How Hospital and Healthcare Services have changed in Dacorum since 2003
There have been several major changes to the original (2003) Investing in your Health (IIYH) plans. The whole configuration has changed. The following were among the assumptions on which IIYH was based:
» The relevant primary care services would be in place before the completion of the hospital configuration
» The hospital at Watford would be built before acute services at Hemel Hospital were moved
» 80% of emergency cases would still be treated at Hemel hospital
» A road would be built to avoid the need to use Vicarage Road (where both the hospital and the Watford Football Club ground are sited) thus easing the problem of access
» The Hemel Birth Centre would remain
» A new hospital incorporating a cancer centre would be built at Hatfield.
» A 'surgicentre' for booked operations would be developed at Hemel.
» Childrens' day case inpatient services and daytime A+E would be provided at Hemel
The current position is that:
a) The planned new hospital at Hatfield has been axed.
b) There is no increase in primary and community services, rather a reduction
c) The 'surgicentre' plan for Hemel was axed and booked operations are now being done at St. Albans
d) No new cancer centre is now being proposed for the area
e) Acute services were moved away from Hemel in March 2009, before the rebuild of Watford was even approved. The rebuild of Watford is in any case highly questionable because of the squeeze on PFI projects caused by the downturn (see last section below)
f) The Burns and Plastics Department has been moved to the Royal Free Hospital: this was not envisaged under IiYH
g) There is no indication that the access road will be built, nor a rail link that was also proposed at the time of IiYH
h) Hemel Birth Centre, despite winning a national award for excellence and having been part of IIYH, has been closed without consultation.
i) The new 'Urgent Care Centre' at Hemel is expected to treat not 80% but around 65% of emergency cases, though whether the true figure will be even lower remains to be seen
How did this happen?
2003 - Investing In Your Health
DHAG was firmly opposed to 'Investing In Your Health' because it involved the loss of Hemel hospital as an acute centre. We always said the Hatfield plan was unaffordable, which was finally admitted in late 2006. There can be no doubt that, if people across Hertfordshire had known what was to come, they would not have supported IiYH. In effect the unrealistic Hatfield plan was used to buy the support of people in Hatfield, St. Albans and other areas for the whole of IiYH.
2006 - Healthy Future
The 2006 'Healthy Future' consultation was run by the West Herts Hospital Trust. They hired someone with strong national political connections, John Underwood, to do an 'independent' evaluation of the consultation. The survey results overwhelmingly supported Hemel hospital remaining as an acute centre with all the services of a district general hospital but this outcome was ignored by the Trust who endorsed the IiYH decision that only Watford should have this status in west Herts. And Hemel should be downgraded. DHAG felt that the whole process was unfair and brought a Judicial Review in the High Court in 2007. The judge trusted the Trust (whose Chief Executive, David Law, resigned shortly afterwards following terrible performance results). He ruled that the consultation was fair, though he did admit that he had reached his judgment "under acute pressure of time" (the Trust had claimed there would be serious financial and clinical consequences if he didn't decide quickly). He did agree with us however that the Trust were wrong to argue that they were bound by the IiYH decisions as these "were not set in stone", but he blamed their lawyers rather than the Trust for putting up this argument. He also ruled that the Trust had to pay most of their own legal costs. We are still firmly convinced that this crucial consultation was grossly distorted and unfair.
2007 - 'Delivering Quality Health Care for Hertfordshire'
In 2007 the West Herts and East and North Herts Primary Care Trusts (PCTs), which had by then effectively become the health authority for Hertfordshire, ran a county-wide consultation called 'Delivering Quality Health Care for Hertfordshire'. This endorsed the 2006 decisions re Watford and Hemel hospitals and claimed that something called a 'local general hospital' would be set up in Hemel on a site to be determined subsequently. This enables the local PCT to claim that Hemel hospital is not closing, but it seems that only rudimentary provision is planned and the 'hospital' will sit alongside a GP-led health centre which no-one has asked for but the government has decided that every PCT must have one and has provided the funding. Also the West Herts PCT will shortly decide where this animal is to be located, and it seems the leading option is a site near the Buncefield oil depot and the M1 called 'Gateway' which is at the far end of the borough of Dacorum.
DHAG believes that a truly 'local' facility should surely be centrally located, and the present hospital site with its good standard of buildings is ideally positioned for this, close to a major bus and coach station. Once again, as with the decision to centralise on Watford hospital, considerations of accessibility and the public's wishes are the last things on the planners' minds. The intention is probably to demolish the hospital buildings and sell the site because the land in that location will be more valuable than land on the fringes of Dacorum - unless we can mobilise to stop it happening.
The planned rebuild of Watford Hospital
The report of the IiYH consultation presented to the Decision Meeting on 3rd November 2003 said this:
"A large number of respondents felt that the Hemel Hempstead site was the best major hospital site in Hertfordshire and so should be the site for one of the two acute hospitals in Hertfordshire".
The authors of the report (from the then Beds and Herts Strategic Health Authority) admitted that "The buildings at Hemel Hempstead are better than the buildings on many of the other major acute hospital sites in Hertfordshire". They mentioned Watford in particular, where backlog maintenance costing more than five times as much as at Hemel would be needed.
In June 2005 the West Herts Hospital Trust Director of Planning Sarah Shaw said at a public meeting that the buildings at Watford could not last beyond 2013. Some interim measures have been taken including the building of an Acute Assessment Unit but the major rebuild which is essential depends on the provision of funding through the government's Private Finance Initiative (PFI). Resulting from the downturn this scheme has however hit major problems as the following press report makes clear.
2009 - Hospital projects at risk in PFI credit crisis, warns leaked memo
- Nicholas Watt, chief political correspondent - The Guardian, Monday 26 January 2009Hospital building and improvement programmes financed through the government's controversial private finance initiative (PFI) are being placed at risk by the credit crunch, according to a leaked health service memo.
Health managers have been told to "expect a capital desert" next year and "a real problem" in completing projects because no banks are financing PFI schemes, the memo claimed.
The stark warning came from Graham Eccles, chief executive of the South East Coast Strategic Health Authority, who was summarising a meeting with Alan Johnson, the health secretary.
His email, leaked to the Tories, said of the meeting about capital investment on 13 January: "A bit of a mixed message. Capital expenditure for 2009/10 is likely to be slightly enhanced to what we have been used to, but is specifically for schemes that can be implemented quickly within year.
"Expect a capital desert in 2010/11. The bad news is around capital schemes that would have been PFIs. PFIs have always been the NHS's 'plan A' for building new hospitals, especially as they used to be off-balance sheet. "There was never a 'plan B'. Now none of the banks have any money or are likely to have any for a few years, the absence of a 'plan B' is going to cause a real problem in taking new hospitals to conclusion. I don't have any answers, but I do know that AJ [Alan Johnson] has asked David Nicholson [NHS chief executive] to go away and think very hard about what happens next."
The memo warned that health spending would dramatically tighten from next year.
Dramatic delays and slippage in deadlines - now over 5 years delayed...
In the light of this DHAG member Ron Glatter wrote to the Chief Executive of the Hertfordshire PCTs, Anne Walker, on 26th January 2009 with a Freedom of Information request: 'What are the PCT's plans for the configuration of hospital provision in west Hertfordshire beyond 2013 should funding for the redevelopment of Watford General Hospital not be forthcoming?' In her reply of 23rd February she said the scheme "will not be seeking project finance for something like 30 months and all the indications are that the money market will have recovered significantly by then. Indeed, it is anticipated that at that time the market will be looking for good strong public sector opportunities". Even if this proves true - a big if - it ignores the huge backlog of projects that is likely to have built up by then and the capacity of the industries involved etc.
The letter goes on to say that the West Herts Hospital Trust is aiming to get the Outline Business Case approved by its Board at the end of December 2009. Then they plan to find a PFI partner with contracts signed and construction starting in 2012/13. "The new hospital will then be available for operation in 2015/16".
This represents a slippage of about 5 years from the IiYH plans set just over 5 years ago. Ron had asked for the reasons for the slippage. Anne Walker's letter attributes it to the Hospital Trust's decision to split planned and emergency care ahead of the Watford rebuild (a hugely controversial decision), the resulting consultation in 2006, the Judicial Review against the decision brought by DHAG and the need to work out the implications of the decision not to go ahead with the new hospital at Hatfield.
The remaining parts of WHHT's initiative... Close and demolish modern / award winning Hospital services in Hemel Hempstead - and keep condemned Watford Hospital, despite becoming unusable by 2013... with no hope of new funding...
What this seems to boil down to is that the decision to go ahead with the structural changes including the effective closure of Hemel hospital before the funding for the Watford rebuild scheme was even secured - which was never envisaged in IiYH - was a foolish and potentially very dangerous one. Even if the new, very much delayed timeline is met - which seems highly unlikely given previous experience - there will be at least a 7 year period in which a population of around half a million people will be dependent on a hospital - in an extremely inaccessible location - whose buildings have been admitted to be in a very poor state such that they could not last beyond 2013. And this assumes that the funding for the rebuild can be found. If not the gap in time might be much greater.
Public bodies are supposed to manage risks and to have contingency plans in place to meet them when, as here, they are significant ones. It is irresponsible of the local NHS bodies just to hope for the best. In a time of financial crisis such as the present, they should use all the hospital premises they have, including the buildings at Hemel that have been admitted to be in particularly good condition and are very accessible, until any new hospital is actually funded, built and open to patients.
April 2009
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