Why NHS services need to change

Epsom and St Helier hospitals are facing significant challenges which we need to take action to solve if we are to keep hospital services within the Surrey Downs, Sutton and Merton area for generations to come.

There are three main reasons why we have to change the way we deliver local NHS services.

  1. Quality
  2. Buildings
  3. Finances


Patients at Epsom and St Helier hospitals do not always receive the level of care that they need and deserve. Issues include the following:

  • Some key services do not meet the agreed national and regional clinical standards, including the staffing requirements that are best practice within the NHS. For example, in the hospitals’ emergency departments and acute medicine services.
  • Nationally, there is a difficulty recruiting doctors and specialist clinical staff. This is a particular problem at Epsom and St Helier -both hospitals run with gaps in their medical rotas and rely heavily on temporary doctors.
  • The Care Quality Commission (CQC), the independent regulator of health and social care, has continued to rate both Epsom and St Helier hospitals as ‘requires improvement’ for emergency care and safety despite giving the Trust an overall rating of ‘good’. We agree with the Trust that unless we change how emergency care is provided, we will not be able to get a CQC rating of ‘good’ for these services.


The hospital buildings are very old and are not fit for delivering 21st century healthcare. Issues include the following:

  • Staff see and treat patients in buildings that are not suitable.
  • There are not enough single rooms to treat patients who need them, including those who are coming to the end of their lives and those who need to be cared for in isolation.
  • Every day, very ill patients are moved in their beds to other parts of the hospital for treatment. This means going outside, in all weathers, as the hospital buildings are not all connected.
  • Many of the lifts are too small to take patients on beds. When these old lifts break down, parts have to be specially designed and patients have to be moved around the hospitals in ambulances.
  • Old buildings are difficult to keep clean and work in safely. A large amount of money is spent on emergency repairs just to keep patients dry and warm.

In its September 2019 report the Care Quality Commission told us:

“… in many areas of the [hospitals], the environment was not always appropriate for the services being delivered, due to the age and structure of the estate.”


As a result of the issues listed in 1 and 2, we have major financial challenges. We need to change the way services are provided so we can afford to run our hospitals with the money we are given.

  • Currently the hospitals cannot live within their means, because of the way services are organised across two sites, without enough permanent staff and in old buildings.
  • A huge amount of money is spent on temporary staff to keep our hospital services safe. (This is mostly so that we can have senior staff on-site in the evenings and at weekends.)

These issues will get worse if we do not tackle them, and the worse they get, the more difficult it is to pay for new buildings. We need to change the way services are provided so we can afford to run our hospitals safely within the money we are given.

Next > Model of care: Proposals to change how we work


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