A verbal update will be provided at the meeting
Minutes:
Helen Brown gave a presentation to the committee.
Councillor Beauchamp referred to the first slide of the presentation which showed a picture of the Watford site and raised concerns that this gave the impression that the only option being looked at was Watford.
H Brown said the preferred option in 2018 was the redevelopment of
the Watford site and the slide shows what this might have looked
like. The expectation from the Strategic Outline Case to Outline
Business Case is that the preferred option is carried forward to
the OBC. The change in the amount of money available is larger than
expected so there is more time to review the long list to a short
list. The picture used is a stock image and does not mean that
other sites are not being included. The preferred option in 2019
was development of the Hemel and St Albans sites.
E Glatter asked where the long list was distributed.
H Brown said the long list follows a slightly different process using the green book and options generator and it has been shared. It looks at different dimensions of options and looked at where to prioritise investment and which site to be delivered from. It displays a list of 9 or 10 indicative options including the redevelopment of emergency care at Watford and a green field hospital site.
E Glatter asked if the clinical group knew what the SRG are doing and vice versa.
H Brown said the clinical group met over the same time period as the SRG and information is shared. Most of the clinical staff are more interested in discussing what services are going to be delivered and where, the new service models and planning for future growth. They are less interested about where the hospital will be.
E Glatter agreed with the earlier comments from Councillor Beauchamp.
Councillor Maddern asked where the new buildings at Watford would go.
H Brown said a short list or preferred option has not been confirmed yet but the buildings will be in the existing car park and down to the new road.
Councillor Maddern
said this was in the middle of a flood plain.
H Brown said a flooding risk hadn’t been identified in the studies undertaken. She said she would go back and discuss with Riverwell Partners. Clearly, whether the site is used for a hospital or new housing, it must have a detailed assessment.
Councillor Maddern referred to the time frame of the build and was curious to know how it was possible to build that quickly and made reference to a new hospital being built in Brighton.
H Brown said we are operating in a different context to Brighton. The funding and approval process is faster in the context of HIT1 and the nature of the site and project is different. Part of the government programme looks to use modern methods of construction and the nature of a hospital contains repeatable rooms and a standardised design which lends itself well to modern methods of construction. This means the work is done off site and assembled on the site. 2025 is ambitious and the estimation for a build time is three years from a clear site.
Councillor Maddern asked if the Acute Assessment Unit at Watford would remain.
H Brown said under the most expensive redevelopment option at the Watford site, it would be the only clinical building retained.
Councillor Maddern said she understood that that the AAU was only built with a ten year lifespan and questioned why a temporary building would be kept
H Brown said the building was put in place in 2009 during the service changes between Hemel Hempstead and St Albans. The planning permission was granted for ten years but the building itself still has life left in it and is one of the better buildings at Watford. It probably has another 20 years left and this could increase with more investment. We need to make a case to the Department of Health for funding and every square metre of cost will be considered so need to demonstrate that all options have been considered and the plans make use of the estate.
Councillor Allen questioned the point of a feasibility study if the purchase of land issues for a new hospital means no other option than Watford can be achieved by 2025.
H Brown said professional experts have given their opinion and it is helpful to have an independent view on the likely timeframes for all of the sites. 2025 is a hard date given by the government and the Board is motivated to a get a good solution in place in a realistic and relatively quick time frame. Also, need to work with the Department for Health and the Treasury to get the funding so need to weigh up the priorities important to the government in this process.
Councillor Allen suggested that site availability, suitability and time scales are the driving force rather than patients, long term benefits to the community and the possibility of a Grade A hospital rather than risking a Grade B. He asked at what point do patients and long term community benefits get assessed in the process.
H Brown said the trust want to secure improved hospital facilities for our patients. The key debate is about access and the benefits of a new hospital being further north and then the quality of the solution. The view of the programme team and the Trust Board is that with good design and working with partners at Watford Riverwell, we can get a really good solution on the current Watford site. We need to secure the capital funding to deliver that.
Councillor Allen said a greenfield site would improve access for all three towns and asked why there was a focus on access to a railway or tube station.
H Brown said that the report was undertaken independently and they made the judgement how to determine accessibility. Accessibility was not a significant factor and the report makes clear that it is not fair to judge new hospital sites that haven’t been developed against those that are existing. The majority of people travel to hospital by car and it is recognised that there are challenges in Herts around travel. The report mainly focuses on suitability, deliverability, time scale and risk.
Under the public participation rules, Steve Day made a statement to the committee and asked councillors if they would robustly challenge the information they received.
Councillor Bhinder confirmed they would.
K Minier said he was sad that they would have to wait and see the Outline Business Case to get a project development plan that will give an idea of the feasibility of the project. He asked if it could be brought forward to support the Trust’s case.
H Brown said at the OBC stage, once the preferred option has been selected a significant amount of detailed work would begin to ensure it is deliverable and feasible. The designs, engineering solutions, site feasibility are put into a well worked up proposal. Once this has been approved, planning permission can be submitted. The key difference in the OBC to Full Business Case is that we go out to market to secure a contractor to build the hospital and will then get a firm cost of the build.
K Minier asked if a detailed outline of the deliverables would be distributed before December 2021.
H Brown said yes, the green book sets it out in huge detail.
Councillor Bhinder referred to the modern methods of construction and said they would apply to a new build hospital.
H Brown said this method of construction would apply regardless of the options considered.
Councillor Bhinder asked what the options generator was.
H Brown said it is a framework in the green book that sets out a complex set of decisions and goes through a structured process for shortlisting.
K Minier asked if they were factoring in the infection control requirement which may now change in light of the covid-19 pandemic.
H Brown said there was no guidance yet. There are active discussions through the network that meet regularly and we may need to adapt the future design to make as safe as possible in the event of a pandemic. We are looking at a number of single rooms, a minimum of 50% is required in guidance and obviously they take up more space and cost more. Clinicians are very engaged in all of these discussions and looking at what we have learnt from covid-19 and how this is fed into our thinking about the new hospital, wherever that may be.
S Day asked about the sites at Hemel Hempstead and St Albans and that there are no plans to do anything until 2030.
H Brown said she didn’t think this was true. The work around confirming the investment objectives and critical success factors was to look at the relative priority of improving emergency care versus planned care services. We believe emergency care and specialist care have the highest priority due to the condition of the current site. It is more than just maintenance on the Hemel site, there will be new urgent treatment facility and new diagnostic facilities. At the St Albans site, it will be new diagnostic facility and improvements to theatres.
D Evans said post covid, we are going to be in a financially challenged position as a country and coming out of this is going to be difficult. We need to make sure we have the most clinically safe services with the ability to build something that moves us forward. A decision hasn’t been made and plans are coming to the Board of both the Trust and the CCG but need to bear in mind the reality of the world we live in right now and the opportunities that might not be available if we do not take them now.
Councillor Beauchamp asked if the trust could guarantee that the money set aside for improvements to Hemel Hempstead and St Albans would be spent in those areas and not used for Watford should costs rise.
H Brown said the OBC will provide the final allocation and it will be clear what it has to be delivered and will include improvements at Hemel and St Albans assuming the three site option is preferred. From a clinical perspective, what we would really like to do is improve the diagnostic facilities at St Albans as quickly as possible to enable us to enhance treatment. In Hemel, we would like to move forward quickly to free up some of the buildings on the site that are undesirable so they can be redeveloped.
Councillor Beauchamp raised concerns that the Hemel Hempstead site was the poor relation across the three sites.
H Brown said the investment was split almost equally across Hemel Hempstead and St Albans sites and including the land contribution, this totals £60 million.
K Minier asked what the CCG’s position is on a central hospital to serve West Herts.
D Evans said that outside London, there are not many hospitals that cover every area. The CCG position is that they are committed to ensuring patients can access services in the best way possible.
T Fernandes said that he understood the strength of feeling in Hemel Hempstead and from a clinician’s point of view, they want the best possible service for patients and the safest clinical service for emergency services means the money is best placed at Watford and the evidence supports that. During the covid-19 pandemic, more is being done remotely. We want a good outcome of services and many of the things people need done, will be done locally. Very few people end up in acute services in Watford compared to the population, the majority of people are getting services that are provided locally.
E Glatter asked what would be changed at the Hemel Hempstead site.
H Brown said it would be dependent on the capital available to be spent at each site. There will be more detail on the service models by Christmas and suggested including it on the next agenda.
Councillor Bhinder referred to the minutes of the last meeting where the committee asked for a financial report from the West Herts Hospital Trust and asked when this report could be ready.
H Brown said the financial position has obviously changed due to covid-19 but will speak to the Director of Finance.