Ellie Cox: In Merton, Labour put political ideology ahead of patient care

Cllr Ellie Cox is a councillor in the London borough of Merton, a former 2024 parliamentary candidate in Mitcham & Morden and 2024 London Assembly candidate for Merton & Wandsworth.

In any organisation—especially one as important as the NHS—understanding where the money goes is not a luxury. It’s essential. Yet too often, crucial decisions are made by people who lack the leadership experience and financial grasp to manage public services effectively.

As Margaret Thatcher warned in her 1983 Conservative Party Conference speech:

“You terminate the health service by pretending there are no hard choices, by behaving as though Britain has a bottomless purse.”

That principle still holds true today. Politicians who ignore financial reality don’t just risk inefficiency—they risk lives.

As a councillor with 15 years’ experience financing London businesses – including over five years working with healthcare providers – I know public service needs more than slogans and good intentions. It requires numerate experienced leadership. On Merton’s Healthier Communities Scrutiny Committee, I’ve questioned Executive Directors responsible for Epsom & St Helier NHS Trust directly – and this scrutiny has revealed a stark financial reality: they face a £68 million savings target, which is approximately a ten per cent reduction in the Trust’s 2024 expenditure.

When I asked how they planned to achieve this, the Executive Director admitted only 40 per cent had been costed so far. Proposed cost-cutting measures include a ten per cent cut in corporate costs, a five per cent reduction in medical spending, and improved rostering to reduce reliance on bank and agency staff. However, it’s clear these measures won’t be enough.

With temporary staff costs totalling £15 million, even eliminating them entirely would leave the hospital still looking for further cost cuts of £53 million. Staff costs were the Trust’s largest expense in 2024, reaching £477 million, 73 per cent of its £650 million income. With pay rising further under the new national deal for doctors, agreed by Labour without any link to productivity, costs will continue to climb. It’s hard to see how the Trust can meet its £68 million savings target without cutting permanent staff, meaning, I expect, Labour’s approach will inevitably result in job losses at St Helier Hospital.

The Trust faces severe financial challenges. Its 2024 Annual Accounts report cumulative retained losses of £210 million, alongside £456 million of taxpayer-funded equity invested as public dividend capital. This pattern isn’t unique in the NHS—but what sets St Helier Hospital apart is that, for years, Labour MP Dame Siobhain McDonagh and the Labour-run Council have fiercely opposed consolidating acute services between Epsom and St Helier. Instead, they’ve insisted on maintaining duplicated services, despite the escalating financial strain.

So, what can and should be done to improve patient care while ensuring taxpayer money is spent efficiently?

When I asked a senior Executive Director at St Helier Hospital about the Trust’s chronic overspending, he was clear: running two full-service acute hospitals is neither financially sustainable nor the best model for patient care. He fully backed the NHS plan to consolidate emergency and specialist services into a single new hospital in Sutton – while retaining and refurbishing 85 per cent of existing services, including urgent care, at both Epsom and St Helier.

He highlighted the high costs, staff strain, and constant building repairs involved in the current model. Staff and patients at St Helier Hospital face unacceptable conditions—including frequent water leaks that close wards and unreliable heating in winter.

Research published in The Lancet and BMJ supports the Executive Director’s view, providing evidence that consolidating specialised services into centres of excellence often improves patient outcomes—reducing mortality, shortening hospital stays, and raising care quality. Several major London trusts already follow this model. At Barts Health NHS Trust and Guy’s and St Thomas’ NHS Trust, for example, centralised services support more efficient staffing—clinically, financially, and operationally—and this approach is also seen at other hospital trusts in London with co-located specialist services.

In contrast, Epsom and St Helier NHS Trust operates duplicated services that require largely duplicate staffing, driving permanent staff costs significantly higher than many comparable London hospitals – resulting in tens of millions of pounds in additional expenses and undermining efforts to improve patient care. While all spending areas require scrutiny – including £22 million spent on clinical negligence last year – staffing remains, by far, the single largest cost. That’s why there is no credible path to financial sustainability for St Helier Hospital without consolidating specialist services.

Yet Labour – particularly Dame Siobhain McDonagh MP and Merton’s Labour Council – have repeatedly blocked the scheme, putting political ideology ahead of clinical evidence and financial reality. They cling to long-held socialist beliefs and political gain rather than evidence, data, and the frontline medical consensus. So entrenched is Dame Siobhain McDonagh’s opposition that in April 2025 she openly admitted:

“I have fought this scheme for 25 years against all governments – my own [Labour] government, the coalition government, and the Conservative government.”

Her assertion that “nobody wants [the new hospital] and nobody supports it” is simply false. The Chief Medical Officer, hospital Executive Directors, and NHS leadership, on record, openly advocate the plan—do they not count? Dame Siobhain McDonagh MP claims that the revised cost of the new hospital is £1.5 billion. When I pressed St Helier Hospital for a copy of the current development costs supporting her bold statement, they confirmed no fully completed cost calculation has been produced since 2020. This makes it unclear where Siobhain McDonagh’s figures come from.

Dame Siobhain McDonagh MP’s main argument – that relocating acute services to Sutton would worsen health inequalities and reduce access for local Mitcham and Morden residents – is based on incomplete evidence. The report, commissioned by Labour, openly admits to major limitations, including the absence of hospital-level data. As a result, it cannot fully or accurately assess impacts on travel times or hospital usage. Basing major policy decisions on such flawed analysis isn’t just weak—it is a failure of judgment and professionalism.

Labour criticises the Conservatives for falling short on the New Hospital Programme promised in the 2019 manifesto – announced before the Covid pandemic forced emergency public borrowing and delayed capital investment. But, after 14 years in opposition and now in government, Labour have offered no clear or credible plan to fund long-term investment in the NHS. Their real plan, so far, is to tax work and business by raising National Insurance and business rates to fund public spending – at the expense of growth and jobs, with further tax hikes on working people expected in their next Budget.

Economists broadly agree that government borrowing – primarily through bonds – is the most cost-efficient way to fund major infrastructure. Yet, under the Blair-Brown government, Labour relied heavily on Private Finance Initiatives, burdening the NHS with decades of expensive repayments. Most alarmingly, in the April 2025 hospital parliamentary debate, Labour’s Health Minister, Karin Smyth MP, repeatedly expressed pride in a similar PFI deal at Bristol’s Southmead Hospital – without acknowledging the long-term financial strain these contracts impose.

Labour’s new plan risks repeating past mistakes and shifting financial pressure onto local NHS leaders without addressing the underlying systemic issues. It offers no real break from failed PFI models, signalling a return to private sector involvement, with vague proposals to expand trust autonomy – allowing hospitals to borrow more and reinvest surpluses, but without a clear and sustainable national funding model. Without this, many NHS trusts will remain under serious financial strain.

As Margaret Thatcher said in 1983:

“There can be no greater issue than the care of the sick and the relief of suffering.”

But she also understood that compassion must be matched with financial responsibility. A strong, growing economy – driven by enterprise, not penalised by Labour’s tax-and-spend approach – is essential to sustainably fund the NHS. As Conservatives, we must champion economic growth as the foundation for long-term investment in public services, applying financial discipline and professionalism to deliver the best outcomes for patients and hospitals alike.