Representatives from West Hertfordshire Hospitals NHS Trust and Herts Valleys Clinical Commissioning Group to provide an update on the hospital redevelopment plans.

Esther Moors and Tim Duggleby from West Hertfordshire Hospitals NHS Trust attended the meeting to provide councillors with a presentation ‘Future of hospital services in west Hertfordshire – Emerging preferred way forward’.

The scrutiny committee was advised that the full version of the presentation, which had been given at a public meeting on 13 June 2019, was available on the trust’s website. 

Tim Duggleby explained that the trust had started with a long list of options which had now been narrowed down to four.  All options kept emergency care at Watford General Hospital and the options set out options for the other sites including a new hospital to provide planned care. 

Esther Moors advised that discussions had taken place with an advisory stakeholder panel, involving clinicians, local representatives and partner organisations who had considered the qualitative merits of each option.  Option one had scored the highest with options four and three close behind.  The presentation included the financial calculations for each option and measure of value for money, for which option four scored highest, but again the differences between options were relatively limited.  An equalities analysis had been carried out, and a more detailed analysis would be undertaken on the preferred option.

Esther Moors set out the next steps that would be carried out.  She reported that the meeting held on 6 June was available to view online.  The final decision on the preferred option would be made on 11 July.  Following this it would be submitted to regulators for consideration as part of the next Comprehensive Spending Review.

Following a question from the Chair, Tim Duggleby responded that a brand new hospital would cost in excess of £700 million.  The trust needed to make a decision on an affordable alternative. 

Esther Moors added that it was recognised that the trust’s hospitals needed investment.  However this was the same as other hospitals across the country.  Regulators would consider the amount of funding available and the schemes that were requesting support.  The business case would articulate the reasons the trust needed to carry out works. 

Tim Duggleby commented that there was an initial filter mechanism that the trust needed to get through before it would be considered for funding.  The team was doing everything it could to try to ensure the scheme progressed through the filters.  The primary funding opportunity was from the NHS as PPFI had been removed as an option.  Potential capital from land sales of St Albans City Hospital and Hemel Hempstead General Hospital could possibly achieve between £30 and £40 million, approximately 10% of the current project. 

Following reference to bringing all services to one site, Esther Moors advised that whilst there were some advantages to this, there were also advantages in maintaining separation between planned care and emergency care; the NHS Long Term Plan’s view was that emergency and planned care should be on different sites.  Tim Duggleby added that there would always be some cases that needed to have surgery at Watford General Hospital due to the complexity of the individual’s circumstances. 

Tim Duggleby responded to a question about consultants for the scheme.  He stated that the expected total cost for planning the scheme would be in the region of 14% of the cost of the project.  Fortunately the trust had been able to draw on previous information, to minimise consultancy costs related to developing the business case.

Tim Duggleby clarified the proposals for option one which would provide more new buildings at Watford General Hospital and the refurbishment of the Princess Michael of Kent building. 

Esther Moors stressed to the scrutiny committee that it was essential the trust showed that any proposal was affordable and the funding could be repaid.  If regulators felt that the funding could not be repaid then the funds would not be released.  Newer buildings meant less running costs.  The team had worked with the clinical teams to work out where efficiency improvements to existing services could be made.  The team discussed the future legacy of the project.  They were mindful of the future and what would happen next and the need to allow for further future changes.

Tim Duggleby agreed to check whether the dividend rate would vary during the life of the loan and would provide a response.

Following a question about pedestrian and vehicle access from West Watford in the options, Tim Duggleby advised that the focus would change.  Emergency vehicles already had their own access from Willow Lane and this would not be changing.  Visitors and patients in other vehicles would need to use Thomas Sawyer Way to access the new car park; it was recognised this would be a longer route for those travelling from West Watford and beyond.

Tim Duggleby added that those parts of the land which had been released and not required immediately would be reviewed in more detail at the next stage of planning.  The dark red areas shown on the image indicated some land could be released for much needed NHS staff accommodation; some could be released for housing sites; the paler shading indicated the land the trust would keep for future expansion. 

In response to questions about additional capacity at Watford General Hospital, Esther Moors explained that during the last winter the ‘trolleys in the corridors’ scenario had been reduced.  The Trust had worked with partners to confirm future bed requirements; in addition to increasing demand, there were also continual changes in medical science, for example some previous open operations could now be carried out by keyhole surgery.  The trust was continuously working with its partners to ensure people could be released from hospital without delay, as soon as they were medically ready for this. 

The Chair thanked Esther Moors and Tim Duggleby for their informative presentation.