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.
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TRUST CUTS DOWN ON PUBLIC QUESTIONS ABOUT HOSPITAL PLANS
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
HEALTH SECRETARY CONFIRMS DELAY FOR WATFORD'S TOWERING INFIRMARY
Building of the new facility for Watford General Hospital won't start until the end of 2026. Construction of the 260-foot tower block hospital was originally scheduled by architects to begin in the autumn of 2024.
The new date was announced by Health Secretary Victoria Atkins on a visit to the hospital last week. Perhaps without realising it, the Minister was confirming a two-year delay.
As recently as November last year, the West Herts Trust told local media that construction would start in 2025/26.
The teetering timetable will disappoint the Trust. But it does give the NHS to chance to reconsider this unrealistic plan and look at new site alternatives that could offer a better outcome for patients and taxpayers.
Money Troubles
The continuing hold-up may be linked to the Trust's dire financial problems. A £20 million deficit looms for this financial year, ending in March, with more to come next year.
West Herts is a smallish trust financially - about £500 million income - and it just doesn't have the financial muscle to take on the £1.3 bn towering infirmary project - one of the most expensive of the whole 40 'new' hospital schemes.
This is the height (pun intended) of financial irresponsibility.
The Trust's Chief Financial Officer warned in 2022 that it needed to break even to help it win Government approval for the towering infirmary. The Trust is miles from achieving that, with the 'outline business case' for the scheme stuck in Whitehall.
So severe financial cuts are being applied to try to get the Watford towers project back on track. The delay is giving management the chance to implement tougher measures on the three overspending divisions: emergency, medicine and surgery.
Our vital caring services are being cut back to fund the Watford Hospital rebuild extravaganza.
TRUST BUY A £13.6 MILLION FLOOD RISK
The West Herts Trust have just spent £13.6 million on an acre of land that suffers from a high risk of flooding.
And they will have to raise the floor level of a major part of the new Watford Hospital by NEARLY FIVE FEET to make sure it doesn't get flooded by surface water.
The Trust have had to pay that enormous sum (about four times the going rate for similar land) to accommodate the front entrance of their new tower blocks. They don't seem to have read their own Watford General planning application from 2021, which said that:
there are some small areas of the site, predominantly at the south corner / low lying areas, which are shown at high risk of pluvial [surface water] flooding. This correlates with the existing site topography, the southern corner of the site being the lowest area of the site and, therefore surface water ponding may occur.
A 'high risk' - the worst category for flooding danger - means that ' each year this area has a chance of flooding of greater than 1 in 30 (3.3%).' With climate change, that chance may be growing.
So the Trust's advisers say, in the planning documents:
It is recommended that the proposed finish floor level of the building located at the south corner of the site are set at above 54.5m AOD [AOD is basically sea level] (53.00m AOD TBC +1.2m + 0.3m freeboard),
which is above the predicted probable pluvial flood level.
In plain English, that means that the front entrance of the new towering hospital will have to be 1.5 metres above the existing ground to keep patients and staff in the dry.
THIS COULD END UP BEING THE MOST EXPENSIVE POND IN THE NHS.
A VISION FOR A NEW HOSPITAL ON A NEW SITE - ESSEX STYLE
This is what our Health Service can do when it wants the best for patients.
It's the design by the Princess Alexandra Hospital NHS Trust for a new hospital for Harlow in Essex, on a new site away from the centre of town.
A spacious site with plenty of greenery and space. There are car parks, but they will have trees. Buildings are functional but on a human scale, a maximum of seven storeys. There is room for expansion.
Harlow's wise NHS managers rejected town-centre options which would have been short on space.
This is the link to the Harlow Trust's redevelopment plans:
https://newpah.org/
This is what should be possible in West Hertfordshire - but our local Trust stubbornly persist in planning for Vicarage Road tower blocks of up to 16 storeys - a height of 260 feet or so. The £1.3 bn-plus towering infirmary will be surrounded by up to 1500 flats and houses. Access and transport are poor, and will remain poor.
The only real landscaping at the new Watford Hospital will be ... on the flat roofs of the tower blocks.
The cost will put the Trust's fragile finances under pressure for years. That is plain irresponsible.
Why can't West Herts have this quality of hospital? Why must the Trust continue with its plans for a looming hospital on a cramped and difficult site?
What motivates the Trust to refuse even to contemplate a new hospital on an accessible new site?
HOSPITAL ACCESS COULD BE KEY POLL BATTLEGROUND
Hospital issues - especially the difficulty of getting to Watford General Hospital - could become an important issue in the polls that are coming up, including the General Election.
That's clear from the results of a major public consultation on plans for the future of South West Hertfordshire.
With the results in several marginal Herts parliamentary seats looking too close to call, candidates will need to listen to complaints about the location of the Vicarage Road hospital. Access to GPs will also be a big issue.
The consultation on the South West Herts Joint Strategic Plan covered thousands of respondents and showed that:
- One of the biggest issues for residents was access to healthcare
- The 'principal concerns' on infrastructure 'related to Watford Hospital and the fact that this was hard to access.'
- People frequently mentioned Health and Transport under the 'biggest single issue' category.
- In the summary of responses - Hospital concerns about Watford featured highly.
A startling 'Word Cloud' showed which issues loomed largest for the people surveyed - and Hospital and Transport came up top.
TRUST IN DENIAL AS DOUBTS GROW OVER MONEY AND DESIGN FOR WATFORD'S TOWERING INFIRMARY
The West Hertfordshire Trust was in full denial mode last week as it insisted that all was well with its 260-foot tower block hospital for Watford.
But there's growing uncertainty that the Trust will get the money to build the hospital - or approval for its preferred design.
- On finance, a Trust Board meeting on 5 October was assured that there was 'full funding' for its triple-tower, 400-foot wide design. A Trust official claimed not to know that funding could be changed under future government finance reviews. Yet the Department of Health made clear in a press release in May that funding could be altered by government. In tough times for public spending, that financial uncertainty casts doubt on the Trust's £1.1 bn plus Watford plans - among the most expensive of all the 'new' hospitals.
- On design, Watford Borough councillors will be taking a very close look at the Trust's present plans and may seek big changes. The Council's policy is to keep new buildings in the hospital area to a decent height of about six storeys. That could mean lopping over one hundred feet off the height of the present enormous design, which runs to the equivalent of 20 plus storeys. The Council's development management committee warned last month that it will also be looking at the quality of the design after doubts were raised about the amount of shadow that would be created by the three tall towers - crammed together just 15 or so metres apart.
The Trust needs to get real and accept that its plans just won't work.
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.
'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.