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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. This 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, including public and stakeholder engagement during 2016. Find out more about the 2016 review of options here.

Alongside this, during 2017 and 2018 the CCG worked with local clinicians, patients, councils and the community to develop complementary plans for new hospital facilities within Hemel Hempstead that could provide urgent, diagnostic and outpatient care.

Refresh of the strategic outline case

In late summer 2018 NHS Improvement (NHSI) gave initial feedback on the strategic outline case for the acute hospitals. They made two key points: firstly they acknowledged the need for funding and secondly that public money for hospital redevelopment is limited with strong competition from other hospitals across the country. In response to feedback from regulators West Hertfordshire Hospitals Trust and the CCG are working on a refresh of the SOC that will provide one plan for hospital facilities and services across the whole of west Hertfordshire.

West Herts Hospital Trust and the CCG are using the need to refresh the strategic outline case as an opportunity to examine a range of options for configuration and location of future hospital services. This examination of options must take account of a clear steer from NHS Improvement that West Hertfordshire Hospitals Trust will not be able to borrow a figure in excess of their annual turnover which is approximately £350 million.

Read responses to frequently asked questions about the refresh of the SOC here

Evaluation of options

Evaluation panels met during February and March to examine options from various aspects including service quality, patient experience, accessibility, deliverability and how they complement other parts of the health and care system locally. The panels 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.

You can download the slides from the February panel meeting here and the extra information pack for the hospital options evaluation panel here.

Download the slide pack from the March evaluation panel here

Detailed information has been gathered to support the evaluation process. This has been shared with the options evaluation panel. Please follow the links below for further details:

- Demand and capacity information and analysis

- Population, catchment area and travel analysis

- Site options review

- HM Treasury guidance on how to appraise and evaluate policies, projects and programmes

Download the slide pack from the May evaluation panel here. This summarises the outcomes of the quantitative (financial) and qualitative appraisal of the shortlist and details the key features of the shortlisted options.

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.

Public meetings

A series of public meetings took place during autumn 2018 in Hertsmere (17 October), Dacorum (23 October), St Albans (24 October) and Watford (6 November). The meetings gave an update on the work being undertaken to refresh the SOC and to answer questions. These meetings were well attended, reaching around 200 residents.

 Presentation and questions and answers from the autumn 2018 meetings

A meeting on 29 January 2019 gave an overview of all options and explained the process for evaluating and shortlisting options. Following feedback from the first events the question and answer session rotated questions between different areas in our patch so that everyone had an equal opportunity to contribute and discussions weren't dominated by one perspective.  

Presentation and questions and answers from the January 2019 meeting

A meeting on 7 March 2019 shared details of the shortlisted options and invited people to comment on these in advance of these being examined and scored at the second evaluation panel meeting.

Presentation from the March 2019 meeting

The most recent meeting on 13 June 2019 updated people on the results of the stakeholder and financial evaluation of the options and on the emerging preferred option that came out of a meeting of the hospital trust and CCG boards. This is described in more detail below under 'Board meetings'.

Presentation from the June 2019 meeting

We filmed the 13 June event in response to requests from people who were not able to attend. View the event on our YouTube channel here.

Board meetings

The boards of West Herts Hospitals NHS Trust and the CCG met together on 6 June to discuss four shortlisted options for hospital redevelopment and to reach agreement on the emerging preferred way forward for securing major investment in local hospital facilities. Link to board papers for this meeting.

View the board presentation showing indicative plans for each of the four shorlisted options

Both boards provided indicative support for option one. This option would see all three existing hospital sites retained and developed. It would provide the greatest amount of investment in the Watford General Hospital site with new clinical buildings housing theatres and critical care as well as women and children’s services and a refurbishment of the Princess Michael of Kent building, allowing significant improvement to inpatient ward accommodation. There would also be investment on the Hemel Hempstead and St Albans City Hospital sites. Hemel Hempstead would become a planned medical centre with services, including a newly provided urgent treatment centre, consolidated into a redeveloped complex. St Albans City Hospital would be enhanced as a planned surgical facility including a new cancer and surgical centre with diagnostic suite as well as refurbishments to theatres and inpatient beds and the development of a small high dependency unit.

The redevelopment described in option one will form the basis of a draft strategic outline case (SOC) document. The SOC needs to be approved by both boards next month before being submitted to central government in a bid by WHHT for around £350m of investment.

WHHT board will make their decision on the SOC a specially convened meeting in public on July 11. Herts Valleys Clinical Commissioning Group will then consider and come to its conclusion on the SOC at its own meeting in public, later the same day.  Papers for these meetings will be published on the Board papers section of our website towards the end of June.

Draft strategic outline case (refresh)

The draft strategic outline case will be considered at separate meetings of the boards of the hospital trust and CCG on Thursday 11 July. These meetings will be held in public.

To give people time to enough time to review the draft SOC before it is considered by each board, we are providing an initial draft in advance of board papers being published. We are making this early version available on the understanding that this may change slightly. For example, detailed work on the impact of the preferred way forward on the Trust’s financial position and how this reconciles to the Hertfordshire and West Essex Sustainability and Transformation Partnership medium term financial sustainability plan is being finalised and this is likely to mean some revisions to the finance case. It is not expected that there will be significant amendments and a briefing note will set out where changes have been made when the draft SOC is re-issued as part of the July board papers.

Read the initial draft strategic outline case

In view of the high level of interest in this topic, we have brought forward the timescales for people to notify the hospital trust or the CCG if they want to make a representation at the meeting - whether through a written submission or a representation in person. People wanting to make a submission should notify the relevant organisation by 8am on Monday 1 July. This timescale is to help us manage all requests in the allotted time. All requests will be reviewed and confirmation will be given by the end of the day on Friday 5 July.

Information note on publication of draft SOC and guidance on making submissions

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.

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