'FULLY FUNDED' FUDGE OVER WATFORD GENERAL IS CRUMBLING AWAY
Remember the big Government statement on 25 May that new buildings for Watford General and 39 other hospitals were to be 'fully funded' ?
Some MPs, and the West Herts Trust, got very excited at the apparent confirmation of billions of money for new hospitals. in their constituencies.
But that phrase 'fully funded' is turning out just to be a bit of a fudge. The cheque is not in the post.
There is absolutely no guarantee that the W Herts Trust will get the funding for their 'preferred option' - a gloomy 260-foot towering infirmary on the current car park - or anything like it.
There are three reasons why 'fully funded' could be fake news for Watford General:
- The Government said the 40 Hospitals would be 'fully funded' first in October 2020 - but it turned out not to be true. The National Audit Office watchdog has attacked the Government for saying this, because Ministers had only set aside a fraction of what would be needed - £3.7 billion, when well over £30 billion will be needed to build the 40 hospitals, The Government were at it again in May this year, claiming that £20 billion would 'fully fund' the new hospital programme. That is simply not enough. 'Fully funded' is not a promise you can rely on.
- The Government has form in not being clear with the public over what 'fully funded' means for individual public services. It could just mean that a category of services or projects are being fully funded. The official statistics watchdog criticised the Government recently for suggesting that it would 'fully fund' the extra spending for teachers' pay rises in each school. That wasn't the case - they were only funding the whole category of schools, and some individual schools might not be able to fund the pay rise. If the Department of Health are pulling the same trick as their Whitehall pals, there is no guarantee at all that the individual project at Watford would be funded fully for what the Trust wants to do. Here is an article about the education case.
- It's all up for review, if you look at the small print. The Department of Health's press release on 25 May admitted that: Final funding will be subject to future spending reviews. Those reviews could be tough, as the Government tries to drive down the public spending deficit, especially in the years after 2025, when the Trust hopes to start building - and paying for - the Hospital. The Opposition has made similar statements about reviewing public spending projects. It doesn't look likely that the Watford General scheme - one of the two or three most expensive of the new hospital proposals at between £1 bn and £2 bn - will have an easy time in any reviews. It will certainly be poor value for money compared with a new hospital on a clear new site, with a lot of extra money being spent on shoring up the tower blocks on very sloping ground.
NO WAY OF KNOWING WHY WATFORD WAS CHOSEN FOR A NEW HOSPITAL
Audit Office says no documented evidence for final selection of Watford General
The Government’s decision to choose Watford General for a new hospital was made without proper recorded evidence, according to the public spending watchdog.
In scathing comments on the list of sites for development under the New Hospital Programme, a new National Audit Office report says it cannot determine ‘whether there was an evidence-based process for selecting these schemes as opposed to others.’ (page 24)
The NAO says civil servants have admitted that ‘the final selection of [NHP] schemes involved choices and judgements for which no further documentation is available ... there is no basis for us to determine why DHSC selected these schemes (page 22).
The Government’s failure to provide any explanation of why Watford General was chosen for the NHP rather than other sites - including clear new sites within West Hertfordshire - undermines the case for redevelopment there.
New Hospital Campaign Co-ordinator Philip Aylett said today:
“This is a devastating blow for the Trust. Neither they nor the Government have ever produced a shred of objective evidence for choosing Watford General for a new building.
“We now know that the Government’s choice of Watford General for development was based not on reliable evidence but on ‘choices and judgements for which no further documentation is available’. It is absurd that the future of our hospitals for the next 60 years should rely on such feeble, secretive foundations.
“The Trust may claim that they have examined and rejected the case for an alternative to Watford General following the three-year-old ‘Site Feasibility Study’. But that's grossly misleading The SFS study report admitted that its judgements were ‘subjective’. The Government’s own spending rules make clear that investment decisions must only be made on credible objective evidence. This whole process has been riddled with subjectivity - bias - from the start“
The NAO report contains many other criticisms of the NHP process. The New Hospital Campaign will be publishing a fuller analysis of the NAO report in the next few days. Here is the New-hospital-programme-report.
MONEY PUZZLE AS DACORUM COUNCIL HEARS CASE FOR BEEFING UP HEMEL HOSPITAL
Dacorum Health Action Group (DHAG) Chair Philip Aylett made the case for investment in Hemel Hempstead Hospital to a full meeting of Dacorum Council this week.
He called on the Council to press West Herts Trust to keep a wide range of hospital services in Dacorum, Hertfordshire's largest borough, slamming as 'misleading' claims by the Trust that their current plans would give Hemel Hospital a 'distinct role' for the future in hosting planned medical appointments. Trust documents analysed by DHAG show that Watford will retain its role as the area's main centre for planned medical appointments.
And there is a mystery about money for new hospital developments, with the Trust position confused.
Council Leader Ron Tindall reported that he was in discussion with the Trust about health services for Dacorum, but revealed that there was no news about finance for any development. Mr Tindall said of his talks with Trust Chief Executive Matthew Coats and Chair Phil Townsend:
We couldn’t actually come to a great deal because the government are still keeping their cards very close to their chest and we’ve still got no details about the money, which is unfortunate because nothing else can be decided without that.
Dr Aylett commented: 'It was good to get a sympathetic hearing and to see that there is interest from our elected representatives in Dacorum in ensuring good hospital services here. There seems to be a cross-party recognition that we need to have convenient hospital care close to home. Action is needed - there is no guarantee in the plans of the unelected and untransparent Trust that Hemel Hospital would have a clear future role, despite their misleading claims to the contrary.
'Whatever happens in the Borough there seems to be agreement across the Council that a new emergency care and specialist hospital on a clear new site would still be the best way forward for Dacorum residents.
'But we are a long way from decisions, and confusion reigns about funding. The Trust say they are unable to tell the Council what money will be available for redevelopment, but less than two months ago they welcomed a Government announcement of 'full funding' for their preferred option at Watford. No funding figures were made public.
'Does that mean that, while Watford funding is agreed, Hemel and St Albans Hospitals will still have to fight for financial support? Or was the 'full funding' announcement just mostly hot air, as we have suspected all along?
'In recent months the Trust has gone into its shell, with almost no public engagement about its plans. The funding picture for Dacorum and West Herts generally is totally unclear and the mystery needs clearing up.'
HOSPITALS ANNOUNCEMENT - MAINLY HOT AIR?
The Government got a lot of publicity for the announcement about the New Hospital Programme (NHP), including Watford General, last week.
But what did it mean? Maybe not that much.
The key headline was that many of the NHP schemes will be 'fully funded'. To a normal person, that would mean that the Trusts would know exactly how much money they will be getting. They would also know what buildings they are being allowed to construct.
But Governments with an election in the offing don't follow the normal rules.
In fact 'fully funded' is a misleading term. There is a very long way to go before the funding is secured and a design decided on.
This is what the NHP website says about funding:
All schemes within the New Hospital Programme follow a business case process, including being reviewed and agreed by ministers. Final individual allocations for schemes will only be determined once the Full Business Cases have been reviewed and agreed.
Watford General and the rest have not yet finalised the next stage of their applications - the Outline Business Case. The West Herts Trust have got to adapt their 260-foot tower block design to national standards based mainly on factory-made prefabs. That won't be easy, especially given the small and steeply-sloping Watford General car park site.
The Full Business Case may be many months off and a lot could happen before the Treasury finally agree the money.
Schemes won't start main phase construction until 2025 - after the Election.
Watch this space - a lot could happen in the next two years.
WATFORD GENERAL FUTURE - STILL MORE QUESTIONS THAN ANSWERS
The 25 May relaunch for the New Hospital Programme, including news on Watford General's redevelopment, leaves many vital questions unanswered.
The Trust have failed to gain government approval for their preferred option, and are now in the middle of a rushed redesign to meet the Treasury's demands for a standardised national approach based on 'modular' buildings produced in factories, known as 'Hospital 2.0'. No one has explained exactly what 'Hospital 2.0' means.
Tower blocks will be needed to squeeze 1000 beds onto the current surface car park. How high will they have to be? 16 storeys, maybe more.
Whatever happens at Watford General, the problems of access to a constricted and congested site in a highly built-up area will remain. The impact of building work on patients during construction will be severe.
Meanwhile, there is no detail on the future funding of Hemel Hempstead or St Albans Hospitals.
The fact is that the Vicarage Road site is a very bad place to put an emergency care and specialist hospital.
The NHC response to 25 May announcement is here
The Government press release about the announcement is here
WATFORD HOSPITAL WARDS RATED WORST IN NHS FOR FOOD SAFETY
Wards at Watford General Hospital have been officially rated the worst in the whole of the NHS for food safety.
The Food Standards Agency (FSA) has given the Vicarage Road facility a hygiene rating of one out of a possible five, meaning that ‘major improvement’ is necessary.
The Hospital is the only hospital of many hundreds in the NHS in England, Scotland, Wales and Northern Ireland to get the 'single star' rating. It has not improved its rating since 2019.
A damning report by Watford Borough Council health inspectors on behalf of the FSA uncovered a litany of hygiene failures. A kitchen in a children’s ward had a dirty floor and bare plaster on the walls. Patients with allergies have been put at ‘serious risk’ by poor safety practices, with stroke patients among those exposed to the danger.
Read the Food safety media release . Read the Watford General Food Safety Report
BOTCHED WATFORD GENERAL PLANS MUST BE REVIEWED
A letter demanding an independent review of the West Herts Trust's botched plans for redeveloping Watford General Hospital has been sent to key health decision-makers.
The letter is jointly signed by Sir Mike Penning, the MP for Hemel Hempstead, and Philip Aylett, the Co-ordinator of the New Hospital Campaign. It has gone to Health Secretary Steve Barclay and the Integrated Care Board for Herts and West Essex.
The letter shows that Watford General is not a suitable site for redevelopment. It is extremely congested, inaccessible - and unpopular.
All options for the Vicarage Road site are unaffordable or offer very poor value for money - or both. Taxpayers will lose out if the Trust persist with their plans.
The Campaign believes a completely new emergency care and specialist hospital on a clear and accessible new central site would be the better way forward.
Public confidence in the Trust’s plans for redevelopment at Watford General is in doubt and political support is weak.
The letter calls for a fully independent review. This must allow for a genuine assessment of all options. The Trust should not conduct or even supervise the review, given its history of error and confusion over the project.
The full letter is below:
WEST HERTS TRUST BOTTOM OF THE LEAGUE FOR PLANNED TREATMENT
West Herts Hospitals Trust has been lagging behind the rest of the English NHS when it comes to elective - planned - treatment.
A recent Health Service Journal article pointed out that the Trust is way behind its target to do more elective work. The targets have been set by the NHS to push trusts into recovering from the backlog of work caused by Covid.
But West Herts is far off the national pace. In early 2022-23 it only managed to do 77 per cent of the pre-pandemic level of elective work, and has been told to increase this to 103 per cent.
This poor performance puts it well behind other local trusts, such as Bedfordshire including Luton and Dunstable, which is achieving 95 per cent of the pre-pandemic figure, and East and North Herts (including Lister) which is recovering well to achieve 110 percent.
And the many years of construction work planned by the Trust on the site of Watford General (and St Albans City) will probably deter people from choosing W Herts. The result will be financial pain for our Trust as patients vote with their feet to avoid our building site hospitals.
Photo: Clay Banks on Unsplash