Review of hospital options in 2016
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.
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.
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.
The Deliverability Panel considered issues around planning permission, utilities and the practicalities around construction.
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.
A Finance Panel looked at the shortlisted sites from a finance and affordability viewpoint.
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.
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.
Conclusion and preferred option
Analysis of the options showed that redeveloping existing sites would be quicker, more affordable and therefore more deliverable than the alternative option preferred by some patients of developing a brand new hospital on a greenfield site.
In particular redeveloping the existing Watford and St Albans hospital sites was found to offer 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.
This was identified as the preferred option.
Strategic outline case
The preferred option was developed into a strategic outline 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 strategic outline case was approved by Herts Valleys CCG board in June 2017.
It was submitted to NHS Improvement in October 2017.