Increasing car parking charges is one of a number of "unpopular decisions" which will need to be taken by Epsom and St Helier hospitals to meet the "huge" financial challenge they still face, according to their chief executive.

Although it was the only hospital trust in South West London at the end of the last financial year to post a surplus - £79,000, an massive improvement on the £7.4m deficit recorded the year before - Daniel Elkeles said it is "by no means certain that we will break even this year".

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He said: "The financial challenge is huge. It’s a huge, huge effort to do it.

"And it’s an even bigger effort because we won’t don’t do it at the cost of compromising patient care.

"The NHS as a whole is not in a great financial position and most acute trusts like us are finding it very hard to balance the books."

He said the hospitals will have to make "hard choices about what to invest in" in 2015-16.

"Are we going to have to make difficult decisions this year? Yes," he said.

"Are we going to have to do some things which are unpopular like put up car parking charges? Almost certainly.

"Are we determined to balance the books? Yes - because being financially sustainable is how we will continue to be successful and be able to do the right things for our populations.

"We won’t make the case for new buildings if the hospital is in big financial deficit."

Mr Elkeles said the trust is "working constructively" with the deficit-ridden Surrey Downs Clinical Commissioning Group (SDCCG), the GP-led organisation which buys hospital services from the trust for patients in Epsom.

But he added the two parties would not be attempting to balance their own books by "passing the deficit back and forth" - a reference to a scenario in which Epsom Hospital could charge the CCG more for the work it does, or the CCG could offer it less money to do the work.

The chief executive said: "We have several proposals about how we can do work for them which will reduce their cost because we will either do work which they are currently sending to another provider which is costing them more money or we will find ways of reducing our own costs to them.

"Epsom and St Helier policy is not to bankrupt Surrey Downs CCG."