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Developing hospital services

The future of our local hospital, or ‘acute care’, services is a key element of our Your Care, Your Future vision for a healthier West Hertfordshire. We need to make our hospitals fit for the future to support a growing population and to reflect changing health needs, healthcare advances and new models of care. We must develop buildings to modern care standards and make sure they have the right capacity in the right area to meet changing needs.

Improved facilities that meet modern building standards will result in better medical outcomes and a better experience for patients, a better working environment for staff, improved safety and fewer maintenance-related service disruptions.

Current situation

Hospitals locally are managed by West Hertfordshire Hospitals NHS Trust.

  • Emergency care is centralised at Watford General Hospital, with accident and emergency and inpatient services and an acute admissions unit.
  • St Albans City Hospital is a dedicated centre for elective surgery with supporting outpatient and diagnostic services.
  • Hemel Hempstead Hospital provides a number of services including urgent care, endoscopy, radiology, outpatient clinics and a small number of intermediate care beds.

The Watford General Hospital site needs urgent investment to provide a lasting solution to capacity needs and to ensure that buildings meet modern care standards.

Hospital transformation plans

In autumn 2017, a plan, called a strategic outline case, to redevelop and refurbish existing acute hospital sites was submitted to NHS regulators. The plan proposed significant redevelopment of Watford General Hospital as the main A&E hospital providing emergency, critical and planned care and redevelopment of St Albans City Hospital for planned care. Read the strategic outline case here.

This followed a wide-ranging review of various options that considered factors such as affordability, deliverability and patient access and experience.  Costs were a  big consideration in view of advice from NHS regulators about increasingly tight financial constraints. Find out more about the review of options here.

During 2017 and 2018 the CCG worked with local clinicians, patients, councils and the community to develop plans for new hospital facilities within Hemel Hempstead providing urgent, diagnostic and outpatient care. This work also looked at other services that could be wrapped around hospital services such as community health, social care and voluntary services and assisted living housing.

Fit with wider plans

Acute hospital plans forms part of the proposals within the sustainability and transformation plan for Hertfordshire and West Essex. Members of the sustainability and transformation partnership confirmed their support for the preferred option. However, they said that as the plans developed further they would want to see further assurances that the proposed solution is affordable and would provide the right amount of capacity.

Hospital plans must factor in changes to services that are happening as part of Your Care, Your Future.  In some areas like gynaecology, musculoskeletal services and diabetes some outpatient services are being provided through newly developed community services rather than in hospitals. New community-based services for ear, nose and throat and ophthalmology will be launching early in 2019. The changes will see acute hospitals increasingly focusing on emergency and critical care and patients with more complex health needs.

Refresh of the strategic outline case

In late summer 2017 NHS Improvement (NHSI) gave initial feedback on the strategic outline case for the acute hospitals. They said that this made a clear case for investment in local hospital facilities but they want further work on the plans to make sure that proposals are affordable in the short and long term and will deliver lasting benefits.

Because of budgetary pressures to fund major developments across the country NHSI can’t support the size of investment (approx £600m) proposed in the original SOC. The refresh will look at how work could be done in stages so as not to ask for a lot of money in one go.

It will incorporate work to develop plans for Hemel Hempstead Hospital and Dacorum to provide a unified solution.

West Herts Hospital Trust and the CCG are using the need to refresh the strategic outline case as an opportunity to comprehensively examine a range of options for configuration and location of future hospital services.

The refresh will also check that hospital plans are in sync with population needs and with changes happening under Your Care, Your Future.

The refresh will start by examining a longlist of options that will include a new planned care hospital as well as re-examining an option to develop a new general hospital including A&E and planned care on a new site. Options will also address phasing of development.

There are various studies to support the refresh. This includes a travel analysis as well as population studies and catchment area analysis (including looking at how different option could impact on attendances at nearby hospitals).

Evaluation of options

Options will be examined by evaluation panels that will take place in January.  These panels will examine a range of options from various aspects including patient care, accessibility and how they complement other parts of the health and care system locally. The panels will include patient and public representatives as well as medical experts and health and council managers. This process will help to arrive at a recommended preferred option which will then be subject to further scrutiny and analysis.

People are being invited to put themselves forward for the patient and public representative roles. Find out more here.

Engaging with patients and the public

We have committed to running the refresh in an open and transparent way so that the thinking and process to arrive at a preferred option is clear for everyone to see.

In late October and early November the Trust and the CCG held engagement evnts in each of the four west Hertfordshire localities to tell people about the refresh and answer questions. These meetings were well attended, reaching around 200 residents. Read the presentation from the engagement events.

There will be further public engagement in early January. This will share some of the information, such as travel analysis and population data, that will support the evaluation of options and will go through options being considered. Thoughts and questions from this enagement will be fed into the evaluation sessions. We will publish more information once details are confirmed.  

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