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Future hospital services

The future of our local hospital services is a key element of our vision for a healthier West Hertfordshire. However, it is only one part of the solution. Our Healthcare in communities page explains how we are working to provide services that care for people in the community, closer to where they live so that people only have to travel to hospital for more critical and specialist care.

Herts Valleys Clinical Commissioning Group and West Hertfordshire Hospitals NHS Trust have led a process to look at options for future hospital services.

This has been about looking at the best way of organising hospital services to provide high quality care and better medical results for patients, which we can afford for years to come, and that will help recruit and retain people with the right skills. We have involved clinicians (GPs and consultants), health and social care professionals from partner organisations, local politicians and a number of patient representatives

  • We have looked at lots of options ranging from building entirely new hospitals on new or existing sites to redeveloping and upgrading existing hospital provision at sites in Watford, St Albans and Hemel Hempstead.
  • We started out by looking at which model of care, or ‘clinical model’, would be best for patients and which should therefore underpin future organisation of services.
  • We agreed criteria to help assess all options objectively.
  • We convened panels to look at each option against the agreed criteria and get to a final shortlist.
  • We did a financial assessment of the final shortlisted options.

As a result of the assessment process we are now taking forward proposals to develop services on the existing hospital sites – Watford and St Albans - with a likely mixture of new build and redevelopment. Developing an entirely newly built hospital on the Watford site remains a possibility and will be explored further as we develop the strategic outline case (SOC).

Clinical model and assessment criteria

Hospital and site options

Analysing hospital options

Preferred model and next steps

Read a pdf short briefing about hospital options (316 KB) .

Clinical model and assessment criteria

We met with local stakeholders including clinicians, health and social care professionals, local politicians and a number of patient representatives to look at which clinical model should underpin the future of hospital care in West Hertfordshire and also agree the criteria we should use for scoring shortlisted options,

The two clinical models discussed were:

Centralised model – this would see all inpatient beds provided at the emergency and specialised care site

Distributed model – this would see inpatient beds provided at the emergency and specialised care site for acutely ill patients, typically for first 48 hours of stay. After 48 hours, stabilised patients who continue to require hospital care will be treated at inpatient beds located in local hospitals. This model follows the proposed option for future hospital care that was submitted by the Dacorum Hospital Action Group.

There was overwhelming support for a centralised model where all emergency and specialist care is located on one site, similar to what we have now. Clinicians in particular, but others too, felt strongly that a more distributed model of care for acute patients would compromise patient safety.

The criteria for evaluating the options were agreed as:

  • access and patient experience (including travel to hospital sites via public transport and car);
  • deliverability (including site suitability, timescales and delivery risk); and
  • affordability.

Read a pdf report of the event (272 KB) .

Hospital options

We looked at various hospital site options, based on the agreed clinical model, for delivering emergency and specialised care and planned care. The list of options can be summarised as follows:

Emergency and specialised care at a new Greenfield site with

  • Planned care co-located at a greenfield site OR
  • Planned care at a separate site in Watford OR
  • Planned care at a separate site in St Albans

Emergency and specialised care at Watford site with

  • Planned care co-located at Watford site OR
  • Planned care at a separate site in St Albans

Planned care refers to acute hospital services where patients have made an appointment, such as planned surgery, orthopedics and urology.

The greenfield site considered for emergency specialist care was a site near Kings Langley close to junction 20 of the M25. Out of seventeen sites looked at by property experts, Amec Foster Wheeler, this site was considered to have the greatest likelihood of getting planning permission and providing reasonable access to patients and staff. Read the pdf Amec Foster Wheeler report (2.30 MB) .

Any development on the greenfield site would need to be new build, but a variety of options were considered for the existing sites including new build, redevelopment and carrying out backlog maintenance and basic refurbishment – a ‘do minimum’ option. This gave a list of 14 options.

Long list of estate options
# Emergency and specialised care site   Planned care site  
  Location Build Location Build
1 Central greenfield site New build Central greenfield site New build
2 Central greenfield site New build Watford General Hospital New build
3 Central greenfield site New build Watford General Hospital Redevelop/refurb
4 Central greenfield site New build St Albans City Hospital New build
5 Central greenfield site New build St Albans City Hospital Redevelop/refurb
6 Watford General Hospital New build Watford General Hospital New build
7 Watford General Hospital New build Watford General Hospital Redevelop/refurb
8 Watford General Hospital Redevelop/refurb Watford General Hospital New build
9 Watford General Hospital New build St Albans City Hospital New build
10 Watford General Hospital New build St Albans City Hospital Redevelop/refurb
11 Watford General Hospital Redevelop/refurb St Albans City Hospital New build
12 Watford General Hospital Redevelop/refurb St Albans City Hospital Redevelop/refurb
13 Watford General Hospital Basic refurbishment St Albans City Hospital Basic refurbishment
14 Watford General Hospital Backlog maintenance St Albans City Hospital Backlog maintenance

 

Analysing hospital options

Non-financial analysis

Expert panels met over the summer to look at the list of options and score them against the agreed criteria. Panels included managers from West Hertfordshire Hospitals NHS Trust, Herts Valleys CCG and other partners; clinical staff (GPs and consultants); staff representatives from WHHT; and patient representatives from the four localities.

The Access and Patient Experience Panel looked at ease of getting to the existing Watford and St Albans hospital sites and the new greenfield site (near Kings Langley). The panel examined a detailed travel study carried out by PA Consulting into average travel times to the sites by car and public transport based on a nationally recognised model and government travel data. This showed little difference between the sites in terms of access.

For patient experience new build options scored most highly with backlog maintenance scoring the lowest.

Read the pdf travel analysis (7.92 MB) by PA Consulting. Note: Following feedback received during the options assessment we have asked our consultants to review the original travel analysis - read the pdf update report (6.47 MB) .

pdf Access and Patient Experience Panel slides (605 KB)

pdf Access and Patient Experience Panel report here (139 KB)

The Deliverability Panel considered issues around planning permission, utilities and the practicalities around construction. The outcome from the scoring gave both new build options – at Watford and greenfield (near Kings Langley) – similar scores.

pdf Deliverability Panel slides (2.11 MB)

pdf Deliverability Panel report (138 KB)

The results of this analysis were considered by a panel of stakeholders, including patient representatives, to come up with a final shortlist. pdf Report (37 KB) available.

Shortlist of sites from non-financial analysis

The results of the non-financial analysis by the ‘expert panels’ were considered by a panel of stakeholders, including patient representatives, to come up with a final shortlist which comprised a mixture of options.

Those discounted included: doing backlog maintenance on the existing Watford site and having a new hospital on the greenfield site together with a new build facility for planned care at St Albans. There was consensus on the outcome of the shortlisting which is shown below.

Read pdf the report (76 KB) .

Proposed short list of options
# Emergency and specialised care site   Planned care site  
  Location Build Location Build
1 Central greenfield site New build Central greenfield site New build
3 Central greenfield site New build Watford General Hospital Redevelop
5 Central greenfield site New build St Albans City Hospital Redevelop
6 Watford General Hospital New build Watford General Hospital New build
7/8  Watford General Hospital New build / redevelop (optimum reconfiguration) Watford General Hospital New build / redevelop (optimum reconfiguration)
10  Watford General Hospital New build St Albans City Hospital Redevelop
12  Watford General Hospital Redevelop St Albans City Hospital Redevelop
13/14  Watford General Hospital Backlog maintenance/basic refurbishment (do minimum) St Albans City Hospital Backlog maintenance/basic refurbishment (do minimum)

 

Financial and affordability analysis

The shortlisted sites were then assessed from a financial and affordability viewpoint, and again patient representatives were involved. This showed that the difference between what we would need to spend to build new facilities or redevelop existing buildings is not as big as anticipated.

However, all options have high capital costs with relatively low financial returns, which is a big consideration in view of messages from NHS England about increasingly tight financial constraints. The most costly options involve building an entirely new hospital for emergency and planned care on a greenfield site.

The financial analysis was combined with the non-financial scores to rank the options and determine which we would take to the next stage.

Wider engagement on hospital options

During the options appraisal process we surveyed local people and also held some ‘conversation events’.

A residents’ survey, during August and September, invited people to tell us about their priorities and their thoughts on site locations. Of around 600 responses, 88% were from people living in Hemel Hempstead or St Albans.

Results indicate that most people want new buildings for their hospital and prefer the greenfield site over redeveloping the current Watford site for the main emergency and specialised care hospital.

A pdf summary report of the residents’ survey (86 KB) is available.

Conversation events were held, with approximately 25 people at each, to update people and get a sense of their priorities.

In Dacorum most people were firmly in favour of the greenfield site option - with no strong preference around whether to co-locate planned and emergency care.

In Watford people had more mixed views. Service standards were more of a concern than the future location. Those who expressed a preference were mostly in favour of a new build greenfield site.

In St Albans people considered priorities – quality being paramount - and the conversations explored the merits of different aspects. No particular choice emerged for either location or in respect of planned care.

Several meetings also took place with small groups of patients –particularly those living in Dacorum – to listen to their views and discuss the way forward.

The Herts Valleys Patient and Public Involvement committee were kept updated at all their meetings.

Preferred model

As a result of the analysis we are taking forward proposals to develop services on the existing sites – Watford and St Albans - with a likely mixture of new build and redevelopment. The option of an entirely newly built hospital on the Watford site remains a possibility and will be explored further as we develop the strategic outline case (SOC).

We recognise and want to respond to feedback throughout the process that people would prefer new buildings. We also need to heed the clear messages from NHS England about increasingly tight financial constraints.

The financial analysis demonstrates high capital costs for all options, with new build as the most costly. At the same time new build options score considerably higher on patient experience. We do not think that the ‘renovation only’ option would create an environment for patients that is fit for purpose so we are not taking that forward.

Our preferred model of redeveloping the existing Watford and St Albans hospital sites gives some flexibility over the level of new build or refurbishment that could be included. It also allows work to be done and financed in a phased way and over a longer period, making such an approach more affordable. More work will be done to tease out the difference in costs between renovation and new build.

Next steps

Our proposals for acute hospital services have been included in the Sustainability and Transformation Plan (STP) for Hertfordshire and West Essex, which is the wider planning area that we are part of.

The STP was submitted to NHS England and NHS Improvement on 21 October and we expect to hear back from them in about February 2017. Our proposal must fulfil NHS England requirements and be viewed as financially credible and affordable if we are to gain their support.

The Herts Valleys CCG and West Herts Hospitals NHS Trust boards received an update on the proposals in November.

We are developing our strategic outline case (SOC) to reflect our proposals and we are continuing our dialogue with NHS England over the coming months.

Our engagement with patients and other stakeholders will also continue during this time.