LONG READ We published the news of the merger decision earlier this week. This piece examines how it came to be made.
UPDATED At the public board meeting of the St George’s, Epsom and St Helier Hospitals and Health Group on 5 March 2026, the interim chief executive delivered what sounded like a routine update:
“The first thing just to add is just to relay into the public board the conversation that was had in the private part of the board earlier today in relation to progressing the case for the merger of St George’s and Epsom St Helier hospitals.
“So the private board did consider a draft strategic outline case to submit to NHS England later this month in order to start the process of looking at the options and ultimately moving towards a merger of the two organisations.
“And I’m pleased to say that the board supported the decisions to submit a strategic case subject to a few minor amendments which we will make before we submit it.”
James Blythe’s announcement took approximately 30 seconds, in a meeting that lasted over two and a half hours. When he finished, no board member asked a follow-up question. No press release followed. No public statement was issued.
What Blythe had just described was the formal opening of an NHS merger process. When that process concludes, Epsom and St Helier NHS Trust will cease to exist as a separate organisation.
In August 2021, when the two trusts joined together as a group, the official position was different. Epsom and St Helier’s own press release stated: “Each Trust will continue to have its own Board and the organisations are not merging, meaning both Epsom and St Helier, and St George’s will remain as statutory organisations in their own right.”
Eight days before the 5 March board vote, the group’s deputy chief executive, Michael Pantlin, sent a bulk email to a distribution list headed “The future of our Hospital Group.” The email disclosed the intention to submit a strategic outline case to NHS England “subject to Board approval in March.”
MPs covering the hospitals’ catchment areas were included on the email, added as blind carbon copies to protect their contact details, the group subsequently explained. No public announcement accompanied the email. When Putney.news found the decision six days after the board meeting, when the meeting was posted on its Board meeting page, there was no public information anywhere online.
The assembly
To understand how the 5 March announcement came to be made, you need to go back to September 2020, when a man called James Blythe was appointed Collaboration Programme Director at Epsom and St Helier. His specific remit: to design the architecture of integration between the two trusts. The group did not formally exist yet. Blythe spent two years building the scaffolding before anyone moved in.
When the group was announced in August 2021, the public rationale was straightforward: two struggling NHS trusts, better together. Shared expertise. Shared leadership. Shared back-office savings. The official language was careful to stress what it was not.
“The organisations are not merging,” Epsom and St Helier’s press release stated. “Both Epsom and St Helier, and St George’s will remain as statutory organisations in their own right.” St George’s, operating as a Foundation Trust with greater legal flexibility, issued its own version of the same announcement. It contained no such reassurance.
By December 2021, a single Group Executive Leadership Team had been announced, one operational structure running both trusts. By 2023, a joint group strategy had been published. The organisations were already, in almost every practical sense, being run as one.
Then, in the space of a few months in 2025, the final pieces moved into place. In April, a new chair arrived: Sir Mark Lowcock, former Permanent Secretary at the Department for International Development and UN Under-Secretary-General for Humanitarian Affairs.
His own board papers described his arrival as “a pivotal point in moving to a mature Group operating model.” He was not a standard NHS appointment.
That same month brought a board-level stocktake concluding the strategy remained “fit for purpose,” and the arrival of a new associate non-executive director, Pankaj Davé, whose NHS career includes post-merger integration work at University Hospitals Dorset, a trust that itself went through a complex merger. He is the only board member with that specific experience. When Putney.news asked him directly about his merger remit on 11 March, he redirected the questions to the communications team.
Then the CEO who had presided over the “not merging” era left. Jacqueline Totterdell had been chief executive for eight years. In July 2025, she announced she was going to lead NHS Wales. “While this new role is another wonderful opportunity,” she said, “leaving GESH has not been an easy decision to make.” She said nothing about the group’s future direction. The recruitment that followed advertised a role requiring someone to deliver the existing strategy. Merger was not mentioned in the pack. Matthew Shaw was appointed in November 2025. He joins in April 2026. The merger process will already be under way when he arrives.
Throughout this period, the board made no public mention of merger. When the group’s Five Year Plan was endorsed in a private board session in early February 2026 and brought to the public board on 5 March for noting, the merger’s presence in it amounted to a single bullet point on page 45 of a 195-page document.
It read: “Develop a strategic business case and subsequently a full business case setting out a clear, evidence-based rationale for exploring a merger between SGUH and ESTH, testing whether a merger would deliver improved quality, safety, and sustainability of services for patients, key risks and opportunities and a robust long term financial case.”
The same page noted that staff “often remain aligned to their individual organisations,” adding that “this can create hesitation around designing integrated services, especially when future organisational change is anticipated.” The organisational change being anticipated was not named.
At that same public board meeting, Blythe set out why. “We’ve been a group for four years,” he said. “We’re hugely ambitious for transformation across the organisation… if we want to pursue an aspiration of becoming an integrated health organisation, we know that the whole group will need to have foundation trust status. And we know that the right route to foundation trust status for Epsom St Helier is as a part of a single foundation trust across what is currently the group.”
The argument was one of ambition and structure. The financial picture (a combined deficit of £176 million, with government support being wound down) was not part of his public explanation that day. It was available, in principle, to anyone who worked through the Five Year Plan embedded in a 195-page board pack.
The NHS Confederation, in a report published in November 2024, had documented exactly this dynamic across group models in the health service.
In most cases it studied, merger plans were described as “a tacit acknowledgement of the likely destination, but not formally announced.” The reason, the report found: “political sensitivity led participants to be cautious about going public about their potential plans.” An earlier phrase used in such situations: “a partnership of equals,” used, the report notes, “partly because of the negative impact any alternative narrative might have on colleagues in the struggling organisation.”
While this was happening
In Roehampton, the operating theatre at Queen Mary’s Hospital closed during 2024/25. Its closure appears in board transcripts as an explanation for improved theatre utilisation statistics at St George’s. No public announcement was made; no formal consultation was triggered. Putney.news had reported on the wider service changes at Queen Mary’s in August and September 2025.
The regulatory picture is serious. St George’s maternity services received a formal CQC enforcement notice (known as a Section 29A) in January 2025, following an inspection the previous October. At the same March 2026 board meeting where the merger was announced, the Group Chief Nursing Officer said: “I think it is extremely challenging when there are multiple reports that highlight shortcomings. That is felt no more keenly than by our staff.” Separately, the CQC inspected Epsom and St Helier’s maternity, urgent care and emergency departments in December 2025; draft inspection reports had not yet been received when the board met on 5 March.
Other concerns
The regulatory picture at St George’s specifically has been the subject of sustained Putney.news reporting over the past year. A CQC well-led inspection found a toxic culture and evidence of racism inside the trust, with staff afraid to raise concerns openly and unresolved discrimination in recruitment and career progression.
We reported that an emergency nurse was suspended following shocking failures in patient care and dangerous errors forced internal reforms that the trust was not fully transparent about. St George’s has also refused to disclose, under Freedom of Information law, its own internal response to the Mark Barry case, including what reviews were conducted and what internal communications passed between staff about the NMC findings. That refusal is now the subject of a formal ICO investigation (case reference IC-402999-T9T9).
On maternity, we revealed that St George’s had been calculating pregnancy risk scores incorrectly for ten months and subsequently downgraded those scores in its own records to avoid the threshold that would have required reporting to the safety regulator. A coroner warned in January 2026 that changes made after two men died in St George’s A&E had not resolved the underlying crisis.
Most recently, we reported that the trust carries four “requires improvement” CQC ratings and is losing £700,000 a day with no financial recovery plan approved by NHS England.
Serious problems
At that same meeting, Kate Slemeck, Managing Director for St George’s Hospital, told the board that January had been “quite a challenging month” for A&E, with high patient acuity and high staff sickness causing “a slight dip” in four-hour performance.
People who attended St George’s emergency department during that month told Putney.news a different story. They described waits of over 12 hours to be seen. Patients in severe pain left unattended for extended periods. Toilets that were not cleaned and unusable. Patients sitting in gowns in the waiting room all day, held there because surgical lists had stalled. At one point, a member of staff announced to everyone in the building that the department had hit a crisis point and no further patients would be seen that day.
The performance figures from GESH’s own board papers, published on the same day the merger was announced, show the scale of the challenge. Against a standard requiring 82% of A&E patients to be seen within four hours, Epsom and St Helier was achieving 70.8%. Against a target of 1% for diagnostic waits of more than six weeks, the trust was recording 13.53%. Ambulance handover delays of more than 45 minutes, which were supposed to be eliminated entirely, stood at 8.8%.
The week before the 5 March meeting, NHS England chief executive Jim Mackey personally convened a summit of the 30 trusts “most challenged” on corridor care in England. Epsom and St Helier was in the room, and had been asked to produce an action plan by the following week.
St George’s figures are better on some measures, worse on others. Its 2026/27 funding gap (£101 million before mitigating action) is larger than Epsom and St Helier’s (£58 million). Both carry structural deficits. Together, the combined underlying deficit for 2025/26 is £176 million. The government has been subsidising most of that gap. That support is being wound down: St George’s funding effectively disappears in two years; Epsom and St Helier’s in three. Without structural savings of the kind a merger is designed to deliver, both trusts face an unsustainable position by the end of the decade.
Meanwhile, the new hospital that was supposed to address Epsom and St Helier’s crumbling estate has been repeatedly deferred. A Specialist Emergency Care Hospital in Sutton, promised in 2020, has been pushed back to Wave 2 of the New Hospital Programme; GESH’s own plan now describes it as “at least 12 years away.” In January 2025, the group’s deputy chief executive said: “We have already had to condemn and demolish one of our wards. It’s only a matter of time before other parts of our hospital become unsafe for treating patients.”
Whether a leadership team assembling a multi-year structural transformation could give sufficient attention to running two major acute hospitals through a period of serious regulatory challenge is a question the board’s own papers do not address. The NHS Confederation’s research found that across NHS mergers, performance does not typically improve in the transition period.
What happens now
The merger requires NHS England approval at two stages. If the Strategic Outline Case, which Blythe said on 5 March would be submitted before the end of the month, receives approval, a full business case follows. Then a Secretary of State statutory instrument formally dissolving Epsom and St Helier as a legal entity. Then a vote of the Council of Governors at St George’s, requiring more than half the full council to approve (meaning absences and abstentions count against). Realistically, the process takes two to five years from SOC submission. It has now begun.
The hospitals themselves are not closing. Epsom, St Helier, St George’s in Tooting, and Queen Mary’s in Roehampton remain as physical sites. The jobs most exposed are not frontline clinical roles. They are the band 8 and above management and corporate functions (human resources, finance, communications, estates) where there are currently two of everything across two organisations. This is the stated financial rationale, and it is how every NHS merger delivers its savings.
In response to multiple queries, GESH provided Putney.news with the following statement:
“We have not agreed to merge — at this stage, we have agreed an intention to submit a strategic case for merger to NHS England, asking them to approve developing a full business case. This builds on the work we have already done to strengthen the ties between both Trusts — sharing expertise and resources, whilst leveraging the strengths of our services to further improve patient care. We want to reassure people that there are no related planned changes to our services.”
On the question of public engagement, the trust has said: “No formal public or staff consultation is required at this stage because there are no changes planned to the provision of clinical services. However, we will be talking to our patients, the communities we serve and staff about the benefits a merger would bring and asking for them to identify concerns and queries.”
The group’s chair, Sir Mark Lowcock, told the same 5 March board meeting: “We note that for ESTH we’re still in Tier One and Tier Two oversight for elective and urgent emergency care respectively, but we have a game plan to try and get out of both of those.”
Four MPs cover the catchment of these hospitals. Dr Rosena Allin-Khan represents Tooting, the constituency containing St George’s Hospital. Fleur Anderson represents Putney. Helen Maguire represents Epsom and Ewell. Bobby Dean represents Carshalton and Wallington. All four were BCCd on the 25 February bulk email, eight days before the board vote, subject to that vote. Putney.news contacted all four with questions on 11 March, sent follow-up emails on 12 and 13 March. None of the four had responded by the time of publication: a sign of the “political sensitivity” that the NHS Confederation warned about in its November 2024 report.
Bristol NHS Group, after announcing merger intent in July 2025, established a Community Participation Group providing independent oversight from patients and the public before the merger process advanced. GESH has announced no equivalent structure.
The SOC is due before the end of March. The process has begun. The formal consultation, if it comes, will arrive years from now, after the business case has been built, after NHS England has approved the direction, after the governors have voted. By that point, the architecture will already be set. The window to ask questions about what this means for local services, for staffing, for the hospitals Putney residents depend on, is now.
What you can do
To contact your MP directly about the merger:
- Dr Rosena Allin-Khan MP (Tooting): allin-khanr@parliament.uk
- Fleur Anderson MP (Putney): fleur.anderson.mp@parliament.uk
- Helen Maguire MP (Epsom and Ewell): helen.maguire.mp@parliament.uk
- Bobby Dean MP (Carshalton and Wallington): bobby.dean.mp@parliament.uk
To contact the hospital group directly: gesh.comms@stgeorges.nhs.uk
To attend a public board meeting and ask questions in person: dates are published at stgeorges.nhs.uk. Members of the public can attend and speak. A member of the public attending the January 2026 board meeting brought a separate matter of public concern into the record through this route.
Correction – 15 March 2026: An earlier version of this story stated that the Care Quality Commission issued Section 29A enforcement notices for both maternity services and emergency care at Epsom and St Helier in December 2024.
This was incorrect. The Section 29A was issued to St George’s maternity services in January 2025, following an inspection in October 2024. The CQC inspected Epsom and St Helier’s maternity, urgent care and emergency departments in December 2025; inspection reports had not been published at the time of the board meeting on 5 March 2026.
The paragraph has been corrected and expanded with links to Putney.news’ wider reporting on regulatory issues at St George’s, which provides fuller context for the merger announcement.
Update – 15 March: We have include additional context around a Freedom of Information investigation into the Trust’s internal handling of case of Mark Barry, after we mistakenly linked to a story about a different nurse, Leonajar Bato Pulido.
