Health bosses went public this week on a process to restructure care across Sutton but St Helier's chief executive has insisted all options remain on the table.

Meetings started in January between health and social care bodies across the borough and surrounding areas to thrash out the basic principles that should govern service provision, with a consultation document expected in the summer. Some subsequent reforms could be immediate while others may take years.

The news will raise the spectre of the controversial Investing in Excellence document, published by Epsom and St Helier NHS Trust in 2000, which met with patient and staff ire because of its proposals to shift services onto just one of the two main sites.

But boss John de Braux has claimed the new clinical services strategy differs in three respects the involvement of patients and community representatives, the fact they concern the region's health system as a whole and the current absence of any proposals.

He said: "I've got a blank sheet of paper. We've got to be open from the start it's no good to try and do this behind closed doors. It's about trying to work out what our values as a health community are."

And he repeated his view that St Helier hospital, in its current form, should be no part of any future strategy. But he added: "I think some services, for a population of this size, may be better provided as a single unit."

He mentioned paediatrics and maternity services as possible candidates.

The main driving force is a steering group including representatives from the trust, Merton and Sutton Primary Care Trust (PCT) which comes into being next month, and Sutton Council's social services department. Members of watchdog Merton and Sutton Community Health Council (CHC) have been acting as observers.

In addition, seven so-called planning groups, covering different areas of care, have been set up, involving senior staff from various fields and patient representatives. They cover community and social care, non-urgent surgery, women's, children's, emergency and outpatient services and diagnostics.