists covering populations of 50,000; and the rollout of the Sutton care home vanguard across southwest London.

Kathryn Magson, senior responsible officer for the STP, and Daniel Elkeles, chief executive of Epsom and St Helier University Hospitals, said in a statement: “The draft STP for southwest London is still being finalised. In terms of numbers of acute sites, initial work does suggest that five acute sites would be difficult to sustain clinically and financially, but we need to do further work on this and on other possible configurations.

“Epsom and St Helier have separately been looking at potential scenarios for the future of their own sites and their work will be taken into account as part of the STP process. The scenarios listed in the draft STP are the ones they have completed a technical analysis of for their strategic outline case. The next phase for the trust will be to engage with their communities on these scenarios, which they intend to do when the southwest London and Surrey Heartlands STPs are finalised in October.

“At this stage, it is very premature to suggest that a consultation will take place on any particular site or configuration. Any significant change would of course be subject to full and meaningful consultation.”