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 Hospital. A 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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