A call for urgent NHS action to correct serious failings in Dacorum's GP services has come from Dacorum Health Action Group (DHAG).

DHAG Chair Philip Aylett has written to the senior leader of the NHS in the area setting out a plethora of primary care problems reported to DHAG on the social media portal nextdoor. These include:

• Difficulty in making appointments

• Questions about the effectiveness of telephone appointments

• The weakening of the role of the GP as an enabler of access to NHS services and an advocate for the patient

• Doubts about the value of the wider range of health professionals now employed by practices

Dr Aylett has invited Paul Burstow, Chair of the Integrated Care Board (ICB) for Herts and West Essex to meet people who are unhappy with the service they get from their GP. He has also asked the ICB to review the workings of Primary Care Networks, groups of GP practices which were supposed to help improve the service. PCNs  seem to have made little impact on raising standards.

Attached to Dr Aylett's letter is a selection of the evidence about GP problems gathered by DHAG.

The letter is here: Letter to P Burstow FINAL


Patients in Dacorum have been sharing their stories of problems accessing and using primary care services. 

Dacorum Health Action Group asked users of the nextdoor social network for their views of GPs and other primary care services in the area. The results were very concerning.

Among the main difficulties encountered by Dacorum people are:

  • It often takes weeks to get appointments, even for urgent and serious conditions
  • Booking systems are very difficult to navigate
  • Phone appointments sometimes don't allow proper diagnosis
  • Online consultation platforms can't replace face-to-face consultations with a real doctor
  • There are doubts about the effectiveness of the increasing numbers of practice staff who are not qualified doctors

The acute hospitals seem content to say to people who turn up at urgent care 'make an appointment with your GP'. They don't always realise how hard that can be.

We will be contacting the regional NHS supervisory body, the Integrated Care Board, asking what they can do to make the situation more bearable. It is clear that some practices are much better than others - they need to be able to spread their good practice to the ones in the slow lane.

A selection of the comments made on nextdoor is below:

Next Door Comments GPs


West Herts Trust caused confusion last week when it disagreed with the Health Secretary over the target start date for building the proposed Watford General towering infirmary.

A Trust release claimed on Friday that building work for the 260-foot triple-towered redeveloped hospital is 'expected to get underway in 2025'  This contradicts a recent statement by Health Secretary Victoria Atkins that construction was 'due to start at the end of 2026'.

As well as the muddle over the date, the Trust's Friday release reheated the discredited claim that the hospital would be 'fully funded'. Press reporting recently exposed this as meaningless because

a) there is no final clarity about what the project will provide, and

b) all figures are subject to government spending reviews - at a time when budgets are being tightened

The release also appeared to show little understanding of how health professionals are trained, claiming that:

'As one of the biggest employers in the area, with 5,800 staff, the Trust will continue to develop a pipeline of future doctors, nurses and clinicians from the local area, working in close partnership with West Herts College and other partners.'

This suggests that staff will come entirely from West Herts.  It also hints that doctors and nurses are not clinicians.

Most oddly of all, the release gives the impression that West Herts College has a medical school. That College is an excellent institution but it does not train doctors.  

People want facts about their hospitals, not muddle and spin.












Patients to suffer as Trust struggles to pay for Watford tower blocks

West Herts Trust will be making big cuts next year as it tries to get ready for the huge financial hit of Watford's new tower block hospital.

The regional NHS body, the ICB, has been told that the Trust will be looking for 'efficiencies' of £21m in 2024-25. But the Trust will still be running a deficit of nearly £25million by the end of that year. The Trust had been hoping to almost break even, so that it could be confident of funding the £1.3bn, 260-foot building with its three closely-packed high-rises.

No such luck. The Trust is deeply in the red and will remain there for the foreseeable future.

Other trusts have money troubles, but West Herts is being especially over-optimistic. It is trying to build the tallest NHS building outside Central London on a (comparatively) modest income of about £500m.

The result - patient services will have to be hit hard to try to get the books straight.

And the money situation will get worse for the Trust if it tries to build at Watford General. 'Elective' income will plummet as patients with a choice stay away from what will become a cramped building site.

Time for a radical rethink before the Trust's cash crisis turns into a care crisis.


Health Minister Lord Markham does not know the meaning of the word 'independent'.

In a letter to a local MP Markham claims that the choice of Watford General for the emergency and specialist hospital was based on 'an independent feasibility study in August 2020,'

This is a misleading statement.

This refers to a Site Feasibility Study (SFS) commissioned by West Herts Trust, which concluded that building a new hospital at Watford General would be much quicker than building on a new clear site. This gave a green light to the Watford project.

But the SFS's conclusions were not supported by the evidence.  It was a poor report, which admitted that its conclusions were only 'subjective'.

Yet absurdly the Government still use the SFS as the only substantial bit of technical evidence for Watford General.

And the SFS was not independent.

Collins dictionary contains this definition:

An independent inquiry or opinion is one that involves people who are not connected with a particular situation, and should therefore be fair.

The Site Feasibility Study was  done by a 'company' called RFL Property Services Ltd (RFLPS). Sounds independent - but it's not.

According to its LinkedIn profile, RFLPS is a 100% wholly owned subsidiary of Royal Free London Group (RFLG).  Set up in 2018, RFL's main job is to be the estates and property department of that big London hospital system.


  1. Is effectively part of the NHS, like the West Herts Trust. Nine of RFLPS's directors over the years have shared their address with the Royal Free London Group or Trust
  2. Were already working on the West Herts projects - something that wasn't disclosed in the SFS

But there's more. The two Trusts have been very close to each other. In October 2018, the Royal Free London Trust and West Herts announced that they had “joined forces as part of a new clinical partnership. The partnership follows months of close collaboration between the two trusts.” It wasn't just clinicians - the Trusts worked together over recent years on digital systems, occupational health and bids for ultrasound contracts

There was no way RFL could take an unbiased, fair and balanced view of the arguments for and against locating the new hospital at Watford General. This is known as a conflict of interest. The close corporate relationships between RFL's owners and W Herts should have been made clear, but they weren't.

The judgement of the SFS is not valid because it is not independent. The Trust have no solid evidence for pushing ahead at Watford General.





Millions of pounds have been wasted as the design for Watford's new tower block hospital  has undergone big changes.

The West Herts Trust has posted a new video and pictures showing selected parts of its new design for Watford General - and it makes major changes from designs published just two years ago.

  • At least one block is now 14 storeys high rather than 12 as the Trust claimed recently
  • The front section of the new design appears to be several storeys higher than in previous designs. It will restrict the views from the main ward blocks behind it, increasing the amount of shade

The Government gave the Trust £53 million in 'scheme development funding' in 2022-23 - some  of that has been wasted as the Trust has kept changing its mind on how to squeeze nearly 1000 beds onto a cramped sloping site.

Just think how many doctors and nurses that could pay for.

This is the 2022 design for the new hospital - the front building was going to be around the same height as the 7 storey multi-storey car park, to the right.

Below is the latest attempt at a design - (from a different angle) All of the front building of the new hospital will now be much higher than the multi-storey, up to 11 storeys.  To the rear is one of the towers - 14 storeys instead of the 12 storeys claimed last autumn. The front building has also been redesigned.

The video is quite glossy (and would have been expensive to make) but only shows one side of the exterior. Here is the link:



Hemel and St Albans Hospitals lose key government funding

The Government’s flagship £20 bn-plus New Hospital Programme (NHP) has pulled out of funding Hemel Hempstead and St Albans Hospitals.

With costs of Watford General’s planned new towering infirmary soaring towards £1.3 bn, the other two hospitals will now have to be funded by the local NHS, including the deficit-ridden West Herts Trust.

That casts serious doubts on the prospects for hospital services in the two towns. There has already been a delay to the construction of some new facilities at St Albans.

The Trust originally assumed that the NHP would allocate money to build at Hemel and St Albans.

Now all the Trust’s NHP capital allocation will go to the Vicarage Road site, where projected costs have doubled in the last four years.

Confirmation that Hemel and St Albans have been cast adrift by the NHP came in a letter from Government Minister Lord Markham to Hemel Hempstead MP Sir Mike Penning.

Lord Markham said:

‘The NHP scheme for West Hertfordshire is for a fully funded new hospital at Watford. Whilst redevelopment work at Hemel Hempstead Hospital and St Albans City Hospital will not be part of the NHP scheme, improvements at these sites will continue to be supported by the Trust in line with their their planned approach and in collaboration with the local Integrated Care Board (ICB)’

The Trust is a long way off the financial stability it will need to fund the new Watford Hospital. It should be nearly breaking even now, but instead it faces an £18 m deficit this year and another deficit next year. Main construction work on the Watford facility will not begin until the end of 2026 – nearly three years away.

The case for a proper review of these impractical and unaffordable plans for Watford General is getting clearer by the day. There is plenty of time to consider the advantages of a new hospital on a clear new accessible site.



West Herts Trust non-executive director Jonathan Rennison  has publicly criticised the culture of Watford General's maternity unit. Speaking in a Trust Board meeting on Thursday, Jonathan also talked about the responsibility of senior management and the Board. Referring to the maternity unit, he said:

“There are a small number of people, but they are very vocal and they are in some senior positions and they drive some poor behaviours as well as a narrative that undermines [inaudible] culture and I think we just really need to be clear that that isn’t acceptable behaviour. There are professional standards for how you work with others, how you have professional respect, how you treat others and we have to be clear about that and start driving that change more ….
“It’s about how we start to empower staff to feel comfortable with that and that they know that we will have their back and that there won’t be any retribution for calling out bad behaviour because that’s where it falls down, it’s the bystander effect. People are afraid to step in and call it out because they see what has happened to others. So we have to be more vocal and we have to be setting that tone and that message around this (Trust Board) table as well, and saying it’s not acceptable because otherwise that change never happens. It has to be set from the top.
“So great work has been done and I have to say Mitra [Bakhtiari, Director of Midwifery and Gynaecology, who is leaving the Trust] has been an exemplar in terms of her behaviour and she does call it out and gets an awful lot of unpleasant backlash that we are not necessarily aware of around this table and it’s about saying that is not acceptable. Just to say thank you to Mitra again for the work she has done ...When she goes we need others to be stepping up and to be doing what Mitra has been doing so we don’t have that gap.”

A senior clinician responded by pointing to ongoing work to get the culture of Maternity better, including a number of recent events aimed at improving working relationships, notably a senior midwifery awayday and a consultant awayday. There are more programmes planned. In terms of improving the culture, he said, “We are on the right path”.



West Herts Trust has drastically reduced the number of opportunities for the public to question it about its redevelopment plans.

During the worst of the Covid crisis, senior staff explained and defended their ideas for the future, including Watford's towering infirmary, in a series of online events for the general public.  Hundreds took part.

But in mid-2022 two senior staff with special responsibility for the new hospital project left the Trust - and since then the number of public discussions offered by the Trust has plummeted.

Figures obtained by the New Hospital Campaign (NHC) show that a grand total of just 43 people attended Trust general public events on redevelopment in the whole of 2023.

Not one general public event was in Dacorum, with its population of 155,000. 

But one body  - the St Albans and Harpenden Patients Group - has been favoured with two visits by Trust redevelopment staff in the last two years. The organisation describes itself as 'a group that represents the public, Total recorded attendance at its two events on redevelopment was 8.

This was the St Albans Group's comment on the Trust's redevelopment plans in 2022:  'we strongly support the Trust’s three-site option.'

The figures obtained by the NHC are FOI 7042 attachment 1




Today the Dacorum Health Action Group (DHAG) calls on all elected local representatives to challenge the NHS to improve provision for the Borough's population.

In its first Newsletter, DHAG points to a number of issues where NHS bodies are failing to provide good service  - or to plan adequately for the future.

We at DHAG believe that elected local and national representatives need to challenge unelected and unaccountable NHS bodies, such as the West Hertfordshire Teaching Hospitals Trust, to do much better for Hertfordshire's most populous Borough.

Headlines from the Newsletter include:

  • The future health needs of the growing and ageing Dacorum population need to be independently assessed before any decision is taken on the location of NHS services in the Borough;
  • The costly, flawed  plans for redeveloping Watford Hospital are seriously threatened by the poor financial situation at the West Hertfordshire Trust. Better and cheaper alternatives on clear new sites must be explored urgently.

The link to the Newsletter is Newsletter 1