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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 Herts Hospitals 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.

When accident and emergency and inpatient services were transferred from Hemel Hempstead to Watford General Hospital around 10 years ago, temporary buildings were used to provide additional capacity. 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.

Preferred way forward: Plans to redevelop existing hospital sites

A wide ranging review of options for developing hospital facilities, during 2016, concluded that taking forward the redevelopment and refurbishment of the Watford and St Albans hospital sites was the most viable option.

  • Watford General Hospital will remain as the main A&E hospital providing emergency, critical and planned care.
  • St Albans City Hospital will be the site for planned care.

Analysis of the options showed that redeveloping existing sites would be quicker, more straightforward, more affordable and therefore more deliverable than the alternative option preferred by some patients of developing a brand new hospital on a greenfield site.

Redeveloping the existing Watford and St Albans hospital sites provides flexibility over the amount of new build or refurbishment. The work can be done and financed in a phased way and over a longer period, which helps with affordability. Costs are a major big consideration in view of advice from NHS England about increasingly tight financial constraints.

The Watford Health Campus, or Riverwell, project will see the regeneration of an area adjacent to the general hospital site. This will provide an added opportunity to develop healthcare facilities to meet future needs and will provided added flexibility to redevelop the Watford hospital site, including car parking.

Review of options

During 2016 Herts Valleys Clinical Commissioning Group and West Hertfordshire Hospitals NHS Trust led the process to look at options for future hospital services.  It involved clinicians (GPs and consultants), health and social care professionals from partner organisations, local politicians and a number of patient representatives.

Clinical model

The clinical model was considered early on in the process. It was agreed that options would be based on delivering centralised care with all emergency and specialist care located on one site, like we currently have.  A distributed model (whereby acutely ill patients would be treated at the emergency and specialised care sites and then transferred to inpatient beds in local hospitals once stable) was rejected on patient safety grounds.

Longlist of options

The review looked at where emergency and specialist care and planned care should be located as well as the extent of development that should take place.

In broad terms the location options considered were:

  • Emergency and specialised care at a centrally located greenfield site with planned care co-located on the greenfield site or at a separate site in Watford or St Albans
  • Emergency and specialised care at the Watford hospital site with planned care co-located at the Watford site or at a separate site in St Albans

Build options considered included: new build (the only option for greenfield); redevelopment; refurbishment; or a ‘do minimum’ option of carrying out backlog maintenance.

Combining the location and build options gave rise to a long list of 14 options.

To analyse the greenfield option a site near Kings Langley close to junction 20 of the M25 was identified as a ‘comparator’ site. 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.

Criteria

The longlist of options were assessed against the following criteria:

Affordability – our ability to raise various levels of capital investment and to be able to finance this investment over many years. This is a key issue given a clear steer from NHS bodies nationally about increasingly tight financial constraints.

Deliverability – the practicalities of making any development happen including getting planning permission and building factors. 

Access and patient experience  comparing travel factors for patients and staff to the different sites and what patient care would be like for different options.

Analysis by expert panels

Panels of managers and staff representatives from West Hertfordshire Hospitals NHS Trust, Herts Valleys CCG and other partners; clinicians (GPs and consultants) and patient representatives met to assess each of the longlist options against the criteria.

The Access and Patient Experience Panel looked at average travel times to the sites under consideration based on a travel analysis by PA Consulting. 

- Read the Access and Patient Experience Panel report

- Read the travel analysis and the updated travel analysis

The Deliverability Panel considered issues around planning permission, utilities and the practicalities around construction.

- Read the Deliverability Panel report

A Stakeholder Panel, including patient representatives, looked at the results from the panels to agree a shortlist of options that would have more detailed financial analysis.

- Read Stakeholder Panel report 

A Finance Panel looked at the shortlisted sites from a finance and affordability viewpoint.

- Read the Finance Panel report.

Public and stakeholder engagement

Residents and health and care professionals across west Hertfordshire were invited to feed in their views through a residents’ survey and conversation events.

- Read the summary report of the residents’ survey. 

There were also meetings with groups of patients and community representatives to listen to their views and discuss the way forward. Herts Valleys CCG Patient and Public Involvement committee members were also kept updated.

All of the above engagement on acute hospitals transformation is summarised in a report that was presented as part of the strategic outline case.

- Read the report about engagement on hospitals transformation.

Acute hospitals strategic outline case

The strategic outline case (SOC), put together by West Herts Hospitals NHS Trust, makes a case for investing in the Trust’s estate.

It reviews all of the main options for transformation, outlining how and why the preferred option to redevelop existing sites has been identified. It requests approval to do a more detailed analysis of the shortlisted options and to move to the next stage of developing an outline business case.

The strategic outline case was approved by the board of West Herts Hospitals NHS Trust in February 2017. Following an extensive checking process to make sure that it fitted with future models of care set out in Your Care, Your Future and was affordable for commissioners, the SOC was approved by Herts Valleys CCG board in June 2017.

The SOC was submitted to NHS England and NHS Improvement in October 2017 and we await their response. Our proposal must fulfil their requirements and be viewed as financially credible and affordable if we are to gain their support.

Acute hospital plans forms part of the proposals within the sustainability and transformation plan for Hertfordshire and West Essex. STP partners have confirmed their support for the preferred option, subject to more detailed work at outline business case stage to show that the proposed level of investment is affordable and to confirm the detailed clinical model and activity and capacity plans

- Read the acute hospitals strategic outline case.

Next steps

Approval of the acute hospitals SOC is the first milestone in a lengthy process.

The next step will be to develop an outline business case. This will involve more detailed costings and design work to look at what approach will best balance value for money and affordability, including showing how any investment will be funded. It will also set out the clinical model (showing which services will be provided from various sites).

This leads to a full business case which is a more detailed delivery plan, covering things such as identifying suppliers and preparing contracts to provide the new services.

There will be further public engagement on plans as part of developing the outline business case.

Plans for Hemel Hempstead Hospital

The CCG is working with local clinicians, patients, local councils and community to develop plans for a new Hemel Hempstead Hospital that will provide urgent, diagnostic and outpatient care.

Any of the options being looked at, including a new building on the existing hospital site, would create potential for developing the rest of the site, including building some new homes. These could be supported living homes for older people or people with long-term conditions so that frailer people can have medical support close to hand – in keeping with our aims to care for people in their own homes rather than in hospital beds.

We are also exploring the potential to bring other health, social care and voluntary services onto the same site to provide more joined-up services for patients.

A strategic outline case is being developed and we expect to carry out some public engagement during autumn 2018.

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