Our Hospital: Preferred Access Route [P.167/2020]

STATES OF JERSEY

OUR HOSPITAL: PREFERRED ACCESS ROUTE

Lodged au Greffe on 14th December 2020 by the Council of Ministers

STATES GREFFE

2020  P.167

PROPOSITION

THE STATES are asked to decide whether they are of opinion

to approve Westmount Road, as a two-way roadway with areas for active modes of travel, such as walking and cycling, as the preferred primary access option for a new hospital at Overdale.

COUNCIL OF MINISTERS

REPORT

Introduction

On 17 November 2020, The States Assembly voted in favour of adopting P.123/2020, which identified Overdale as the preferred site for Our Hospital. At the same sitting, the Assembly also adopted two amendments to the Proposition, the second of which was proposed by the Connétable of St. Helier and requested the Council of Ministers, prior to the acquisition of land required for access to Our Hospital, to provide a report for approval by the Assembly on alternative access strategies designed to:

• Maximise sustainable modes of travel

• Minimise  the  impact  on  homes,  leisure  facilities  and  the  surrounding environment

The accompanying report cited that a one-way system should be investigated as a potential tool to achieve this.

In addressing the States Assembly, the Connétable of St. Helier stated that his purpose in bringing the amendment was to ensure that properties required to access the Overdale site "should not be purchased until we are absolutely sure that Westmount Road will not work as a one-way system." He also made clear that there was no intention on his part to delay acquisition of properties for the assembly of land required for the hospital building itself but, "merely to make sure that the access up to Westmount Road is properly looked at."

As required by the amendment to P.123/2020 brought forward by the Connétable of St Helier, Appendix 1: Our Hospital – Framework, Criteria and Access Options provides a technical report undertaken by the Our Hospital Design and Delivery Partner, which includes design and construction professionals from the fields of transport planning, engineering, architecture, town and landscape planning. It presents:

• A broad range of access options, including two and one-way road options and supporting measures

• Criteria that should be considered for identifying preferred access options, following consultation with key stakeholders

• An analysis of the options against the criteria to maximise sustainable transport solutions and minimise impact on homes, leisure facilities and the surrounding environment

In addition, the report in Appendix 1: Our Hospital – Framework, Criteria and Access Options also confirms that:

• A  vehicular  solution  is  required  to  ensure  year-round  access  is  always maintained, for any time of day,

• A one-way system as the main means of access is not feasible, including any incorporating Westmount Road; and

• The only primary vehicular access route to Overdale that should be taken forward for further analysis is via Westmount Road, and that this access option was properly explored in the technical analyses in support of P.123/2020

Methodology

The Design and Delivery Partner, including Arup has provided expert advice to the project on design, transport, engineering and planning (incorporating environmental considerations) to arrive at a robust options appraisal.

The outcome of this options appraisal has been used to support this Proposition on a preferred primary access option for Our Hospital at Overdale. In order to arrive at a preferred site, an extensive range of roadway options – in total 70 one and two-way permutations - were evaluated. All of the options have been appraised against a set of agreed  criteria,  which  were  developed  and  prioritised  following  consultation  and engagement with:

• Jersey Ambulance Service

• A Panel of Health and Community Services staff established to engage with the Our Hospital Project

• The Our Hospitals Citizens' Panel

• Officers  from  Infrastructure,  Housing  and  Environment  (Operations  and Transport and Planning)

These key stakeholders agreed that it was appropriate to categorise the agreed criteria in groups, from those that had the most strategic impacts, to those which had more local impacts. For example, if an access option could not provide assurance of blue light access or if it had an extensive number of potential conflict points for pedestrians and vehicles – which could compromise journey safety and security – then the option was discounted. The study also considered more localised criteria such as the area of tree canopy affected and disruption caused to local users and neighbours.

The full criteria can be found at the Appendix 1: Our Hospital – Framework, Criteria and Access Options.

As a result of this extensive appraisal two-way, primary access via Westmount Road has been shown to be the most feasible option.

Based upon the evidence of the options appraisal, this Proposition asks States Members to approve Westmount Road as the preferred access option for a new hospital at Overdale, on the basis that:

• Extensive and detailed technical analysis has been undertaken objectively by technical experts

• The analysis has considered the specific needs of Jersey and what is appropriate for our Island community

• An extensive range of alternatives have been considered

• Consideration has been given to balancing the differing interests of Islanders directly impacted by the access options, and the strategic benefits to the Island of a new hospital

• Consideration has been given to maximising sustainable transport options

• Consideration has been given to minimising the impact on homes, leisure facilities and the surrounding environment

Section 1: Supplementary access options

1. The Our Hospital Project supports methods of sustainable transport in its design of the new hospital. As part of the options appraisal, the feasibility of a range of sustainable transport options has been considered. These include pedestrian and cycle infrastructure, cable car, funicular railway, cycle lift, and shuttle bus options.
2. However, it is concluded that all these modes of travel need to be supplementary to a  vehicular  solution and  not  a  replacement  for  one  owing to the  operational requirements of a hospital.
3. Whilst mass transit solutions such as a cable car system or a funicular railway are very appealing in principle, they are impractical as part of a hospital design: these solutions do not allow patients, particularly those with mobility issues, direct access to the hospital main door in all conditions and at all times. Any such transport provision would need to provide suitable departure and landing stations, that would involve greater impact on St Helier areas below the Overdale site, as well as positions of intermediate support for a cable car. In addition, these types of transit solution  are  costly  to  design,  involve  complex  engineering  works  and  have associated costs for regular maintenance once in situ.
4. Installation of mass transit solutions could not be achieved within the timeframe set out in P.54/2019 and would not be deliverable within the £550m affordability limit agreed with the Design and Delivery Partner. In addition, when these solutions experience technical difficulties, they can be more complex to resolve and leave patients, visitors and staff trapped, whereas, a bus that breaks down can allow passengers to disembark easily and be picked up by a replacement bus.
5. Sustainable transport interventions will be explored further as part of the travel plan in the next design stage.
6. The most feasible and financially viable sustainable transport option remains a regular bus service or shuttle bus. Therefore, improvements will be made to the routes and frequency of public transport, including bus services to support patient, staff and visitor access. Consideration has also been given to offering a park and ride service, to reduce both patient, staff and visitor parking requirements, but initial assessments suggest that this would not be a popular option amongst staff and patients. Further work will be undertaken on this suggestion.

7. The primary access route will be supplemented by designated areas to encourage pedestrian and cycle access, for those who have the physical ability to utilise them.
8. Additional detail can be found in Appendix 1: Our Hospital – Framework, Criteria and Access Options.

Section 2: Feasibility of a one-way system

1. The technical assessments undertaken by the Design and Delivery Partner have evaluated the feasibility of a one-way system as a primary access route for Our Hospital at Overdale.
2. The most significant observation of these assessments is that a single direction access/egress route limits blue-light efficacy by slowing critical response times if ambulances need to approach from the wrong geographical area. The consideration of patient safety and outcomes would need to be a priority over a preference for a one-way system. This would be true for the inbound or outbound journey. In addition, a one-way system limits the resilience of other blue-light services: if there is an accident or incident that blocks the one-way route, these services may not be able to access the hospital.
3. The one-way routes considered would have other negative impacts on the wider neighbourhoods in the proximity of Overdale. For example, a one-way access via Queen's Road and St John's Road with egress via Westmount Road would increase traffic on roads used by pupils travelling on foot to Rouge Bouillon, Mont a L'Abbe, D'Auvergne and Haute Vallée schools. Other options would result in significant traffic impacts at First Tower and St Aubin's Inner Road or increase traffic on residential  streets  –  which  would  necessitate  a  greater  number  of  property acquisitions than the preferred option to facilitate access for service vehicles.
4. A one-way route is likely to require more numerous improvements to the strategic highway network to manage traffic flows and ensure that appropriate infrastructure is in place to meet the needs of a hospital facility. Such a system would be disruptive, complex and have substantial financial and time implications.
5. None of the one-way options can be delivered within the programme and have considerable planning risk.
6. Additional detail can be found in Appendix 1: Our Hospital – Framework, Criteria and Access Options.

Section 3: The preferred access option

1. As noted in the Site Evaluation Report which formed Appendix 3 of P.123/2020, the proposed preferred primary access option via Westmount Road can provide appropriate access for a hospital facility and could deliver within the planned project timetable and within the agreed affordability limit.
2. Given the nature of the Island's topography, every access option presents a different set of challenges. It is not necessarily appropriate to promote the benefits of a

single, preferred solution, rather that the impacts of the preferred access option should be balanced against the impacts of other options. Based upon the evidence that can be found in Appendix 1: Our Hospital – Framework, Criteria and Access Options, it is clear that the impacts of the preferred solution on minimising the impact on homes, leisure facilities and the surrounding environment are lesser than those less feasible ones.

3. The proposed preferred access  option does not compromise blue light access resilience, including in adverse weather conditions, with routes available from three directions.
4. When compared to other options, the proposed preferred primary access option maximises opportunities for supplementary sustainable transport solutions. The proposed preferred option could feasibly be supplemented by areas to encourage pedestrian and cycle access, whereas other options could not, due to being restricted by  the  need  to acquire  further  properties, listed  places  or  other  geographical features. For example, the escarpment at Tower Road or the narrowing of the road restricted by Mont a L'Abbe and Westmount Cemeteries.
5. Any access option will have some impact on the homes and users of the immediate area. The proposed preferred primary access option minimises the impact of property acquisition for access purposes to three residential properties. Whilst it is regrettable that any residences are impacted, the proposed primary access option provides a lesser impact than many of the numerous alternative options would have on existing properties. The proposed primary access option would also have a lesser impact on other construction costs. For example, the impact of acquiring the three properties for the preferred access option would have a lesser impact than the option to deliver an access option via the George V Cottage Homes, which would have a greater impact on the number of residences, have more ecological impact – on areas such as Le Val Andre, and require more complex engineering requirements. In addition, the option to provide a car park and service elevator for blue light and patient access is considered to be costly and carry the same maintenance and breakdown risks as described above with reference to mass transit options.
6. The Jersey Bowls Club will need to be relocated. However, whilst fully recognising the attachment that the Jersey Bowling Club has for its current grounds and the disruption and inconvenience it will experience, the Club would not need to vacate their current site until September 2021, following the 2021 summer season. The Club is being consulted and alternative sites are being explored.
7. The Overdale site needs to be accessed by heavy goods traffic in order to enable construction of Our Hospital. The proposed preferred access option would allow construction traffic to access the Overdale site and minimise disruption to other traffic flows and road users. For example, heavy goods vehicles routing from St. Helier 's harbours through Cheapside, then Rouge Bouillon, Queen's Road and St. John 's Road would result in significantly more traffic disruption and environmental impact than vehicles travelling from the port via Westmount Road. In addition, heavy goods vehicles routing through the Queen's Road option would need to negotiate challenging pinch points and turns for heavy and long vehicles. It is not considered viable that States of Jersey or Honorary Police escorts could be semi- permanently posted at these positions to safeguard the safety of pedestrians, cyclists and other road users, including for this particular route, school children.

8. Whilst the preferred route will be able to accommodate construction traffic, its overall width would be fixed by operational traffic, including two-way buses and an active travel corridor.
9. Additional  detail  about  the  impacts  of  the  proposed  preferred  access  option compared to other options can be found in Appendix 1: Our Hospital – Framework, Criteria and Access Options.

4  Section 4: Risk of delay Land assembly

1. In October 2020, the project team engaged with landowners at Overdale about the potential sale of their properties, as requested by the Council of Ministers. The objective of this engagement was to reach negotiated agreements with landowners to avoid the use of compulsory purchase powers where possible and enable the land to be assembled for a new hospital without delay should P.123/2020 be adopted by the Assembly.
2. Further to discussions with landowners, it should be noted that all of the residents of the houses immediately affected by the proposed alterations to Westmount Road were  willing  sellers  at  the  time  of  adoption  of  P.123/2020.  Some  had  made arrangements to complete on purchases of new homes. However, the adoption of the Connétable of St. Helier 's amendment has meant that house sales have been blocked.
3. The delay has caused great uncertainty for some residents and put the purchase of their future homes at risk, the stress of which may have a negative effect on their wellbeing. An extended delay will create additional risk to the land assembly programme. This is because it will undermine the relationships that have been established and the  negotiations that have taken  place  with those Westmount residents affected by the preferred access option, who have to this point engaged with the proposals in a positive manner with great understanding of the benefit to Jersey of a new hospital at Overdale.
4. The interests of any resident who does not wish to sell needs to be balanced against those who do.
5. Appendix 1 to this Report clearly demonstrates that every primary access route impacts its surrounding area and those Islanders resident nearby. Just as there was no ideal site for Our Hospital, there will be no ideal access route. However, a primary  access  route  via  Westmount  Road  is  the  option  that  minimises  the immediate impact on homes whilst delivering the reliable access necessary for a new hospital.

A new public debate

6. Over the years, there has been significant public debate over the site of a new hospital. We are now in a position that the Assembly has supported a preferred site that has a ground swell of support from Islanders. The vocal detractors are in the

minority. It is important that we do not create a new debate about access that could ultimately undermine the delivery of Our Hospital at Overdale and this Proposition provides an opportunity to mitigate this risk.

7. Members are asked to note that the Connétable of St. Helier asked for the access route to be properly looked at' and did not want to cause unnecessary delay the delivery of the project. This Report and the technical evidence in Appendix 1 demonstrate that this has been done and done thoroughly.

Cost of delay

8. Section 2 of P.123/2020 set out the risks involved with failing to meet the planned timetable for delivery of Our Hospital. There is a tipping point' of 2026 where the cost of maintaining the current hospital estate increases sharply. At the same time the threat to service continuity, patient safety and patient experience also increases significantly.
9. It should also be noted by Members that this project follows a critical path – a series and sequence of activities that must be followed in order to deliver on time. A failure  to  resolve  the  preferred  access  option  restricts  the  project's  ability  to assemble  land,  progress  design,  and  will  delay  a  planning  application  for adjustments to access routes. The current programme is for the start on site to begin in earnest once access works have been approved and completed. Any delay means that the project's critical path is likely to be compromised, with associated rising cost implications.
10. The cost of delay to the project is significant. Should we be unable to resolve the access issue in a timely manner, there is a risk that we would lose the experience and expertise of our Design and Delivery Partner, RokFCC. This would further damage Jersey's reputation in the hospital construction market, which has been negatively impacted due to previous false starts for the project. In this scenario it is possible that the Island would not be able to secure another suitably experienced Design and Delivery Partner without having to repeat a lengthy and expensive procurement process and risk being severely compromised in the commercial negotiations.
11. The combination of the above factors should they materialise, plus others such as the impact of inflation, would inevitably lead to an increase in the cost of the programme. Whilst appropriate contingency has been built into the cost estimate, calls on it should be minimised where possible to ensure that the finances of the scheme are not adversely impacted.

Section 5: Next Steps

1. Adopting this Proposition will provide the Our Hospital project assurance that the States Assembly has supported and agreed a preferred access route. It will enable the project to progress detailed design work, not only for the highway works, but for the hospital facility itself, all of which will be dependent on how the site is accessed. Once completed this will also give the Assembly more cost certainty by providing detailed information for the Outline Business Case, that will be brought to the Assembly before summer 2021.

2. Should the Assembly adopt this Proposition the next steps will be:

• Continue  to  engage  with  Overdale  residents,  Island  clinicians  and  health professionals, States Members and all Island stakeholders.

• To assemble the land needed to deliver a new hospital at Overdale:

o Complete purchases with willing sellers

o Continue to negotiate with other landowners through an extensive engagement and communications plan, which includes further virtual exhibitions, virtual meetings and the formation of community liaison groups

o Assemble the required land by using compulsory purchase powers, if necessary – although this will never be the preferred option

• Proceed with concept and detailed design and subsequently submit a planning application for highway alterations

• Proceed with concept design of the new hospital

Section 6: Financial and manpower implications

Financial and manpower implications related to access works

1. It is important to stress that the fees payable to the Design and Delivery Partner and the capital works to deliver the preferred primary access option to Overdale are included within the £550m affordability limit agreed with the Design and Delivery Partner. The specific costs to deliver the off-site highways and junction upgrades is estimated to be £15.1m. Further detail of the affordability limit is outlined in section 6.5 onwards.
2. The costs to acquire the sites for access works are included in the other site-specific costs outlined on page 11 of P.123/2020 - Our Hospital Site Selection: Overdale.
3. Any delay would result in additional cost to the project, as described above in paragraph 4.11.
4. There are no additional manpower implications of the preferred access route, apart from the necessary detailed design work that has already been anticipated.

Summary of overall project financial and manpower implications

5. The detail of the affordability limit for the capital build element of the project is shown in the Table 1 below:

Table 1

6. Other site-specific and non-site-specific costs are estimated to be £254.5m, of which by far the largest element is Optimism Bias and Client Contingency. This is broken down in detail on page 11 of P.123/2020 - Our Hospital Site Selection: Overdale.
7. Optimism Bias is a financial allocation that mitigates the tendency to be overly optimistic when pricing capital projects, especially at the earlier stages of the Business Case process. Optimism Bias is an accepted psychological principle and it is recognised HM Treasury best practice to include a detailed Optimism Bias calculation as part of business case development. In line with best practice, it is the Government's intention to review this assessment at each stage during the project lifecycle, which will increase cost certainty at each stage, and decrease Optimism Bias.
8. The recommended range for a project at this stage – Strategic Outline Business Case stage – could be as high as 20-24%. However, the extensive work undertaken to date on the Overdale site option has meant that we have been able to reduce this to 18.4%. In addition, the Future Hospital Review Panel's external advisors have agreed that an appropriate Optimism Bias level has been included at this stage.
9. As noted above, allocations in the business case for Optimism Bias will reduce over time as greater cost certainty is achieved. However, this does not necessarily mean the total cost of the scheme will reduce. As the project progresses, Optimism Bias may be re-allocated into other cost categories as each category reaches a greater degree of cost certainty.
10. The other large element of the £254.5m site-specific and non-site-specific costs is general Client Contingency. All clients require suitable levels of contingency to manage unexpected cost pressures or changes in client brief during the life of the project. It is best practice to account for a suitable level of contingency to cover client allocated risks.
11. In a similar way to Optimism Bias, Client Contingency may or may not materialise. The level of Client Contingency has been benchmarked and has been confirmed as appropriate. The Future Hospital Review Panel's external advisors also agreed that an appropriate Client Contingency has been included at this stage.