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Ambitious plans agreed to transform hospital sites in west Herts

The course is set for a complete transformation of the Watford General site and considerable improvements – including new buildings – at Hemel Hempstead Hospital and St Albans City Hospital, following a decision by local NHS leaders earlier today (Thursday, 1 October).

The decision was made by the boards (which include clinicians) of West Hertfordshire Hospitals NHS Trust (WHHT) and Herts Valleys Clinical Commissioning Group (HVCCG) who gave their unanimous support for retaining and redeveloping the trust’s existing three hospital sites.

The plans will be subject to review by the Department of Health and Social Care, NHS regulators and the Treasury as part of the business case process.

At the heart of today’s decision was the issue of ‘deliverability’ with discussions focusing on the risk of any further delay balanced against the opportunity on offer and the pressing need to improve current facilities.

The estimated cost of the trust and CCG’s emerging preferred option is approximately £590m (at today’s prices). The majority of the funding would be spent at Watford General Hospital which sees a far higher number of patients and has more buildings in poor condition than the trust’s two other hospitals in Hemel Hempstead and St Albans. Around £50m of the £590m would be invested at these two smaller hospitals.

A previous funding envelope had been set last year by the Prime Minister at £400m but NHS England and the Department of Health and Social Care wrote to the trust this year confirming that higher cost options (up to approximately £590m) could be considered and that proposals should demonstrate that new buildings could be delivered by 2025, or soon after.

The boards did not support the option of a new hospital on a new site (sometimes called a greenfield option), following an independent report* presented to the boards. The report outlined the risks of this option as being higher than the Watford-based options, namely that the new site might not be possible to progress or that it might not deliver on time due to land purchase and planning requirements as well as highways and access issues which could add considerable time before and during construction. The risk of similar delays was assessed as being much lower at the Watford site, where the land is already owned by the NHS or has been pledged by Watford Borough Council and where there is existing public transport and car access.

If the funding is approved, the plans at Watford include a large new clinical block to replace nearly all the clinical facilities on the site at present – excluding the current acute admissions unit. Most clinical services would be accommodated within brand new hospital facilities and the majority of inpatient accommodation would be single occupancy rooms. The redeveloped hospital will sit within a major regeneration project – Watford Riverwell – which will be landscaped and will offer green spaces and shops.

At Hemel Hempstead there are plans to provide a new purpose built urgent treatment and diagnostics centre and to further develop the range of medical care such as specialist diabetes and dermatology, which will move to this site. Hemel Hempstead Hospital will continue to provide diagnostic and outpatient services, with a focus on medical specialties and long term conditions.

St Albans City Hospital has been designated as the trust’s ‘Covid-free’ site and so its ability to continue to provide planned surgery is very important. This will be further enhanced by plans to overhaul its theatres, create a rapid access cancer diagnostic centre and expand the range of diagnostics available by providing MRI and CT scanners. This will increase the number of ‘one stop shop’ clinics and speed up diagnosis.

The boards now need to hear further from regulators and the government to confirm whether this option could be funded; any proposed option needs to be affordable on a national level, following the outcome of the government’s spending review. The trust must demonstrate that the preferred option delivers the best overall value for money and meets the government’s requirements in order to secure this funding.

WHHT chief executive Christine Allen, said: “This is an important day and a big step forward on our journey to better buildings and facilities. Our boards have now set us the challenge to secure the funding and deliver fantastic new facilities by 2025, or very soon after. We will work as hard and as quickly as we can because our patients and our staff deserve better than we can offer at present.

“This milestone is, I believe, a positive development for all our patients. However, I acknowledge that the continued concentration of emergency and specialist services at Watford will disappoint some residents of west Hertfordshire.

“Having carefully reviewed the findings of the site feasibility study, listened to the representations today and read the written submissions from those who don’t agree with our plans, as well as taking note of letters and emails on this topic for some time, we do understand the strength of feeling on this issue and the appeal of a completely new hospital on a completely new site.  

“At the same time, we also have a responsibility to deliver significantly improved facilities as soon as possible. We approved a shortlist without a greenfield option because we believed that the risk of the timely delivery of this option was too high. All the new sites reviewed had pros and cons but we all felt – and this was underlined powerfully for us today by our clinical leaders - that we must not pass up this significant opportunity to enhance all of our hospitals and make a massive positive impact to the experience of our patients and staff.

“We are grateful to the thousands of people who took part in our recent survey. The feedback will guide us through the next steps, particularly on transport and access which many people said was an issue. We will continue to work with our local stakeholders on this and other areas of concern.”

David Evans, managing director of Herts Valleys Clinical Commissioning Group, said: “We took a significant step today – and one that builds on our success in providing a growing range of local care options to an increasing number of our patients.”

The plans for new buildings will go hand in hand with this work as we simultaneously transform the facilities on offer and the way care is managed and accessed.

“There has been enormous progress on making more care available closer to home, or - with the addition of digital technology - in patients’ own homes. Together, with our clinical colleagues at the trust and with input from stakeholders, we will design the new facilities to fit the needs of patients rather than allowing services to be constrained by out of date buildings. We have a wonderful opportunity to modernise how we work and I am confident this will benefit all our patients in west Herts and not just those who live near the trust’s three hospitals.”

WHHT’s chairman Phil Townsend added: “I’d like to thank the team, including our CCG colleagues and the many independent experts we’ve called upon, for their hard work, energy and commitment in getting us to this point, particularly at this time when we are responding to a pandemic. I’d also like to thank all of those who made representations today.

“The decision to press ahead with a Watford option has now been made by our boards and we want to focus our efforts and expertise on these exciting plans. For that reason and to protect the time of those tasked with making this happen, I hope all the communities around us will get behind our vision and support us.”

“Speaking on behalf of both boards, I can give the communities we serve and our staff a cast iron guarantee that we will work tirelessly to deliver the very best buildings and facilities possible. That’s our sole intention and we are keen to focus on the next steps.”

The decision was made by the boards (which include clinicians) of West Hertfordshire Hospitals NHS Trust (WHHT) and Herts Valleys Clinical Commissioning Group (HVCCG) who gave their unanimous support for retaining and redeveloping the trust’s existing three hospital sites.

The plans will be subject to review by the Department of Health and Social Care, NHS regulators and the Treasury as part of the business case process.

At the heart of today’s decision was the issue of ‘deliverability’ with discussions focusing on the risk of any further delay balanced against the opportunity on offer and the pressing need to improve current facilities.

The estimated cost of the trust and CCG’s emerging preferred option is approximately £590m (at today’s prices). The majority of the funding would be spent at Watford General Hospital which sees a far higher number of patients and has more buildings in poor condition than the trust’s two other hospitals in Hemel Hempstead and St Albans. Around £50m of the £590m would be invested at these two smaller hospitals.

A previous funding envelope had been set last year by the Prime Minister at £400m but NHS England and the Department of Health and Social Care wrote to the trust this year confirming that higher cost options (up to approximately £590m) could be considered and that proposals should demonstrate that new buildings could be delivered by 2025, or soon after.

The boards did not support the option of a new hospital on a new site (sometimes called a greenfield option), following an independent report* presented to the boards. The report outlined the risks of this option as being higher than the Watford-based options, namely that the new site might not be possible to progress or that it might not deliver on time due to land purchase and planning requirements as well as highways and access issues which could add considerable time before and during construction. The risk of similar delays was assessed as being much lower at the Watford site, where the land is already owned by the NHS or has been pledged by Watford Borough Council and where there is existing public transport and car access.

If the funding is approved, the plans at Watford include a large new clinical block to replace nearly all the clinical facilities on the site at present – excluding the current acute admissions unit. Most clinical services would be accommodated within brand new hospital facilities and the majority of inpatient accommodation would be single occupancy rooms. The redeveloped hospital will sit within a major regeneration project – Watford Riverwell – which will be landscaped and will offer green spaces and shops.

At Hemel Hempstead there are plans to provide a new purpose built urgent treatment and diagnostics centre and to further develop the range of medical care such as specialist diabetes and dermatology, which will move to this site. Hemel Hempstead Hospital will continue to provide diagnostic and outpatient services, with a focus on medical specialties and long term conditions.

St Albans City Hospital has been designated as the trust’s ‘Covid-free’ site and so its ability to continue to provide planned surgery is very important. This will be further enhanced by plans to overhaul its theatres, create a rapid access cancer diagnostic centre and expand the range of diagnostics available by providing MRI and CT scanners. This will increase the number of ‘one stop shop’ clinics and speed up diagnosis.

The boards now need to hear further from regulators and the government to confirm whether this option could be funded; any proposed option needs to be affordable on a national level, following the outcome of the government’s spending review. The trust must demonstrate that the preferred option delivers the best overall value for money and meets the government’s requirements in order to secure this funding.

WHHT chief executive Christine Allen, said: “This is an important day and a big step forward on our journey to better buildings and facilities. Our boards have now set us the challenge to secure the funding and deliver fantastic new facilities by 2025, or very soon after. We will work as hard and as quickly as we can because our patients and our staff deserve better than we can offer at present.

“This milestone is, I believe, a positive development for all our patients. However, I acknowledge that the continued concentration of emergency and specialist services at Watford will disappoint some residents of west Hertfordshire.

“Having carefully reviewed the findings of the site feasibility study, listened to the representations today and read the written submissions from those who don’t agree with our plans, as well as taking note of letters and emails on this topic for some time, we do understand the strength of feeling on this issue and the appeal of a completely new hospital on a completely new site.  

“At the same time, we also have a responsibility to deliver significantly improved facilities as soon as possible. We approved a shortlist without a greenfield option because we believed that the risk of the timely delivery of this option was too high. All the new sites reviewed had pros and cons but we all felt – and this was underlined powerfully for us today by our clinical leaders - that we must not pass up this significant opportunity to enhance all of our hospitals and make a massive positive impact to the experience of our patients and staff.

“We are grateful to the thousands of people who took part in our recent survey. The feedback will guide us through the next steps, particularly on transport and access which many people said was an issue. We will continue to work with our local stakeholders on this and other areas of concern.”

David Evans, managing director of Herts Valleys Clinical Commissioning Group, said: “We took a significant step today – and one that builds on our success in providing a growing range of local care options to an increasing number of our patients.”

The plans for new buildings will go hand in hand with this work as we simultaneously transform the facilities on offer and the way care is managed and accessed.

“There has been enormous progress on making more care available closer to home, or - with the addition of digital technology - in patients’ own homes. Together, with our clinical colleagues at the trust and with input from stakeholders, we will design the new facilities to fit the needs of patients rather than allowing services to be constrained by out of date buildings. We have a wonderful opportunity to modernise how we work and I am confident this will benefit all our patients in west Herts and not just those who live near the trust’s three hospitals.”

WHHT’s chairman Phil Townsend added: “I’d like to thank the team, including our CCG colleagues and the many independent experts we’ve called upon, for their hard work, energy and commitment in getting us to this point, particularly at this time when we are responding to a pandemic. I’d also like to thank all of those who made representations today.

“The decision to press ahead with a Watford option has now been made by our boards and we want to focus our efforts and expertise on these exciting plans. For that reason and to protect the time of those tasked with making this happen, I hope all the communities around us will get behind our vision and support us.”

“Speaking on behalf of both boards, I can give the communities we serve and our staff a cast iron guarantee that we will work tirelessly to deliver the very best buildings and facilities possible. That’s our sole intention and we are keen to focus on the next steps.”

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