The Director of Community and Housing gave a brief overview of the history of plans for re-configuration at Epsom and St Helier Hospital over the last fifteen years. Merton Council commissioned Roger Steer an independent expert to review the Improving Healthcare Together proposals and he will set out the findings from his research. This consultation took place during the height of COVID-19 therefore Merton asked for the consultation to be postponed to allow time to understand impact of the Pandemic. This request was denied and the consultation concluded 1^st April 2020 as originally planned.

The Committees in Common of the South West London and Surrey Heartlands NHS Clinical Commissioning Group met on 3^rd July and agreed to adopt the preferred option of building a new hospital in  Belmont ,Sutton.

Officers therefore recommend that this Panel refer this decision to be reviewed by the Secretary of State for Health and Social Care on the grounds that it is not in the best interest of local residents.

Roger Steer, independent Consultant gave an overview of the findings of his research outlining the context of the review and the important issues to be considered. Mr Steer said there was a danger that this model would lead to poor access to services, a specialist unit which will not meet the needs of local residents and there had been an over reliance on rigorous South West London Clinical Standards. The Plans need to be reappraised in light of the COVID-19 Pandemic.

Mr Steer said many senior consultants saw this as an opportunity for a new state of the art hospital however it is important to balance this with the needs of the wider community.

Mr Steer informed the Panel that he has held a number of senior roles including the Chief Executive of an NHS Trust and Director of Finance.  He has advised politicians of all political persuasions and been  involved in many reconfigurations across the country. 

A panel member asked about the impact of the reconfiguration of acute services on deprived communities. Mr Steer said the effect of centralising services for the most deprived is worse in comparison to a two centre model therefore his analysis has shown this needs to be re-examined.

A panel member expressed concern that there is a risk of losing the £500 million if the decision is delayed which will have a detrimental impact on local health services. Mr Steer said the biggest risk is that the decision is rushed and not considered properly.  It is important to ensure plans are coherent and in line with guidance.

A panel member expressed concern about the potential loss to the community of the services at St Helier causing a domino effect on services at St George’s. It is also a difficult journey by public transport to get to Belmont for Merton residents.

A panel member asked if COVID-19 had taken place before the Improving Health care Together consultation and the £500 million had not been confirmed, would there have been a more rigorous evaluation of the impact of COVID on local health services. Mr Steer said there has been a number of critics of NHS reconfigurations who have argued that the NHS plans rely on insufficient resources, staff, and number of beds in comparison with European neighbours. As a result COVID-19 has shown that the NHS has not been resilient and struggled with the surge in activity during the pandemic.

A Panel member asked which MPs were contacted by the council to discuss the Improving Healthcare Together proposals.  Mr Steer said he tried to speak to as many as possible but they were not available. The Director of Community and Housing said due to diaries clashes they didn’t get the full response they had hoped for, even though both telephone and face to face meetings were offered.

A panel member asked about Marmot Review (2010) and what it tells us about health inequalities in areas of deprivation and also the disproportionate impact on BAME communities during the COVID-19 pandemic.

Mr Steer said the Marmot Review was commissioned by the Government to investigate health inequalities in the UK.  As a result of the findings public authorities are under a duty to help the most deprived and ensure that health inequalities do not worsen, Belmont as a site for the new hospital is one of the most affluent areas in the country. Statistics have been clear that the BAME community was disproportionately affected. It is important to retain as much access to health care as possible. Also, St Helier has a high proportion of BAME communities.

A Panel member asked Mr Steer for clarification on the process for the final decision and the Americanisation of NHS. Mr Steer said the final decision is a series of steps that need to be taken. It is better to intervene at this stage and to seek independent review earlier rather than later. The American healthcare model is good at specialist medicine not as good at general medicine. The founding principles of the NHS are that there should be high quality accessible services available to the majority of people.

A panel member asked how we can we be sure the council’s evaluations are correct and the Clinical Commissioning Group is wrong. Mr Steer said the NHS proposals in North West London were a good acid test.  The Independent Review Panel is devised to point out any biases that may have been introduced locally. There is a danger that vested interests could take over, and promote their own preferences.

A panel member highlighted that data showed that 69% of the Black and Minority Ethnic Community said it was easier to travel to St Helier hospital and it is important to listen to and meet the needs of the local population.

The Leader of the Council with responsibility for Adult Social Care and Health was invited to address the Panel. The Leader said the council has for a long time been opposed to any downgrade of services at St Helier hospital. The council has written to Merton CCG outlining our concerns and asking for additional work to understand the impact of deprivation, this more important due to the recent Covid-19 pandemic. The Leader highlighted the concerns raised by Chris Grayling MP asking for additional work to be done.

The Leader said he recognises the important role of independent scrutiny and the Independent Review Panel are well placed as they are not personally involved the recent decision. The Leader urged the Panel to refer the matter to the Secretary of State for Health and Social Care.

A panel member asked if the council will accept the decision of the Independent Review Panel. Mr Steer said the Panel makes suggestion for improvement, the council should reserve its opinion and wait and see what emerges. The Leader said the council will reflect the interest of residents.

Panel members had a discussion about travel to the new hospital site. A panel member expressed concern about the travel to Belmont. Another Panel member said there is public transport available to get to hospital for those who need it and provided a personal example of when they had used it.

A panel member said those who endorse the plans should agree to refer to the Independent Review Panel to confirm their belief. Concerns was expressed about the whole Improving Healthcare Together Programme including not taking full consideration of the impact of deprivation,  the consultation process along with expression of preferred options. It was expressed that this scrutiny panel should stick to the council’s position to retain all services at St Helier and not go against officer’s advice.

Councillor Dave Ward formally proposed that the Panel accept officer’s recommendations and refer the matter to the Secretary of State for Health and Social Care. This was seconded by Councillor Mary Curtin.

A panel member asked what would the councils course of action will be if the Independent Review Panel recommended two district sites and a Centre of Excellence at Belmont. The Leader said he will not agree to reducing services at St Helier Hospital.

A Panel member said there are many unknowns about how long it will take, there is money on the table we have had a consultation. Going down the route of referring to the Secretary of State adds to the uncertainty it could take years to get a decision.

Mr Steer said the process is automatic and normally a review is conducted over a reasonably short spaces of time. There is a hiatus because of the recent pandemic which will help in the long term to shorten the decision process.

The Chair moved the motion put forward by Councillor Ward asking Panel Members to accept the recommendations in the report and refer the decision of the Committees in Common of the South West London and Surrey Heartlands NHS Clinical Commissioning Group  to the Secretary of State for Health and Social Care by 31^st July 2020.

Those in favour of the motion were as follows:

Councillor Peter McCabe

Councillor Pauline Cowper

Councillor Mary Curtin

Councillor Jenifer Gould

Councillor Rebecca Lanning

Councillor Dave Ward

Those not in favour of the motion were as follows:

Councillor Thomas Barlow

Councillor Nigel Benbow

The motion was carried.

RESOLVED

The Panel agreed to accept all the recommendations in the report.