NHS boss sets 2025 deadline for west Herts hospitals development

And they’ve been given a list of options NHS chiefs want to see on their shortlist.

None of those specified options include plans for a new purpose-built hospital on a new site – although the shortlist will not be limited to those specified options.

The New Hospital Campaign (NHC) obtained the crucial letter about hospital redevelopment in west Herts which the West Herts Hospitals Trust (WHHT) has received from the Department of Health and Social Care (DHSC).

This has been disclosed to the NHC’s solicitors Leigh Day and Co as part of the current judicial review process against the Herts Valleys Clinical Commissioning Group (HVCCG).

The letter, which was sent on June 16, and neither the Trust nor the CCG had previously made public, until now, despite referring to it in meetings with stakeholders which could later be viewed on the Trust’s website, and in public statements - it is now available on the Trust's website.

The letter seems to instruct the Trust to put only three options on the shortlist, all involving the Watford General site as the main A+E hospital for the area.

The shortlist is to be drawn up in the autumn as part of what is known as the Outline Business Case (OBC).

These options were decided by the Capital Delivery Committee, a group of civil servants from the DHSC and NHS England and Improvement.

The letter says: "We understand that in order to further inform the trust position a workshop with the trust and relevant stakeholders, including DHSC and NHSEI, was held on the 8th April 2020 which discussed the range of options being considered and that the workshop concluded that there are 3 options that should be taken forward for in depth analysis at OBC stage as follows:

- Option 1: £300m investment in a new clinical block at Watford General Hospital (WGH), plus £50m investment at Hemel Hempstead Hospital (HHH) and St Albans City Hospital (SACH).

- Option 2: £370m investment in a new clinical block at WGH, including ED [Emergency Department] re-provision, plus £50m investment at HHH and SACH.

- Option 3: £540m investment to replace the Prince Michael of Kent (PMOK)

building, re-providing the majority of clinical services at WGH into a new build

facility, plus £50m investment at HHH and SACH."

Signed by the DHSC’s second permanent secretary David Williams, it highlights a number of options that it says should be taken forward for in-depth analysis.

Those various options include investment of between £300m and £540m at the Watford General site and a further £50m and St Albans City and Hemel Hempstead.

But Mr Williams warns that this does not an indication that a scheme above the ‘indicative envelope’ of £400m would be “nationally affordable or supported”.

And he states: “The view of DHSC and NHSEI is that whilst options should not be artificially constrained by the £400 million indicative allocation, our appetite for deliverability and timelines particularly in the current climate, remains high.

“With this in mind, we would not expect you to undertake options appraisal on any proposal that significantly increases the timescales for delivery of the scheme beyond 2025 and we would also not expect options to be developed that materially change the indicative values of the options set out above.”

But the failure by the NHS to specify that the option of a new hospital be included in a shortlist has concerned some campaigners.

And they have hit back claiming that a new hospital could be delivered more quickly than redevelopment at the existing Watford General (WGH) site.

A spokesperson for NHC said: "Many members of the public believe this is the only viable approach for the decades to come given the dilapidated state of the Vicarage Road site, its inaccessibility to many parts of the area and the great risks to safety in rebuilding on a site where patients are currently being treated.

"The DHSC have said that cases which are complex and politically sensitive can receive extra support and the approvals process can be ‘streamlined'.

"However, while we know that Watford is a sensitive marginal constituency, critical long-term plans for hospital provision must not be decided on political grounds.

"The Trust have commissioned an ‘independent’ feasibility study of a small number of possible sites for a new hospital based on carefully selected

plots of land. They are also running a process of stakeholder ‘engagement’.

"We call on the Trust to act fully in the interests of local residents and to include realistic and viable new hospital options – which may be single site or have planned care on an existing site – on the short list.

"A complete rebuild of Watford General would take far longer than such options and cost considerably more.

"Recent experience suggests it could take seven years or more to build a new at Watford while still operating Watford General as an acute site."

In response, bosses at the West Hertfordshire Hospitals Trust (WHHT) have stressed that the option of a new hospital is still being considered.

And they say they will not know until the autumn – after all options have been subjected to the same ‘rigorous’ process – whether it will be on the shortlist of options, or not.

Bosses at WHHT – which operates Watford General, St Albans City and Hemel Hempstead hospitals – were told they could bid for capital funding last year (2019).

That approval was based on initial proposals to NHS bosses that focused on the re-development of the Watford General site, on Vicarage Road, with some additional works at Hemel Hempstead and St Albans City hospitals.

But as part of the continuing bidding process the Trust is now considering a range of options, including the development of existing sites and the feasibility of new ones.

Throughout the process the New Hospital Campaign and the Herts Valleys Hospital groups have continued to push for a new purpose-built hospital.

Following the publication of the letter, the Herts Valleys Hospital group – which believes the best option would be for a new hospital on a site in Bricket Wood – have highlighted the 2025 deadline in Mr Williams’ letter.

And they have suggested that a new hospital on an alternative site could be a quicker option.

“The suggestion that providing either new or refurbished facilities by that date on the current WGH site is, frankly risible,” say the campaign group.

“[. . .] The construction phase of a new build facility on a clear site could without question be considerably quicker than that offered in Watford, and so deliverability and timelines are not a valid reason to discount our proposal.”

Edie Glatter of the NHC said: “If the Trust keeps a new A+E hospital on a clear, central site off the shortlist it would make a mockery of any meaningful involvement of patients and the public in health service provision.

"The engagement programme would be a farce and a waste of everybody’s time and money.

"It would create a lack of trust in our decision-making processes."

Helen Brown, deputy chief executive of the West Hertfordshire Hospitals NHS Trust, said: “We are aware that the mention of a potential larger investment is of interest to those who want to see an all new hospital on a new site.

"This option will be part of our long list and will be subject to the same rigorous process and financial constraints as the other possibilities we are looking at.

“The process of reducing the long list to a shortlist is due to take place this Autumn so we cannot say at this stage if a new hospital option will be on the shortlist.

"The Department of Health and Social Care has been clear that we should not consider any options that significantly increase the timescale for delivery of the scheme beyond 2025.

“The key elements of the letter from the Department of Health and Social Care were shared with our Stakeholder Reference Group in June, shortly after the letter was received.

"The presentation given to that group, with a copy of the wording regarding the potential additional funding, was made available on our website in June.

“The full version of the letter is now also on our website. As it is a letter sent from another body, we needed to seek their agreement to share it.

“The letter from our regulators does not state that only three options will be on the shortlist.

"The letter set outs three options that they expect to see on the shortlist, which will have at least four options.

“We continue to share information about the appraisal process and will be holding another session with stakeholders in the coming weeks to explain this in more detail.

“We will also be talking to them about the site review and the part it will play in our decision-making.

"The site review is being carried out at present and we will publish its results later this month. It looks at the deliverability of five sites, including the current Watford General site and is being conducted by two external organisations who have proven expertise in this field.

“We await their report and so cannot comment at this stage on potential completion dates for new builds or a redevelopment option at Watford.

“We are sorry to learn that some people are claiming that the engagement is not genuine. We have enjoyed meeting stakeholders, albeit virtually, and have found their feedback tremendously valuable.

"We have already made changes to our appraisal criteria in light of their comments and we are expending considerable effort in answering their questions and providing presentations on all aspects of our outline business case.

“We have had really positive comments about our engagement programme and will to continue to reach out to the communities we serve.”

More information, including a Frequently Asked Questions sheet and short films and presentations can be found on the trust’s website.