Huge deficits at Epsom and St Helier Hospitals are now running at half the expected level thanks to a surge in patients and improved efficiency, the board announced on Friday.

Managers rejected a call for business managers to be brought in and assured residents that they are "doing a hell of a lot behind the scenes" to maximise income and minimise waste.

The October finance report showed a £5m deficit, compared to the budgeted £9.4m deficit, so the trust has revised down its end of year forecast deficit from £19.4m to £16.8m.

The future of Epsom Hospital remains uncertain after the merger Ashford and St Peter's Hospitals was halted in October partly because of the high forecast deficit.

But the trust now has had more income than expected with a spike in patients attending A&E and greater non-elective hospital activity.

Director of finance and performance Chrisha Alagaratnam said: "We have put lots of controls in place and there is still room to improve further.

"However, there has been a lot of efficiency over the last year and we are seeing the fruits of that coming through."

At the board meeting there was a call to bring in business managers to make sure services are properly paid for by commissioners.

Paula Sneath, a retired paediatrician at Epsom Hospital, told the hospital managers: "If we are all in debt we must try to earn our way of it and get paid for what we do.

"It’s quite apparent we do a lot we don’t get paid for, which is quite ridiculous.

"If local GPs and population don’t use hospitals then perhaps the board and this trust should have a campaign that someone has already coined ‘use it or lose it.'

"What I don’t hear from you all is a group feeling that you are going to do something about how you feel about these hospitals."

Dr Sneath highlighted the example of a five-hour diagnostic service for autistic children, which earns the trust just over £200 while other establishments like the Maudsley Hospital charge more than £2,500.

She said: "I know they are small fry compared with huge amounts of money but if you don’t start looking at this and selling it as a business and having some enthusiasm, things are not going to get better."

Trust board chairman Laurence Newman said obviously they want to be paid for extra work and hope the new commissioning system being introduced next year would be more sensible and realistic.

Mr Newman said: "The unfortunate fact is that the system has one amount of money.

"It goes from one bit to another and one person’s surplus is another’s deficit.

"That system inevitably sets up an argument because everyone wants to balance their books."

He added that financial difficulties facing the hospitals were viewed as a ‘positive challenge.’

He said: "Despite all pressures and challenges, the fact we are perhaps better off than people expected us to be is very important.

"We are doing a hell of a lot behind the scenes and hope we will be in a position in the next few months to make some of that available to all concerned."

Deputy chief executive Karen Breen said they were working to maximise income as well looking at income from community services and the amount charged for different work.

She said: "There is an awful lot going on, not necessarily bringing in a business manager is the right answer. Action is being taken."

Campaigner Bob Mackison, from Epsom, said local residents could put pressure on GPs to send them to the hospital instead of other providers.

Mr Mackison said: "We will work very hard with you to make sure they are used.

"It’s going to be a war. I think I shouldn’t say it like that but these groups are very large and well established."

Chief executive Matthew Hopkins cautioned that a war would not be helpful and groups need to work together.

Mr Hopkins said: "What we can’t get into some kind of artificial scrap between providers and commissioners.

"To create a sustainable health and social care economy - which is what we don’t currently have and haven’t had for a decade because the deficits that have been passed back and forth between commissioners and providers - we need to get into a set of conversations."