CAMPAIGN HITS PARLIAMENT WITH ATTACK ON BOTCHED NEW HOSPITAL PROGRAMME
The New Hospital Campaign has sent Parliament a scathing attack on the Government's hospital-building efforts, especially the plans for Watford General.
The Campaign has submitted to the House of Commons Public Accounts Committee a detailed report setting out the many failings of the Government's New Hospital Programme. The Programme aims to build 40 new (or refurbished) hospitals in England by 2030. The Campaign's report says that:
- The reasons for the choice of sites for new hospitals, including Watford, have never been explained. There was no proper evidence to say why one hospital is to be given a new building while others are to be left as they are;
- Plans for 'Hospital 2.0', a standard system of building, using factory-made components to cut costs and construction time, have been very slow to emerge. The West Herts Trust have been allowed to waste years on their absurd 260-foot high tower-block hospital, which will never fit Hospital 2.0;
- The Trust will struggle to find any company to build their big and expensive hospital because there is not enough capacity in the construction industry. The narrow, sloping site right up against a working hospital makes Watford an unattractive proposition for contractors.
The Committee is likely to publish a very negative report on the Government's programme, and the NHC criticism will certainly play into that.
The NHC report to Parliament is here
SIR MIKE BACKS CAMPAIGN CALL FOR REVIEW OF WATFORD PLANS
Hemel Hempstead MP Sir Mike Penning has backed New Hospital Campaign calls for a review by senior NHS officials of redevelopment plans for Watford General Hospital.
A scathing report by spending watchdog the National Audit Office has recently uncovered serious problems with the NHS's efforts to deliver 40 'new' hospitals, including the proposed collection of tower blocks at Watford, by 2030.
In a letter to the Hertfordshire and West Essex Integrated Care Board (ICB), which oversees the conduct of the West Herts Trust, Philip Aylett, NHC Co-ordinator, shows how the NAO report helps to undermine the Trust's case for Watford. Key issues include :
- Confusion over the amount of money needed to build the 260-foot Watford structure. The Trust have suggested it will take about £1.2 bn, but the NAO reveals that it could cost up to £2 bn;
- Concern that any new Watford building will be too small to serve the rapidly growing and ageing population of West Herts. The Trust is having to look again at its 'costs and scope' to make it fit within national guidelines;
- Lack of capacity in the construction industry. Few building companies will risk taking on massive projects like Watford General, where a severe and potentially contaminated slope alongside a busy existing emergency hospital makes the site very unattractive. That could mean higher costs and delay for the Trust's plans;
- Failure to consider alternatives that could offer better services for patients, and better value for money, which is a key factor for the spending watchdog.
Mr Aylett calls on the ICB to carry out 'a new review of possible sites for an emergency care and specialist hospital in West Hertfordshire.' That should include a new, independent and comprehensive review of potential clear, new accessible sites away from Vicarage Road.
Sir Mike has sent the NHC letter to Health Secretary Steve Barclay and West Herts Trust Chief Executive Matthew Coats, saying that he fully concurs with Mr Aylett's letter. Sir Mike continues:
'We have a great opportunity here to make sure that we have a hospital facility for the 21st and 22nd Century, and I urge all recipients of this letter to take the contents of it very seriously and treat it with the respect that it deserves'.
The NHC letter to the ICB is here.
CASH CRISIS FOR TRUST AS TREATING PATIENTS IN CORRIDORS PROVES EXPENSIVE
West Hertfordshire Teaching Hospitals Trust is facing a potential £33 million deficit this year as costs run out of control and the Government refuses to pay for high inflation. The best scenario for 2023-24 is a deficit of £11 million.
The Trust may have to borrow this autumn just to keep afloat - just as it prepares to borrow another billion to build the Watford General triple towers.
The Trust Board will hear at a meeting tomorrow (7 September) that:
- A and E pressures including opening 'surge beds' and 'caring for patients in Emergency Department corridors' have bust the budget by £1.5 m
- The drugs and clinical supplies budget has been overspent by £2.7m
- The budget for outsourcing - which is supposed to save money - is overspent by £500,000
- The Trust is burning through its cash reserves rapidly - it had £35 m 'in the bank' in March, £16.9m in May and just £11m in July. Borrowing could be needed by early next year
- Tight spending controls are being imposed to bring costs down
THE GOVERNMENT'S FAILURE TO FUND INFLATION AND THE IMPACT OF THE STRIKES HAVE MADE IT DIFFICULT FOR THE TRUST.
OTHER TRUSTS ARE PROBABLY SUFFERING TOO.
BUT QUESTIONS MUST BE ASKED ABOUT WHY THE WEST HERTS TRUST MANAGEMENT HAS ALLOWED THIS TO HAPPEN QUITE SO QUICKLY - AND WHY, FOR INSTANCE, HIGH SPENDING HAS NOT BROUGHT BETTER RESULTS IN A AND E, WHERE WEST HERTS LAGS THE REST OF THE NHS ON SOME MEASURES
WATFORD GENERAL 'SINKHOLE' HAS ITS FIRST BIRTHDAY - BUT NO-ONE'S CELEBRATING
The collapsed services duct unpopularly known as the Watford General sinkhole has just passed its first birthday. The Trust have been struggling to sort out the mess in the road by the main hospital entrance for a year now, and the digger is still digging.
To be fair it looks as if they are nearing the end of the fiasco and the road may be open before too long. That would be a big relief to patients and staff.
But the saga has shown up the frailty of the vital services tunnels, with cables and pipes, under the hospital. The Trust took months to work out what had happened and what repairs were needed. They still don't know what lies beneath the old buildings and how safe it would be be to build on top. All sorts of things, including asbestos and other pollutants, may be down there.
That matters because it looks likely that the Trust will have to use the site of the existing buildings in the future, for whatever new hospital emerges from the mess that is the acute redevelopment project.
This is just a terrible place to put a new hospital.
ARE WE SAFE IN THE HANDS OF THE NHS? RATE YOUR LOCAL SERVICES
Hertfordshire's top NHS body is asking the public to rate local health and social care services by how good - and how safe - they are.
People will also be able to say how well online services provided by GPs and others are working. The Integrated Care Board (ICB) for Herts and West Essex is running the online survey.
This is a chance to tell the NHS what we think of it, and the Dacorum Health Action Group (DHAG) is urging people to take the chance to get their voices heard.
DHAG Chair Philip Aylett says:
'It's not often that the NHS lays itself open to judgment like this, and I hope a lot of people will take the opportunity to make clear where services are safe and of good quality - and where they're failing. That means we can say what is good or bad at Watford General, St Albans and Hemel Hempstead Hospitals, but also give our views of GP and social care services.
'The NHS is going to rely more and more on online services in the future, so we need to tell it where they can be improved.
'This is a simple survey which doesn't take long to do. I hope lots of people will fill it in.'
The link to the NHS survey is below
https://www.smartsurvey.co.uk/s/4M3QZ1/
How confident do you feel, using a scale of 1-5, that the care you or a family member received was safe?
'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