Outcome of Foundation Trust Public Consultation...Foundation Trust Consultation Response...

Outcome of Foundation Trust Public Consultation

Foundation Trust Consultation Response Author: Interim Programme Manager, FT Application Version: Draft v 0.4. 17.04.14 of 34

Background

1. Name of applicant Surrey and Sussex Healthcare NHS Trust

2. Area served by the Trust East Surrey

North West Sussex

South Croydon

3. Contact details of person responsible for

the public consultation

Gillian Francis-Musanu

Director of Corporate Affairs

Surrey & Sussex Healthcare NHS Trust

Canada Avenue

Redhill

RH1 5RH

Tel: 01737 768511 Ext 2862

e-mail: [email protected]

About the public consultation

4. Dates of public consultation Started

21 November 2013

Finished

28 February 2014

5. Which media were used for the public consultation document?

Engagement planning

Public events

To advertise events we placed newspaper adverts, arranged for posters to be displayed locally and

within the hospital on our notice boards and 24 digital information screens, advertised on our website

and alerted our 5000 twitter followers, sent out press releases and offered regular interviews to print

and broadcast. We walked around and gave out flyers to people visiting the hospital, sent posters to

GP surgeries, placed articles in CCG and council newsletters, e-bulletins, intranet sites and websites.

Many local groups, particularly the local business groups also placed articles and adverts in their

newsletters and on their websites. We emailed and wrote to as many local organisations, voluntary

sector, other health groups, and business partners that we could find and on the day we encouraged

passers-by to join the FT discussion.

The events were arranged to offer maximum flexibility for people, with some held in the morning,

some in the afternoon and many in the evening.


Stakeholders

The consultation booklet was sent to all GP surgeries and other stakeholders identified in the

consultation plan, plus we have taken a very proactive approach to engaging with others – WI,

nursing homes, sports/football clubs, libraries, local shops, schools – requesting they cover FT in

citizenship lessons etc.

In our mail-outs, we asked partner organisations ‘when’ we could attend their meeting and present.

Uptake of this request was slow although Surrey County Council and Reigate and Banstead Council

were very supportive. Reigate and Banstead, Mole Valley and Tandridge councils were also very

supportive by publishing our consultation materials on their websites and staff intranets, helping us

with venues for our events and offering us free editorial in their magazines.

In our mail-outs we asked local groups if they would like us to come and present, and to GPs, we

asked for all GPs and practice managers to send us their feedback and to display our materials in their

waiting rooms.

Staff

Staff engagement activities took place throughout the consultation period with the aim of a member

of the Executive Team to visit every staff team meeting, as well as holding specific FT events and

having information stalls around the hospital, so that every member of staff has had the opportunity

to raise questions or concerns. We have utilised our All Staff, Senior Leaders, All Consultants and

Trade Union Stewards, JNCC Committee meetings to take the opportunity to give the latest FT

updates. At the February All Staff meeting we invited a member of staff from Kingston Hospital who

was previously at the Royal Surrey County Hospital, to talk to our staff about how it feels as a member

of staff going through the FT process, and beyond.

Managerial materials including a toolkit for managers and FAQs for staff were available on request

and via the staff intranet. Regular ‘All staff’ (html) emails keep staff updated and notify them of FT

engagement opportunities. We created a staff guide to becoming an FT leaflet and a schedule of

activities was listed in the Consultation Plan. In their February payslips, every member of staff

received a copy of the leaflet and a membership form so they can sign up a friend or patient.

Our monthly internal staff newsletter carried FT stories throughout the consultation period, and it

was one of the main campaigns running on our intranet.

Full consultation document in hard copy Yes

Summary consultation document in hard copy Yes for staff

Web-based consultation document Yes

Talking Book / audio tape / CD Rom Available on request

Large print versions Available on request

Versions in ethnic languages (specify which) Available on request

Other


5.1 Presentation at public meetings (specify where meetings were held and the number attending)

Date Meeting type Venue Attendance

6 November 2013 Hot topic – care of the

elderly and FT

ESH 12

25 November 2013 Public meeting Dorking Halls

Dorking

11

29 November 2013 Public meeting Oxted community

Centre

18

3 December 2013 Public meeting Meridian Hall

East Grinstead

0

9 December 2013 Public meeting ESH 15

13 December 2013 Public meeting Crawley Hospital 3

17 December 2013 Public meeting Reigate Community

Centre

5

2 January 2014 Public meeting Harlequin Theatre

Redhill

22

7 January 2014 Public meeting Drill Hall Horsham 23

10 January 2014 Public meeting Crawley Civic Centre 16

26 February 2014 Public meeting United Reformed

Church Purley

17

27 February 2014 Hot topic – care of the

elderly / dementia and FT

ESH 45

5.2 Presentation at other meetings (specify where meetings were held and the number attending)

Date Meeting Venue Attendance

11 September East Surrey League of

Friends AGM

ESH 75+

21 November West Sussex Health and

Wellbeing Board

County Hall

Chichester

22

28 November Board to Board with East

Surrey CCG

ESH 30

2 December Reigate and Banstead Local

Committee

Reigate Town Hall 20

2 December Patient Experience Forum ESH 14

12 December Surrey Health and

Wellbeing Board

County Hall

Kingston upon Thames

16 December Surrey Traveller Community

Forum Health and

Wellbeing Group

Burpham, Guildford 9

9 January Surrey CC Health Overview

& Scrutiny Committee

County Hall

Kingston upon Thames

16

13 January Horsham League of Friends Horsham Hospital 13

14 January East Surrey College Redhill 33

15 January Surrey Information Summit


20 January

West Sussex Health and

Wellbeing Board

County Hall

Chichester

22

20 January East Surrey Empowerment

Board

Tandridge 16

22 January West Sussex CC – Health

and Adult Social Care

Committee

County Hall

Chichester

17

24 January East Surrey Hospital

Volunteers

ESH 25

30 January West Sussex Health and

Wellbeing Board

County Hall

Horsham

20

February East Surrey CCG Patient

Reference Group

Nutfield 30

13 February Reigate and Banstead

Council – member briefing


13 February West Sussex HASC liaison

members (Peter Griffiths, Dr

David Skipp)

County Hall

Chichester

2

6 March Reigate and Banstead

Voluntary Services


Any meetings with MPs

5.3 Presentation at staff meetings (specify where meetings were held and the number attending)

Date Meeting Venue Attendance

15 November All staff meeting ESH 75 - 100

21 November Senior leaders ESH 50 - 75

13 December All staff meeting Crawley Hospital 25 - 50

13 January 2014 Junior doctors ESH 25 - 35

15 January Medicine senior managers /

Clinical Leads

PGEC ESH <25

16 January Medicine and Surgery

Matrons, Surgery Senior

Sisters

ESH <25

16 January All staff meeting ESH 75 - 100

17 January Staff road show at main

entrances

ESH 75 - 100

19 January Surgical Division senior

managers and clinical leads

ESH <25

23 January Anaesthetists ESH 25 - 50

23 January Theatre staff ESH 25 - 50

23 January Staff Road show ESH 50 - 75


23 January Senior leaders ESH 50 - 75

23 January Microbiology staff Crawley 25 - 50

23 January All Staff Crawley – Comet Ward <25

24 January Volunteers ESH 25 - 50

29 January All Staff Health & Wellbeing

event

ESH 600 - 700

31 January All Staff Horsham <25

3 February Medical Division ESH <25

20 March WACH Division ESH <25

7 February All consultants ESH 25 - 50

10 February All consultants ESH 25 - 50

12 February Unions - TUSC ESH <25

13 February Surgical Division ESH <25

14 February All Staff inc presentation

from staff member of

another FT

ESH 50 - 75

4 March Clinical Support Services

Division

ESH <25

24 February Lead Clinicians ESH <25

25 – 28th

February Senior Sisters ESH 6

Finance and procurement ESH 10

Porters ESH 25

Housekeeping ESH 25

12 March Transport and post room

staff

ESH <25

21 March PALS and complaints ESH 5

12 February Night shift staff ESH 15

5.4 Consultation information sent / e-mailed to

Local Authorities

West Sussex County Council (Chair, CEO, HASC, Director Adult Services, Director Children’s Services,

Health & Well Being Board)

Surrey County Council (Chair, CEO, HSC, Director Adult Services, Director Children’s Services, Health &

Well Being Board, Local Committee)

Mid Sussex District Council (Leader and CEO)

Horsham District Council (Leader and CEO)

Crawley Borough Council (Leader and CEO)

Reigate and Banstead Borough Council (Leader and CEO)

Tandridge Borough Council (Leader and CEO)

Mole Valley Borough Council (Leader and CEO)

East Grinstead Borough Council (Leader and CEO)

Ash Parish Council


Capel Parish Council

Charlwood Parish Council

Godstone Parish Council

Tandridge Parish Council

Wotton Parish Council

Abinger Parish Council

Buckland Parish Council

Chaldon Village Council

East Horsley Parish Council

Limpsfield Parish Council

Salford and Sidlow Parish Council

Tatsfield Parish Council

Brockham Parish Council

Betchworth Parish Council

Leigh Parish Council

Ockley Parish Council

Headley Parish Council

Holmwood Parish Council

Mickelham Parish Council

Health Overview & Scrutiny Committees

West Sussex County Council HASC

Surrey County Council Surrey HSC

HealthWatch

Health Watch Surrey

Health Watch Sussex

MPs

Crispin Blunt

Sam Gyimah

Henry Smith

Chris Grayling

Fancis Maude

Nicholas Soames

CCGs

Surrey Downs CCG

East Surrey CCG

Crawley CCG

Horsham and Mid Sussex CCG

Croydon CCG

CCG Patient Reference Groups (via host CCGs)

Surrey Downs CCG Patient Reference Group


East Surrey CCG Patient Reference Group

Crawley CCG Patient Reference Group

Mid Sussex CCG Patient Reference Group

NHS organisations

Ashford St Peters NHS Foundation Trust

Brighton and Sussex University Hospitals NHS Trust

East Sussex NHS Trust

Frimley Park NHS Foundation Trust

Queen Victoria NHS Foundation Trust

Royal Surrey County NHS Foundation Trust

Surrey & Borders NHS Trust

South East Coast Ambulance NHS Foundation Trust

Sussex Partnership Trust

Local Training and Education Board

Kent Surrey Sussex Deanery

Brighton and Sussex University Medical School

Other healthcare providers

Sussex Community Trust

First Community Health and Care

Central Surrey Healthcare

GPs

All GP surgeries in the proposed public constituencies (full lists in Appendix 1)

Libraries

Materials for display throughout libraries in Surrey and Sussex

Hospital League of Friends

East Surrey Hospital League of Friends

Crawley League of Friends

Horsham League of Friends

Surrey and Sussex Healthcare NHS Trust Patients Council

Voluntary organisations

Carers Support

Crawley Community Relations Forum

Crawley Council for Voluntary Services

Oxted Council for Voluntary Services

Horsham Area Council for Voluntary Services

Reigate and Banstead Council for Voluntary Services

Surrey Compact


Surrey Empowerment Board

Tandridge Council for Voluntary Services

Tandridge Health and Social Care Forum

Action for Life – the East Surrey Walking for Health Scheme

Horsham Voluntary Action

Mid Sussex Council for Voluntary Services

Family Line

St Peter’s House Project, Redhill

Voluntary action in Elmbridge

Crawley community and Voluntary Services

Carers support (East Surrey)

Community Groups

Men’s Health Forum

Surrey Youth Support Service

Gender Identify Research and Education Society

National Childcare Trust

Schools and Colleges

Royal Alexandra and Albert School, Reigate

East Surrey College, Redhill

Reigate School, Reigate

Reigate 6th

Form College, Reigate

Dunnotar School, Reigate

Oakwood School, Horley

Oriel High School, Crawley

St Bedes Secondary School, Redhill

Reigate Grammer School

Woodfield School, Surrey

Thomas Bennet Community College, Crawley

St Wilfred’s Catholic School, Crawley

Hazelwick School, Crawley

Ifield Community College, Crawley

Holy Trinity C of E Secondary School

Residential Care Homes

Coppice Lea Care Home, Merstham

Chaldon Rise Nursing Home, Merstham

The Reigate Beaumont

The Elms Nursing Home, Redhill

Wray Common Nursing Home, Reigate

Kings Lodge Centre for Complex Needs, Nutfield, Redhill

Acorn Court Care Home, Redhill,

Nuffield Care Centre, Redhill

The Barn House, Merstham


Rutland Care Home, Reigate

Wykeham House, Horley

Chaldon Rise Nursing Care Home, Merstham

Oakhurst Court Nursing Home, South Godstone

The Brambles Care Centre, Horley

Old Wall Cottage in Reigate, Betchworth

Rosewood, Horley

The Woodhatch Centre, Reigate

Other

Regent House Community Centre, Horley

Oxfam, Redhill

Oxfam, Reigate

Shopmobility, Redhill

British Heart Foundation, Redhill

British Heart Foundation, Crawley

Redhill Evening Townswomen Guild, Redhill

Marie Curie Cancer Care, Redhill

St Catherine’s Hospice Charity Shop, Redhill

Cancer Research UK, Reigate

Age Concern, Merstham, Redhill and Reigate

Age Concern, Banstead

Age UK, Horley

Age UK, Surrey

The Children’s Trust, Crawley

Donyngs Recreation Centre, Redhill

The Children’s Trust, Tadworth

Young Epilepsy

5.5 Other consultation activity

Hospital wards and departments

Our Membership Officer regularly visited wards and departments around East Surrey, Crawley and

Horsham hospitals. This face to face activity proved to be extremely effective at explaining the FT

proposals and recruiting members.

Posters and leaflets were displayed prominently throughout all facilities from which the Trust

provides services.

Media / Social media

We regularly engaged with our 5000 plus followers on Twitter about FT and had radio coverage from

Heart and Radio Redhill.

Letters to community groups

We met with other local groups as opportunities arise and in particular we have been keen to attend

meetings with groups of people that are often more difficult to reach, such as the Gypsy and Traveller


group. With our Chief Nurse a consultation and engagement Afternoon Tea event was held at East

Surrey hospital with some of our patients with learning disabilities.

Website / intranet

Both the website and intranet have dedicated FT pages targeted at patients and members of the

public as well as staff.

Posters and leaflets

Posters and leaflets are located in all main entrances and available on all digital display screens at East

Surrey Hospital and Crawley Hospital.

Communication with staff

In addition to the meetings with staff, [Corporate Governance Officer, and members of the

Communications and Corporate Affairs Team) were available to hand out information and receive

feedback:

• in the main entrance on 17 January between 7am and 9am to catch staff on their way in to

work

• in the main entrance on 22 January between 12 and 1pm

• In the restaurant between 12 and 1pm on 22 January

Display stands

These were set up in key locations in the hospitals:

• East Surrey hospital – main and east entrances; outside the restaurant, X-ray, OPD & ED

restaurant

• Crawley – main entrance

• Horsham – outpatients department

Pop up stall

We have been out and about with a pop-up stalls. The Trust Executive Team accompanied our

Membership Officer talking to shoppers in local shopping centres, and this engagement activity will

continue beyond the consultation period.

• Belfry, Redhill

• Whitgift Shopping Centre, Croydon,

• Mid Sussex shopping centre,

We also took the stall to engage with the students at East Surrey College and will continue to engage

with students at other nearby colleges as and when we are granted permission. We have written to all

local schools asking how best to engage their students in our membership.

6 Number and type of formal responses received

Type of response Number received

Hard copy using proforma provided 23


Hard copy – others eg letter 5

On website 5

By e-mail 1

By telephone 0

By fax 0

By text 0

Verbally at public meetings 71

Verbally at community forums etc 38

Other – specify Comments were received at staff meetings,

meetings with stakeholders including Trade

Union Stewards Committee; Traveller Forum,

local college, MPs, HWBBs etc

Reigate Borough Council Members meeting 9 comments / questions

An e-mail reminder was sent to all partner organisations in the middle of January requesting feedback

on the consultation proposals.

7 Was the pattern of responses to the public consultation in line with the demography and

geography of the area? Were there any areas or groups that were not adequately represented

in the responses received? Provide explanations where necessary. And details of Trust action

plan to target under-represented areas

Different approaches were used to engage with different sectors of society and ensure the

consultation engaged with a representative population.

Public engagement

Public meetings were held in each of the proposed public constituencies and all except the meeting in

East Grinstead (Mid Sussex constituency) attracted some attendance from local residents and other

interested people. Although the numbers attending were often relatively low, the level of

engagement and interest was high with the majority of people being very supportive of the Trust and

the aspiration to become a foundation trust. The majority of people attending these meetings were in

older age groups

The pop up stand in shopping centres provided excellent opportunities to meet with younger people

including mothers with children and people of working age.

The meetings at East Surrey College [any other colleges] were well attended by students who were

interested not only in the plans for FT status but also in the work of the Trust and potential future

employment opportunities. More than 30 students also signed up to being members of the Trust.

Meetings were held with several user and other interest groups including Travellers in Surrey and

Reigate voluntary services forum, Surrey Empowerment Forum & Disability group.

Patient and Carer engagement

Throughout the consultation period our Membership Officer regularly visited wards and departments


around East Surrey, Crawley and Horsham hospitals. This face to face activity proved to be extremely

effective at explaining the FT proposals and recruiting members.

Presentations were also given to the Trust’s Patient Experience Forum and each of the League of

Friends for East Surrey, Crawley and Horsham hospitals.

Membership information is included in all new appointment letters and is resulting in a number of

new members being recruited each week.

The Trust has entered into a contract for membership support services with Membership Engagement

Services who will provide regular analysis of the demographics of the membership and will also

undertake targeted membership recruitment in any underrepresented public or patient

constituencies. Staff living in underrepresented areas are being asked to identify opportunities for

engagement with local groups.

Staff engagement

A comprehensive programme of presentations and discussions at staff meetings included ward and

departmental meetings, staff group specific discussions (junior doctors, Clinical Leads, Matrons etc) as

well as the monthly All Staff meeting. It is estimated that approximately one third of all staff attended

one or more meetings and some also attended the public meetings with relatives.

A toolkit and communications pack was also provided for managers to support discussion within

teams and all members of staff received a summary leaflet with payslips in February.

Regular updates were also provided to the Trades Union Staff Consultative Committee.

Partner organisations

The Trust FT Project Board includes members from both County Councils and the four Surrey and

Sussex CCGs. Key elements of the FT application, including strategic intent; consultation plan and

consultation document, were discussed by the FT Project Board prior to the start of consultation.

Following the consultation the outcome of the consultation and the draft consultation response

report were considered by the FT Project Board which made consequent recommendations to the

Trust Board for changes to the proposed composition of the Council of Governors.

Engagement with the County Councils was positive throughout the consultation with presentations

given to members of the HOSC / HASC committees and the Health & Wellbeing Boards. The Reigate

and Banstead Council also accepted the offer of a presentation which was provided to members.

Perhaps reflective of the newness of their organisations and the breadth of issues they are managing,

access to and comment back from CCGs was minimal. [No CCGs were willing to receive a presentation

on the proposals, although a joint Board to Board was held with East Surrey CCG during the

consultation period, and only two submitted a formal response to the consultation].

A meeting with the Reigate and Banstead Voluntary services was well attended.


About the consultation responses / comments received

8 Responses received from major stakeholders (individuals and organisations) and their general

view – including local MPs, local authorities, local NHS organisations, professional and staff

representative bodies, local commercial organisations, national and local voluntary

organisations

Name Broadly in

favour /

neutral

opposed

Main issue raised

Surrey County Council Not stated Keen to work in partnership with the Trust and to

have representation on the Council of Governors

Surrey Health Scrutiny

Committee

In favour Notes improvements in performance by the Trust in

recent years

Recommend emphasising quality of Trust leadership

and encouraging participation of younger people

(14+) for mutual benefit of public services

Family Line (charity)

Not stated Keen to work in partnership with the Trust and would

like to be a member

West Sussex County

Council Health and Adult

Social Care Select

Committee

In favour We have no objections to your proposals as set out in

the consultation document and support your

application to become an FT.

We welcome the fact that your proposed governance

arrangements will give West Sussex County Council a

seat on your Council of Governors through an

appointed governor. This is particularly important,

given the interface and increasing integration

between health and social care. We also welcome

your vision and values.

Crawley CCG

In favour (with

financial

caveats)

Recognise demonstrable improvements in service

delivery and overall performance.

Concerns relate to:

• impact of wider economic environment and

Better Care Fund

• little growth in CCG allocations

• SaSH proposals for increasing range of services

provided at ESH

Horsham and Mid Sussex

CCG


Payment by Results not seen as sustainable

and placing financial risk with CCGs

Brighton and Sussex

Medical School

In favour No comments provided other than support for all of

the consultation questions

Reigate Borough Council

(Members meeting)

In favour Based on population size should Reigate have 3

Governors

Is the Trust as passionate about having good

managers as it is about good clinicians?

Will having a membership help the community to be

involved and aware?

Has been a step change , good improvements

demonstrated by number of good consultants

How can the Estates Strategy be improved?

Need to look at how to do more fundraising

Asked about relationships with CCGs and how

commissioning decisions are made.

HealthWatch Surrey

In favour Healthwatch Surrey responded in support of the

application to become an NHS Foundation Trust and

the appointment of a Health Watch representative to

the Council of Governors to represent Surrey and

Sussex

Trade Union Staff

Consultative Committee

(TUSC)

In favour Requested assurance that if it became authorised as

an FT that the Trust would not go ahead without

meaningful consultation with staff and the TUSC of

any plans they may have to change any terms and

conditions (i.e. to Agenda for change).

Asked whether the Trust had received any indication

from any members of staff who were objecting to the

“Auto-enrol” for staff.

Sussex Health & Wellbeing

Board

In favour Responded that responses to the consultation should

really come from the constituent members of the

Board (i.e. the CCGs, NHS England, Healthwatch etc.) –

and that it isn’t really the HWB’s role, as a


commissioning body, to respond to such

consultations. The response noted that this shouldn’t

be interpreted as lack of interest in SaSH - but rather

that it’s not within the Board’s remit.

9 Apart from those listed in Q8 above, how many other responses were received in total?

28 formal

109 informal – i.e at meetings – excluding feedback from meetings with staff

9a. Was there a HOSC review process?

Surrey Health Scrutiny Committee

Alan McCarthy, Chairman, and Michael Wilson, CEO, attended the January meeting of the Health

Scrutiny Committee at Surrey County Council and presented the plans for the Trust’s FT application.

Writing to the Trust after the meeting the Chairman of the Health Scrutiny Committee made the

following comments:

The Committee would like to offer its support for the (FT) application based on these plans and the

discussion had with the Chairman and Chief Executive at the meeting.

The Committee would also like to note the improvements made by SASH in recent years which have

allowed it to make quick progress to the application for FT status. As a result of the discussion on 9

January, the Committee recommended that:

a) The Trust should emphasise the quality of its leadership when publicising their FT application;

and

b) Encourage the participation of the younger cohort (14yrs+) for the mutual benefit of public

services.

Additionally, the Committee offers its support while continuing to note the financial situation at SASH,

which though much improved was in technical breach of the statutory breakeven duty of the NHS Act

2006 in 2013.

The Committee hopes to continue its positive working relationship with SASH in the future and will

continue to monitor its progress.


West Sussex Health and Adult Social Care Select Committee (HASC)

The consultation documentation was sent to HASC along with a request to meet with members to

present the proposals. Although it wasn’t possible for the whole committee to meet with the Trust

two of its members did meet with the Trust CEO to discuss the proposals.

The Chairman of the Committee subsequently wrote to the Trust with the following response to the

consultation:

Thank you for sending me a copy of the consultation document on Surrey and Sussex Healthcare NHS

Trust’s proposal to become an NHS foundation trust. I am sorry that it was not possible to arrange for

you to attend a meeting of the West Sussex Health and Adult Social Care Select Committee (HASC) to

present your proposal, but we did forward the consultation document to all members of the HASC for

comment. I was pleased to hear that HASC liaison members Peter Griffiths and Dr David Skipp had the

opportunity to discuss this with you on 13 February. Their comments are included in this response.

HASC is aware that Foundation Trusts (FT) have more financial and operational freedom, but remain

within the NHS, and that all NHS acute, mental health, ambulance and community service trusts are

expected to become Foundation Trusts. As such, HASC understands that Surrey and Sussex Healthcare

NHS Trust has no option but to apply for FT status. We have no objections to your proposals as set out

in the consultation document and support your application to become an FT.

We welcome the fact that your proposed governance arrangements will give West Sussex County

Council a seat on your Council of Governors through an appointed governor. This is particularly

important, given the interface and increasing integration between health and social care. We also

welcome your vision and values and hope to be updated on your plans for the future, either through

our liaison members or through briefings for the Committee (as appropriate).

10 Excluding those recorded at Q8 above how many responses were:

Broadly in favour Broadly neutral Broadly opposed

25

2

1

In addition to these formal responses, feedback was received from people attending the public

meetings, meetings with special interest groups, conversations with the public in shopping centres

and staff meetings with the vast majority being in favour.


Responses received to the specific questions raised

Only one formal response was received from a member of staff. However the tenor of all staff

meetings, which were attended by approx. one third of all staff, and meetings with the Trade Union

Staff Consultative Committee, was that staff were in favour of the proposals.

Q1 Do you agree with the Trust’s objectives and plans for the future?

Staff Public

Yes 1 24

No 2

Not stated 1

Total 1 27

Q2 Do you agree with the proposed geographical areas for our membership?

Staff Public

Yes 1 (but not for Croydon) 20

No 6

Not stated 1

Total 1 27

Q3 Do you think they are representative of the communities we serve?

Staff Public

Yes 1 20

No 6

Not stated 1

Total 1 27

Q4 Do you agree that people aged 14 should be able to become a member?

Staff Public

Yes 1 16

No 10

Not stated 1

Total 1 27


Q5 Do you agree with our proposals for the Council of Governors?

Staff Public

Yes 24

No 1 (think there should be an

additional nurse / midwife)

1

Not stated 1

Total 1 27

Q6 Do you agree with the proposed new name: Surrey & Sussex NHS Foundation Trust?

Staff Public

Yes 1 21

No 5

Not stated 1

Total 1 27

Trust response

11 Does the Trust have any comments about the general tone of the responses received? For

example were those opposing the proposals expressing fundamental objections or picking up

minor (possibly technical) issues?

Many of the responses received, and questions posed at meetings, related to issues broader than the

Trust’s FT application, including

• Concerns about the removal of services from Crawley hospital

• How SaSH services relate to services provided at Crawley and Horsham hospitals and why

more services aren’t provided at these locations

• Wanting to see additional primary care / community base services e.g. new GP surgeries in

Crawley and Oxted, audiology (hearing aids) in Surrey, services to support frail older people

• How services are funded e.g. if activity increases through Choice how will the Trust be funded

to ensure quality doesn’t deteriorate

• Concerns about transport system and difficulty for non-drivers to access services

Many respondents, and especially at the public meetings, raised understandable concerns about

maintaining quality as an FT citing the failures at Mid Staffordshire and Morecambe Bay.

Responses relating to the FT proposals included

• Wanting to more / understand better the differences between NHS trusts and NHSFTs; role of

members and governors

• Seeking assurance that the patient voice will be heard and that the emphasis on public


governors doesn’t dilute this

• Seeking assurance that the quality of services will be maintained

• Questions about the minimum age for membership, membership constituencies, Council of

Governors and name of the Trust

For the two CCGs that responded, the challenges facing the health economy were prominent in their

joint response:

• Financial – managing demand with limited income; transfer of funding from the NHS to the

Better Care Fund

• Integrated Care – delivering integrated care pathways in the community and patient’s homes

rather than in an acute hospital

Within this context the CCGs recognised the demonstrable improvements in service delivery and

supported the aim of providing excellent DGH services for the catchment population. The response

acknowledged that it is in the interests of all parties for SaSH to achieve FT status with the CCG

wanting to play an active part in ensuring this success.

Responses from local councils noted the step change in quality and performance at the Trust in recent

years. Surrey Health Scrutiny Committee positively encouraged the participation of younger people

for the mutual benefit of public services.

Staff meetings were overwhelmingly in support of the FT proposals which were also supported by the

Trust Trade Union Staff Consultative Committee. There were no objections from staff to the proposal

to auto-enrol eligible staff as members.

Only one response was firmly against the proposal to become an FT. A member of the public felt that

the Trust was not yet ready to become an FT and gave two reasons for this – firstly their experience of

being a member of other FTs and secondly their experience as a patient at ESH.

12 What were the main topics that attracted critical response and what was the trust’s response?

Issue (include in brackets the name of the main

person(s) / bodies raising it)

Trust’s response

Trust objectives and plans for the future

Several people asked to see the IBP or to have

more information about services currently

provided and those planned for the future

(patient, public)

The consultation document, by its nature,

provided summarised information. The

presentation given at meetings [and in

information on the trust website] provided more

detail of range of services currently provided and

the areas for future development.

A short version of the IBP will be published later

in the FT application process - once the Trust

makes its final submission to the Trust

Development Authority for their approval to


apply to Monitor for consideration for FT status

In both formal responses and at meetings people

questioned whether to the aspirations of the

Trust can be sustained. In particular they were

concerned that the quality of services has

deteriorated at other trusts after they have

become foundation trusts.

One respondent expressed concerns about the

quality of care they had experienced both as an

inpatient at ESH and also when accompanying a

mental health patient to A&E. These concerns

were given as reasons for not supporting the

Trust’s plans for FT as they didn’t think the Trust

is yet ready.

(patient, public)

All NHS trusts, including Surrey & Sussex

Healthcare NHS Trust are very mindful of the

appalling levels of care exposed in some NHS

hospitals. The provision of high quality of services

is a key objective of SaSH along with

implementing our plans to continue to improve

the experience of patients.

The Care Quality Commission has recently

introduced a rating for all trusts in which the

Trust was placed in Group 6 which is the group

considered least at risk of poor quality of care.

Also, nationally the Care Quality Commission has

introduced a risk rating and inspection by the

Chief Inspector of Hospitals. Without a good or /

excellent] rating from this the Trust will not be

able to apply to Monitor for FT status.

The two GGCs that responded were concerned

about the Trust’s plans for the future which they

considered to be ambitious plans for growth that

are at odds with wider NHS policy / planning

guidance and especially the Better Care Fund

(CCGs)

The Trust is working with all its CCGs to ensure all

our plans and priorities align with each other and

deliver the maximum benefit for the local

community.

The plans to develop the ESH site to provide a

broader range of specialist and tertiary services in

partnership with others have two main aims:

• Firstly to provide services more locally for

patients so that they do not have to travel

out of the area for treatment

• To support CCG plans to repatriate activity

from London teaching hospitals

At a meeting with local councillors the Trust was

asked about the Estates Strategy for ESH

(LA Councillor)

The Trust has an estates strategy and works in

conjunction with the LA both for planning

applications and in developing, for example, its

travel plans.

Membership

Several responses questioned the rationale for

including part of South Croydon in the public

membership constituencies:

• Catchment too large and Croydon should

be excluded

The number of people who live in South Croydon

and choose to receive panned treatment at ESH is

increasing year on year.

The public constituencies comprise those


• The catchment population is too large

given the poor quality of public transport

• Croydon is part of Greater London and

there is no benefit in including it

Don’t want Mayday Hospital to be included

(patient, public, staff)

electoral wards from which around 10% or more

of the resident population has received

treatment at the Trust.

The consultation isn’t about Mayday (Croydon

University) Hospital which is a separate NHS trust.

Around a third of responses disagreed with the

proposal for children 14 years and older to be

eligible to be members. The reasons included:

• 14 seen as possibly too young

• Members need to have a broad and

balanced view of the issues involved -

sceptical of the input from people of this

age group other than specifically for

children’s’ services

• Minimum age should be the same as the

legal voting age

• Minimum age should be the same as for

consent to treatment

• 18 considered more appropriate

(patient, public)

Two thirds of respondents supported the

proposed lower age limit of 14 years.

In deciding to retain this age limit the Trust is

keen to engage with younger people many of

who either have been, or may be patients or who

are carers for a relative who is a patient. Their

experiences and insights in to the way services

are provided will therefore be especially valuable

in developing patient and carer awareness and

focus for service developments.

Several responses suggested 9000 members is

low given 3500-7000 are potentially staff and

their partners and so will have a better informed,

or perhaps biased, view of services

(patient, public)

The target public membership at authorisation as

a FT is planned to be c5500 based on 1% of the

population in each catchment area becoming a

member. As noted above, the catchment area is

all those electoral wards from which around 10%

or more of the resident population has received

treatment at the Trust.

A further 546 patient members are also planned

to be recruited. This target was determined on

the basis of it being 10% of the total public

members which is a little above the current 7% of

patients who live outside the Trust’s catchment

area.

These membership targets are the minimum

membership numbers that the Trust hopes to

achieve. Membership recruitment will be on-

going and so over time these numbers will be

expected to increase until such time as the


number of new members balances the number of

members who leave.

The public and patient Governors elected to the

Council of Governors will have an important role

to play in representing the views of their

constituencies not just their own personal views.

Suggestion that patients and carers living in a

public constituency should be able to choose

whether to be a patient or public member and

hence to be able to stand for election as a

Governor in either category

(patient, public)

This was considered by the Trust but was

considered administratively complicated in

comparison to the proposed approach.

This will be kept under review by the Council of

Governors with review informed by appropriate

analysis of the membership.

Request for information regarding whether any

members of staff had indicated their objection to

auto-enrolment of staff.

(TUSC)

No concerns or objections have been raised by

staff during the consultation process.

Council of Governors

The composition of the Council of Governors

attracted a broad range of comments regarding

appointed Governors:

• There should be additional representation

from ‘special interest’ / user groups e.g.

third sector, long term mentally ill,

disabled, elderly, carers

• It will be difficult to have just one

umbrella organisation for voluntary sector

covering two counties and similarly for

Healthwatch

• Reigate and Banstead should have an

additional governor

• Not having an appointed Governor for

Croydon could make the Croydon public

governor feel quite isolated

(public, patient, staff, voluntary sector, LA

Councillor)

To be effective the Council of Governors has to

be of a manageable size and the proposed

representation for partner organisations provides

a broad spectrum of interest and relevance to the

work of the Trust.

The number of governors for each of the public

constituencies is proportional to the resident

population for the constituency. This mirrors the

statutory requirement for the membership to be

representative of the population served.

In considering the overall size of the Council of

Governors the Trust has decided to reduce the

number of CCG Governors and so not all public

Governors will have a CCG counterpart. The Trust

will provide development support for elected

governors and a key role for the Chair of the

Council of Governors is to ensure that all

Governors have equal opportunity to participate

in discussion and to influence the decisions of the

Council.

There were also several comments and

suggestions regarding elected Governors:


• A 5th

staff Governor to represent patient

interests was suggested, as was

• An additional nurse / midwife governor

• Elected Governors need to be

representative of the socio-economic,

ethnic, religious and age profile of the

patient population (which itself will be

different from the population as a whole)

• Concern that if patient membership is

restricted to only those patients / carers

living outside the public constituencies

then having 4 Patient Governors for a

potentially small membership

constituency would seem to be too many

(patient, public, staff)

The constitution of the FT has clear guidelines

and procedures for managing conflicts of interest.

Several responses related to the overall size of

the Council of Governors:

• Will it be too large to be an effective

decision making body?

• The number of appointed governors may

be too high and also some may have

conflicts of interest

(patient, public, voluntary sector forum )

One respondent suggested that Governors should

not be employed by / or be beneficiaries of

private healthcare providers

(patient, public)

The constitution of the FT has clear guidelines

and procedures for managing conflicts of interest.

However, a blanket exclusion of anyone

employed by or a beneficial of private healthcare

providers would not be beneficial as a key benefit

of the Council of Governors is to consider new

and different ways of providing services to better

meet the needs of the local population.

Elections should be every 5 years

(patient, public)

The requirement of the DH Model Election Rules

is for elections to be held every three years

Name of Trust

20% of respondents disagreed with the proposed

name of the Trust:

• The name doesn’t describe what the Trust

does just where it is

The majority of respondents supported the

proposed name.


• The name isn’t geographically correct as

doesn’t cover all of Surrey and Sussex

• The name should include the word

hospital

• The name implies the intention to take

over other NHS Trusts in Surrey & Sussex

• The name should better describe the

services provided

Several alternative suggestions were offered:

• ESNEWS – East Surrey and North East

West Sussex

• REACH – Royal Earlswood and Community

Health

• East Surrey

• East Surrey and Mid Sussex

(patient, public)

Other

Several respondents asked about the cost of the

FT application process and being an FT:

• of the reorganisation (FT application) and

the time it will take;

• of recruiting and maintaining a

membership

• CRB checks for governors

(patient, public, voluntary sector forum)

There some additional costs associated with the

FT application and of being a FT.

Wherever possible additional activity, and hence

cost, is being managed through existing teams

and budgets. Where additional resource is

required this is / will be procured in accordance

with Standing Financial Instructions to ensure

value for money.

Several respondents said they would have liked

to have had more information on the non-FT

options – merger, acquisition, franchising

– and why they were discounted

(member of the public who works for a CCG)

Achieving FT status the NHS policy preferred

approach. The Trust Development Authority only

considers other options where FT status is not

considered achievable.

Request for assurance that if the Trust becomes

authorised as an FT that it would not go ahead

without meaningful consultation with staff and

the TUSC of any plans they may have to change

any terms and conditions (i.e. to Agenda for

change).

(TUSC)

The Trust does not have any plans to make

changes to staff terms and conditions. If this

changes in the future then the normal

consultation processes would be followed.


13 What were the main topics that attracted support locally? (indicate in brackets the main sources

of support e.g. patients, staff, general public)

Topic Comments received

Trust objectives and plans for the future

Stakeholder responses noted the improvement in

quality of the Trust’s leadership and the services

provided.

(County Council)

Membership

Almost two thirds of those who responded

agreed with children aged 14 yrs and above being

eligible to be members:

• Definitely need insights from teenagers’

who are often uncluttered with adult style

expectations

• They are the adults of the future

• They should have a say in children’s’

services

(patient, public)

Participation of younger people (14yrs +) will be

for the mutual benefit of public services

(County Council)

Council of Governors

The majority of those responding agreed with the

proposals for the Council of Governors and did

not provide any further comment

Name of Trust

The majority of those responding agreed with the

proposed name of the Trust and did not provide

any further comment


14. Specifically, what was the general tenor of the responses with regard to:

Membership At public meetings there was general interest in becoming a

member with the majority of those attending also completing a

membership application form.

One respondent specifically raised a concern about the balance

between the number of members who are either staff or related

to staff and everyone else and felt this might introduce bias

No objections were received from staff regarding the auto-

enrolment / opt out approach being proposed.

Council of Governors The proposals were generally supported.

Comments related to the size of the Council, and the number and

type of Governors

Several comments asked about the level of help and support that

will be provided to people wishing to stand for election as a

governor.

Board of Directors No comments were received

Elections Although not a specific consultation question one respondent

suggested that Governor elections should be held every 5 years

Constituencies Seven respondents thought the overall catchment area was too

large. Of these four respondents specifically questioned the

rationale for including a public constituency for the five Croydon

electoral wards.

Respondents were against the proposal for two reasons:

• The larger the geographic area covered the more people

to be treated which would impact negatively on those

living in areas closer to the Trust

• Transport links are not good enough to enable people to

travel from south Croydon to the Trust

Boundaries The only comments received related to the proposal for a public

constituency for Croydon (described above)

Constitution No comments were received


Age limits Approx 2/3 of respondents were in favour of children aged 14yrs+

being able to be members with 1/3 against

There were no comments on the proposed minimum age for

Governors

Youth representation Those in favour of membership from 14years described benefits

in terms of the general perspective that younger people would

bring as well as the ability to comment on children’s services

Staff representation Staff were in favour of the proposals to become a Foundation

Trust and were also in favour of the representation of staff on the

Council of Governors.

The Trade Union Staff Consultative Committee was in favour of

the FT proposals

Vision The public and key stakeholders, other than the two CCGs that

responded, liked the proposals to develop the ESH site to provide

a wider range of specialist and tertiary services.

The two CCGs that responded were concerned that the proposals

were expansionist and would put the CCGs at risk financially.

Transitional arrangements Not part of the consultation

HR Strategy Not part of the consultation

Communications Comments emphasised the need for effective communication

Any novel suggestions received

as a result of the consultation?

One respondent suggested that Governors should not be

employed by / or be beneficiaries of private healthcare providers

Name of Trust The majority of respondents were in favour of the proposed name

for the Trust.

A few respondents felt that the name could be improved and

made suggestions for how this could be achieved e.g.:

• Including the word hospital in the name

• Having a name that describes what the Trust does rather

than where it is

• Being more accurate geographically

Other issues - specify No other material issues were raised


15. Is there anything else about the public consultation exercise and outcome that the Trust

would like the Secretary of State or regulator know?

The overwhelming majority of the formal responses and comments received at public staff and other

meetings were supportive of the Trust’s aspiration to become a FT, its strategic plans and most of the

proposed governance arrangements.

However, the consultation process did raise two pertinent concerns about the proposed governance

arrangements, especially

• That 28 Governors was too large for the Council of Governors to be effective

• That the proposed number of patient governors was too high given the number of patient

members

Following consideration by both the FT Project Board (which has Council, CCG and patient

representation) and the Trust Board the following changes will be made to the composition of the

Council of Governors:

• To reduce the overall number of governors to 23 (from 28), and to achieve this by

o Reducing the number of patient governors to 1 (from 4)

o Reducing the number of CCG governors to 2 (from 4) with each CCG governor

representing two CCGs – i.e. one for Crawley CCG and Horsham & Mid Sussex CCG; and

one for East Surrey CCG and Surrey Downs CCG

These changes address both issues identified in the consultation whilst also ensuring the Council

remains legally constituted with a majority of patient / public governors. By reducing the number of

CCG governors it was also felt that the time commitment for CCG nominated governors would be

reduced without losing valuable CCG input to the Council.

16. Contact details for the person who will

be available to answer detailed question

on the public consultation and provide

copies of any responses required for

scrutiny?

Gillian Francis- Musanu

Director of Corporate Affairs

Surrey & Sussex Healthcare NHS Trust

Canada Drive

Redhill

RH1 5RH

Tel: 01737 768511 Ext 2862

e-mail: [email protected]


Staff engagement, involvement and wider cultural change

17. How have staff been given ample opportunity to play an active part in the dialogue and

deliberations around the NHS Foundation Trust application? Where have staff dialogue and

views influenced the broad HR strategy, which in turn supports the service development

plans and organisational goals of the Trust?

As an organisation we have used a number of ways of engaging staff in our vision and values, and on

ways to improve performance for the benefit of our patients.

At the heart of our Workforce Strategy is staff engagement which we see as more than just good

communication. We have therefore concentrated on developing leadership at all levels of the

organisation which has enabled the views of staff to be taken into account in our development and

performance improvement plans. Our new partnership agreement negotiated with union

representatives has further strengthened our work with staff representatives.

18. How did (and for the future, ‘how will’) the organisation ensure effective staff involvement

and participation in shaping cultural change and service development and delivery, and

embracing social partnership in its broadest sense?

Our strategy has been to ensure our workforce is representative of the communities we serve; we

have and will continue to recruit locally recognising the positive impact that employment has on

individuals. As a major employer in the area we are well placed to further engage with our

communities. We have and will continue to develop our links with local schools and colleges and

offer a wide range of work experience opportunities.

19. How has the organisation engaged with (and how will it continue to engage with) clinicians

in determining the future direction of service provision, and how have the outcomes of such

discussions been analysed from a cost / benefit perspective and integrated in to the service

development plans outlines in the business plan (IBP)?

SaSH prides itself on being clinically led and managerially enabled and is pro active in the engagement

and participation of clinicians in agreeing the vision and future direction of future service provision.


This has been done at trust wide, divisional and specialty levels in the development of the Clinical

Strategy.

At a trust wide level the clinical strategic objectives were proposed and developed by the medical

director and chief nurse. These were then shared with the divisional chiefs and lead clinicians who

developed clinical priorities for their service developments which have been included in the clinical

strategy. Each of the individual developments at specialty level were then linked backed to the

clinical strategic objectives and the trust strategic objectives so that there was line of sight with how

local developments enabled the Trust to meet its overarching strategy.

As the strategy was being developed the updated versions were shared with all of the lead clinicians,

chief of services and chief nurses so that everyone could see the priorities of others and how

everything fitted together across a five year timescale. The priorities were then aligned to other core

strategies i.e. estates, workforce which in turn link to the long term financial model.

The clinical strategy will be reviewed on an annual basis as part of the annual business planning

process. This will ensure that there is on-going engagement with clinicians and that clinically led

service developments are reflected in the forward plans for the organisation.

20. How is the Trust developing / managing new (and existing) relationships with local health

organisations and other local networks, social care, good citizenship and social

responsibility, and playing a role in the wider community?

SaSH plays an active part in the local health economy working with CCGs, County and local

authorities. This is evidenced in the part played in the Local Transformation Board, Urgent Care Board,

Kent, Surrey & Sussex AHSN, along with a wide range of partnership and clinical and network events

and meetings in both Surrey and Sussex along with other Provider and Commissioning organisations.

The Trust will continue to engage and with our key stakeholders and with the wider community

through the voluntary and community networks.

21. What is the degree of ‘integration’ of first rate HR practice in all the main functions of the

organisation (operational, strategic and clinical) – with a view to demonstrating that good

HR practice and thinking is present in the wider organisation and not only in the specialist

HR function itself

The Trust recognises the importance of good people management skills in the delivery of excellent

healthcare care to our patients and the key role that line managers play in supporting, developing and

motivating their teams.


A small team of professionally qualified corporate HR staff led by the Director of HR support the

Board develop a culture of staff engagement through our Workforce Strategy and ensure that the HR

policy framework to support managers and staff is effective. Our Partnership Agreement recognises

the importance we place on engaging with our trade union colleagues as we develop our

organisation.

At the heart of our strategy is the organisational development aspects of staff engagement which we

describe in our ‘staff engagement star’. This provides a vehicle for delivering actions within the five

themes of:-

• Every role counts

• Management and leadership

• Promoting a health and safe working environment

• Supporting personal development

• Involvement in decision making

Operationally managers are supported by professionally qualified Divisional HR Business Partners

who, as part of the management team provide leadership and professional expertise to support their

Divisions deliver excellent services to patients through good people management. The Business

Partners have developed ‘management guides’ and training which ensures that managers are

equipped with the technical skills to interpret and apply the Trusts people management policies and

procedures. More importantly they ensure that managers understand fully their key role in

motivating, developing and managing their staff. Development of people management skills is also

provided as part of our Essentials of Management training for new and aspiring managers in the Trust.

Transactional HR advice and support is provided to Managers by our HR Advisory Service through

Capsticks HR via telephone and attendance at formal employee relations ‘cases’.

22. How has the organisation demonstrated its commitment to unlocking the potential of all

staff and enabling all staff to progress their skills and careers through lifelong learning and

development?

The process of learning and development begins before an employee commences with us with

development into the role through induction and provision of job related training. Throughout their

employment learning and development needs are identified through our performance management

and appraisal process. We have developed new roles for assistant practitioners and physicians

assistants and will continue to work with staff and managers to develop our workforce to deliver our

service development plans.


Appendix 1: GP practices to which the Consultation document was sent

NW Sussex

Bewbush Medical Centre, Crawley

Bridge Medical Centre, Crawley

Coachmans Medical Practice, Crawley

Crawley Health Centre

Furnace Green Surgery Crawley

Gossops Green Medical Centre, Crawley

Ifield Medical Practice, Crawley

Langley Corner Surgery, Crawley

Leacroft Medical Practice, Crawley

Pound Hill Medical Group, Crawley

Saxonbrook Medical Centre, Crawley

Southgate Medical Group, Crawley

Woodlands and Clerklands, Crawley

Courtyard Surgery, Horsham

Holbrook Surgery, Horsham

Orchard Surgery, Horsham

Park Surgery, Horsham

Riverside Surgery, Horsham

Rudgwick Medical Centre, Rudgwick

The Village Surgery, Southwater

The Brow Medical Centre, Burgess Hill

The Surgery, Cowfold, Partridge Green

Crawley Down Health Centre

Cuckfield Medical Practice,

Dolphins Practice, Haywards Heath

Judges Close Surgery, East Grinstead

Lindfield Medical Centre

The Meadows Surgery, Burgess Hill

Mid Sussex Health Centre, Hurstpierpoint

Moatfield Surgery, East Grinstead

Newtons Practice, Haywards Heath

Northlands Wood Practice, Haywards Heath

Ouse Valley Practice, Handcross

Parkview Health Partnership, Burgess Hill

Ship Street Surgery, East Grinstead

Silverdale Practice, Burgess Hill


Surrey

Whyteleaf Surgery, Whyteleaf

Warlingham Green Surgery, Warlingham

Caterham Valley Medical Practice, Caterham

Pond Tail Surgery, Godstone

Oxted Health Centre

Wayside Surgery, Horley

Greystone House Medical Practice, Redhill

Elizabeth House Medical Practice, Warlingham

Chaldon Road Surgery, Caterham

Townhill Medical Practice, Caterham

Lingfield Surgery

Smallfield Surgery

Birchwood Medical Practice Health Centre, Horley

Moat House Surgery, Merstham

South Park Surgery, Reigate

Woodlands Road Surgery, Redhill

Wall House Surgery, Reigate

Rusper Road Surgery, Newdigate

Leith Hill Practice, Dorking

Hawthorns Surgery, Redhill

Holmhurst Medical Centre, Redhill

Brockham Surgery

North Holmwood Surgery Dorking

South Holmwood Surgery Dorking

Westcott Street Surgery, Dorking

Croydon (public constituency electoral wards)

The Moorings Medical Practice, Kenley

Mitchley Avenue Surgery, Sanderstead

Purley Medical Centre, Purley

Keston House Medical Centre, Purley

Woodcote Medical Centre, Purley

Bramley Avenue Surgery, Coulsdon

Downlands Surgery, Old Coulsdon

Chipstead Valley Road Surgery, Coulsdon

Old Coulsdon Medical Practice

The Coulsdon Medical Practice

Dr Irfan, Old Coulsdon

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