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.




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”.



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 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:


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? 


There's a great opportunity for a professional to begin to make waves on the West Herts Trust Board.

At present, there's not a single non-executive director on the Trust Board with a main residence in Dacorum.

We desperately need more people who understand Dacorum's health needs, to make the grossly unbalanced West Herts Board fairer.

Can you help to correct that outrageous situation?

The NHS is running a recruitment campaign for a Non-Executive Director for West Herts Trust - they must have senior experience as a registered nurse, midwife or an allied professional.

Do you have that sort of experience - or do you know someone who does?

It would be great if someone from Dacorum could get on the Board. That would be a small but important step towards ensuring the Borough's health and hospital needs are properly represented in decision-making, for the first time for years.

It would also be good if there was someone on the Board with an independent mind - who could push for alternatives to the Trust's disastrous plans for Watford General.

This is the link to the application forms. You'll have to be quick - closing date is 1 November.




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.









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.



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



Many thanks to Sarah Cottingham for knocking up this powerful video for our crowd funding page. Says it all, really.