Strategic Outline Case Summary an Introduction to Our Next Steps in Securing a Sustainable Future for Our Hospitals 2 3
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Strategic Outline Case Summary An introduction to our next steps in securing a sustainable future for our hospitals 2 3 Providing high-quality healthcare services 2020 to 2030 This is an Epsom and St Helier University Hospitals NHS Trust In July 2017 we embarked on a major exercise undertook of the three scenarios we proposed document. It is a summary, and a detailed version is published to engage with our local communities on (an acute specialist facility at Epsom Hospital, at on the Trust’s website (www.epsom-sthelier.nhs.uk). the possible scenarios for the long term St Helier Hospital or co-located with The Royal future of our hospitals – this work built on a Marsden on our Sutton Hospital site) shows wide-reaching review of our estate in 2015, that the Trust would be able to deliver all of the The purpose of this document is to describe the Trust’s current which found that our ageing buildings are quality standards. We would also see a large position on different scenarios for delivering its clinical model. simply not suitable for delivering 21st century absolute improvement in finances, regardless healthcare. Thank you to everyone who invited of which site would finally be identified as the It is being shared with commissioners, who the Trust requests us to attend meetings, took the time to meet home to the new facility. This financial analysis consider the conclusions of the document and appropriate with us in groups and individually, ask questions shows a relatively small difference between Daniel Elkeles, next steps. The document is a summary of the Trust’s strategic and complete our questionnaire. I would also these scenarios and therefore no preferred Chief Executive outline business case for investment in its hospital sites. like to thank those people and organisations scenario can be identified at the stage. Officer It includes: who wrote to us and shared their views, as well as those who got in touch by email and over Using the appropriate NHS methodology to • the case for change; social media. This has provided a wealth of estimate the capital needed, we would need information which we, and the wider NHS, will between £377 million and £444 million capital • the proposed clinical model; now use in shaping the future for our hospitals. investment to build the new facility, upgrade • feedback from the public on this model and the ways our existing estate and provide for improved it can be delivered; This document provides a summary of the case facilities in other neighbouring hospitals. We for change, what we think will happen if we do are proposing that we will need to broadly keep • initial analysis of the financial impact of some of the nothing, the clinical model we have proposed the same number of beds as now, and have ways the clinical model can be delivered; and and how it will improve our clinical quality, as well modelled that we secure the funding for the • proposed next steps. as what we heard in our engagement campaign. new buildings from the Government. You can It also provides information on how much money find more information about this financial we will need to build the new facilities on each analysis in section eight of our full strategic The approach taken to financial analysis included in this of our sites and the improvement this will make outline case (available online and in hard copy). document has been agreed with the Trust’s commissioners and to the overall financial position of our hospitals. regulators. Capital costs have been estimated based on the With the support of the local NHS, we also Our conclusion at this stage is that, on the basis prescribed Department of Health methodology and include suggest what we need to do to proceed to the of the far-reaching engagement and financial significant contingency to reflect the uncertainty at this stage next stage of decision making. analysis, we have a strong case to continue to in planning. The financial analysis has been submitted to the develop all of these three scenarios in more detail Trust’s commissioners and regulators for them to assure. This The thousands of people who took the time and work towards a public consultation. We have to read our Epsom and St Helier 2020-2030 set out how we would like to work with the rest process is expected to take several months. Following this materials (available in hard copy and online), of the local NHS to achieve this. process, the Trust intends to publish further details of the join us at a meeting or watch our video, will financial analysis. As this assurance has not been completed, know that we propose to consolidate six Our staff go above and beyond to provide every the financial information in this document is not final. services, representing 15% of patient care, patient with great care, every day, and we are onto a brand new, single acute facility. committed to keeping all of the services at both The Trust believes this document will form a solid basis for any Doing so will mean that we can provide our of our hospitals whilst this work is underway. further work required. It is prepared to support commissioners sickest patients with the very best of care in a Our clinical teams want to meet all of the new in any next steps, potentially including a pre-consultation purpose-built facility, while 85% of patients quality standards, and improve patient outcomes will continue to receive care as they do now. in an environment which delivers a great patient business case if required. Our engagement has shown that people are experience. Collectively, we believe that this can broadly supportive, with 79.8% of 1,059 only be achieved by bringing together services for people responding to the questions we asked patients who are acutely sick or those who are at- supporting this model of care. risk of becoming acutely sick, in a new purpose- built facility. This will enable us to deliver on our What is clear from all of our work is that we ambition of outstanding care in facilities which cannot continue to run all our acute services on our patients and our staff deserve, and ensure the two sites because we will not have the clinical long term future of services for decades to come. staff to deliver all of the standards. We will continue to run an ever larger deficit and we This document is just an overview of our findings will not have the money to invest in our staff so far. You can read the full document (known and to make our buildings fit for purpose. as a strategic outline case) on our website, or request a hard copy from our Communications November 2017 As a brief overview, the financial analysis we Team by calling 020 8296 4996 or by email [email protected] 4 5 Strategic Outline Case Summary We are facing three very serious issues: 1 Clinical sustainability Our Case for 2 Buildings Change 3 Financial sustainability Clinical sustainability “We are facing significant clinical challenges, Epsom and St Helier University The Trust has made significant Working across two main sites, we will including workforce. Working across two sites Hospitals NHS Trust is a safe and improvements since 2015, investing increasingly be unable to deliver all the means the Trust needs at least an additional 52 consultants to meet current seven day effective Trust, primarily operating in over 300 more frontline staff required quality standards because there are 1not enough senior clinical specialist staff to standards across both sites. This would add across two sites (Epsom Hospital and stabilising its finances. run key services at two hospitals. This means to our financial challenge and we (like many and St Helier Hospital) with a small other hospital trusts across the country) would presence at Sutton Hospital. that in the long term, our hospitals will not be clinically sustainable and at risk of services struggle to recruit sufficient junior doctors to being closed and moved to other hospitals. staff rotas across two sites.” Dr Ruth Carlton, Joint Medical Director. Providing care to the sickest patients across two acute sites means it is increasingly challenging to meet clinical standards. This includes: Our 1,000th 54,419 • Ensuring on-site emergency medicine In the past 12 dialysis patient consultants working in the Emergency • Having sufficient 24/7 obstetric patients had recently joined consultant coverage on-site. months: elective our care Department 16 hours a day, seven days surgery with a week (with off-site back-up and the us – from hip 1000 ability to arrive on-site within 30 minutes The new standards, together with the We kept a replacements staffing levels needed to provide care for Welcome to the world! if needed outside of these 16 hours) firm grip on to cataract the sickest patients across two acute sites, • Achieving admission to a ward for our finances 4,828 babies were surgery creates a need for a workforce larger than born in our care patients within one hour of the and drove that available to the Trust. Providing care decision to admit down our for the sickest patients across two acute spend on • Providing timely access to emergency sites means the Trust needs 52 more agency staff key diagnostics 24 hours a day, seven consultants to meet current seven day days a week. standards across both sites. We spent £16.7 million Clinical Director of Gynaecology, Mrs Carolyn Croucher, said: “I first worked at this on maintaining our buildings Trust in 1989 as a newly qualified doctor and have always been struck by the amazing staff and buying new equipment We saw who work here, and care so much for their patients.