Epsom Hospital – Meeting 17th May 2013

Epsom General Hospital has recently been included in a review of hospital facilities for the South West London region.  The current proposals would likely lead to the closure of (amongst other wards) the current Paediatric and Maternity facilities at both Epsom General Hospital and St Helier.  This would mean that patients would have to travel to either St George’s in London, Kingston or Croydon for in-patient paediatric or maternity facilities.  This could potentially affect us all. 

There is a public meeting of the Commissioning Group’s Governing Board taking place on 17th May at 1.30pm at the Epsom Downs Racecourse, where these proposals will be discussed.    We are in danger of being railroaded  into these changes, so if you would be concerned about having to travel to St George’s for in-patient paediatric care, or for maternity facilities, please come to this meeting and make your views heard.  Even if you have nothing to say, your presence will show your support for our local services.  Please put this date in your diary now.

The background:

Current Paediatric facilities at Epsom

Epsom Hospital currently has a consultant led paediatric facility with 8 Consultant Paediatricians, complemented by 3 Associate Specialists, 3 Staff Paediatricians and full tiers of Middle and Junior Grade doctors.  The Consultants work an ‘attending week’ system taking responsibility for the acute admissions for one week in six, returning to their outpatient working during the other weeks. During the attending week, Consultants are free from all other duties, providing two ward rounds per day as well as Consultant-delivered care to all children attending acutely according to clinical need.

‘Out of hours’ provision for acute Paediatric care is well developed with twice daily Consultant supervised handovers (8.30 – 9:30am and 4pm – 5pm) on Monday to Friday , which encourages good standards through in-site training and ensures patients are managed safely via effective communication. On weekends Consultants again supervise handover from 08:30- 09:30 and then conduct both Neonatal and General Paediatric Ward rounds, reviewing all children present on both units. In addition a Consultant ‘virtual’ ward round is undertaken between the Consultant on call and the duty ST4+ every evening at 10 pm discussing all patients & admissions during the intervening period. Consultants regularly and frequently return to site to aid management of children with complex or difficult presentations.     

Inpatient Services are provided in Epsom General Hospital within a dedicated Children’s Ward serving over 1500 patients each year (16 beds & cots) with the ability to provide short term intensive care / high dependency provision, including for acute severe asthma, bronchiolitis, seizure disorders, management of children with complex disability (e.g. patients from the Children’s Trust, Tadworth), Paediatric Oncology patients with neutropenic sepsis as well as management of all common paediatric acute medical problems.     Facilities also include 6 isolation cubicles catering to the requirements of children with infectious illnesses, very young infants and children requiring oncology inpatient treatment.

There is a Paediatric Day Case Unit which serves about 4300 patients each year, with around 900 day surgery cases, a Neonatal Unit (level 1)  with 1 HDU/ITU stabilisation cot and 7 Special care cots  which admitted 350 patients in 2011 and which provides 24 hour support to Delivery Suite, Postnatal Ward and all newborn infants for the Epsom and Mid Surrey areas. It is also able to deliver temporary intensive or high dependency care for extremely premature or sick infants prior to transfer to a specialist unit.  The Neonatal service is led by an attending Consultant Paediatrician as well as having separate daytime rotas for Middle and Junior doctors and Paediatric A&E facilities.
The Paediatric A & E dealt with around 14,000 admissions in 2011.  As a percentage of total A & E admittances this equated to 30%, of which more than 10% were admitted to the inpatient ward at EGH. 
Outpatient clinics are held both in hospital and community settings with outreach clinics operating in local health care centres throughout the Epsom and Mid Surrey area.
All Consultants undertake General Paediatric clinics but also offer specialist clinics in Asthma, Cardiology & Echocardiography, Diabetes, Endocrinology & Growth, Autistic Spectrum Disorders and ADHD, Epilepsy, Child development and Neurodisability (CP clinic), Chronic handicapping conditions, Haematology, Audiology, Oncology, Respiratory and Cystic fibrosis.
In addition there are regular tertiary specialist clinics in Paediatric Surgery, Cardiology, Respiratory and cystic fibrosis, Genetics, Neurology, Endocrinology, Audiology and Gastroenterology.  Epsom General Hospital is a Paediatric Oncology Shared Care Unit for Mid Surrey and Dorking as well as Sutton & Merton. Without inpatient facilities at EGH this status will be withdrawn, meaning families will face on-going care further from home for these highly vulnerable children.

Similarly inpatient facilities at EGH support the nearby Children’s Trust at Tadworth Court. If inpatient Paediatrics at EGH were to close these children with highly complex disabilities will face longer journeys to receive care when they are critically unwell.
The Review of Paediatric Services which took place in April 2011 found that ‘Epsom currently provides an economical/flexible Consultant Delivered Service meeting the majority of the standards outlined in “Facing the Future”’. 

Proposals for St. George’s Site
The CSU would have approximately 130 beds, with 2 consultants on call from 8am to 6pm.  The Clinical Lead for Paediatrics at EGH has expressed the view that ‘it is unsafe for 2 Consultants to cover this number of beds and many children would not be seen by a Consultant once admitted to Hospital.  It seems illogical that the sickest children (i.e. those who require admission to the in-patient unit) should not be seen on a daily basis by a Consultant. Currently, we have a flexible Consultant delivered service where the sickest children are all seen on or soon after admission by a Consultant and all children are seen at least once a day by a Consultant thereafter. Regular handover occur with Consultant presence, ensuring that Consultants are fully aware of the needs of all children under their care. We will firmly resist participating in a system that will not allow these essential safety standards to be maintained.’

Current maternity facilities at Epsom General Hospital
Epsom General Hospital provides a broad range of services for women by a team of 6.5 Consultants in Obstetric and Gynaecology, supported by 1 Associate Specialist, 3 Senior Staff Grade and full tiers of Middle and Junior grade doctors.  Inpatient services include a Labour Ward with a dedicated obstetric theatre supported by specialist Obstetric anaesthesia, an Antenatal and Postnatal Ward, inpatient Gynaecology beds in a female elective surgery ward and a day case unit, where the majority of gynaecology surgery now takes place. Experienced Midwifery staff support all obstetric activity in inpatient and outpatient facilities delivering Midwife-led care for all women wherever possible.  Outpatient services for women include Antenatal clinic facilities located in immediate proximity to Paediatric facilities, as well as local outreach services in all areas of Epsom and Mid Surrey, working together with Midwifery and Primary Health Care services to deliver accessible care to all women.  

    All Consultants provide designated Consultant-led cover to Labour Ward as well as providing a range of specialist services including:

      • Obstetrics
        • Medical and High-risk Obstetrics
        • Antenatal screening (including antenatal ultrasound and prenatal diagnostic procedures)
        • Counselling services (working in concert with Paediatric services)
        • Diabetes in pregnancy
      • General gynaecology
        • Fertility support services
        • Gynaecological oncology
        • Colposcopy / vulvoscopy
        • Out-patient hysteroscopy
        • Uro-gynaecology
        • Recurrent Miscarriages
        • Early Pregnancy Assessment Unit (EPAU)

    Gynaecological Oncology
    We have a respected and comprehensive gynaecological cancer service led by a Consultant with a special interest in this field with tertiary support from the Royal Marsden HospitalA Gynaecology Clinical Nurse Specialist provides expert advice in addition to the facilities provided by our McMillan Butterfly centre.
    Gynaecological Oncology Screening: We have just secured the setting up of a complimentary ultrasound service on the same site, running in parallel with a Consultant-led clinic to enable the immediate assessment of suspected ovarian disease and act as an adjunct to the hysteroscopy service.  This diagnostic clinic will optimise the experience and specialist training of the nursing staff already on site, to provide a comprehensive one stop clinic.

    The Labour ward currently delivers 2,100 babies per annum with a growth of 6% per annum since 2004.  Most importantly the safety figures for Epsom are some of the best in the country, which calls into question why the facilities should be closed, when safety is cited as one of the key drivers:

    ·          The maternal mortality in the trust including Epson has been zero for the past 10 years;

    ·         New figures from a national report show that premature and newborn babies born at Epsom and St Helier hospitals are receiving some of the best care in the country.

    ·         The report, published by the Centre for Maternal and Child Enquiries (CMACE), shows that the death rate of newborns delivered at our hospitals was significantly less than the national average. It also showed that the number of stillbirths that occurred at the Trust is below average.

    ·         The report showed that sadly, for every 1,000 births in the UK, an average of 5.4 perinatal babies (the period from 24 completed weeks gestation to seven days after birth) died. At the Trust, the figure is lower at 3.2 deaths/1000 births.

    ·         The average number of neonatal deaths (the period from seven to 28 days after birth) across the UK was 2.1/1000 births. At the Trust, this figure was 0.8.

    Co-located Midwifery-Led Unit (MLU)
    Epsom General Hospital has  recently secured funding from the DoH to refurbish part of  the in-patient facilities to be an MLU co-located with the current labour ward. The building work has already started and due to open in May 2013. 

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