Future Hospital Project - Ministerial Response - 10 January 2017

Findings

Comments

1

Continued  investment  in  out  of hospital  or  community-based  care strategies is imperative in order to deliver the future hospital project.

Agreed.  The  Department  prepared  and submitted  plans  and  funding  requests  as part of the preparation of MTFP2 and the 2016 MTFP Addition. Following the States debate, funding for 2017 and the funding full year effect for 2018 has been issued to the Department. Further funding for 2018 and  2019  is  subject  to  further  States decisions  in  the  relevant  Annual  Budget debate.

During the MTFP Addition debate in 2016, the  Assembly  decided  not  to  adopt  the proposed  Health  Charge.  The  Council  of Ministers  has  been  clear  that  "future revenue-raising measures" will be brought forward  to  replace  the  funding  from  the Health  Charge  for  2018  and  2019,  in advance  of  the  Budget  2018.  After  the rejection  of  the  income-based  Health Charge, the Treasury will continue to work to  identify  options  for  a  long-term, sustainable funding mechanism for Health for  consideration  during  the  next  MTFP period 2020–2023.

2

Failure of States Members to agree a site  will  severely  compromise strategic  objectives  to  provide  a safe,  sustainable  and  affordable hospital for the Island.

Agreed.  I  welcome  the  States  Assembly decision on P.110/2016.

Findings

Comments

3

A Waterfront option has consistently performed well in evaluations of site options.

Agreed. However, it is noted that in terms of access for patients and the general public the Waterfront option did not perform well.

4

Ministers  have  consistently  sought other options on the occasions that the Waterfront site ranked best.

Agreed.  However,  Ministers  have consistently stated that the Future Hospital site assessment process could never capture the  full  economic  benefits  of  Waterfront redevelopment  for  purposes  other  than  a hospital.

5

Indecision by Ministers has created delays  in  delivering  the  future hospital in a timely fashion.

Not  agreed.  Ministers  have  responded  to stakeholder  views  throughout  the  site assessment  process.  The  Chief  Minister made clear there was no perfect site.

6

P.110/2016  is  presented  as  an in principle  decision  to  approve  a site.  In  practice,  this  will  mean  a commitment  to  that  site  and  the related  expenditure  unless something  significant  is  identified during  the  detailed  evaluation process.

Agreed.

7

The  Sub-Panel  is  concerned  about the  appropriate  level  of  expertise within  the  current  Future  Hospital Project  team  in  relation  to  the construction of new hospitals. It is the view of the Minister for Health and Social Services and Minister for Infrastructure that at the present time the  Project  Team  comprises  the correct mix of experience which is supplemented  by  the  expertise  of Gleeds.

Agreed. The Sub-Panel and its independent adviser  heard  and  acknowledged  the considerable  experience  and  commitment of  the  project  team.  However,  it  is acknowledged that the project and advisory team  will  need  to  be  augmented  as  the project proceeds.

8

The Sub-Panel's adviser (Concerto) found  that  a  Programme Management Office was not in place to  support  the  wider  redesign process of health and social services. Some  projects  within  the transformation  programme  have developed  their  own  project infrastructure but these, so far, have been  implemented  on  an  ad hoc basis.

Agreed.  This  recommendation  will  be considered  in  the  coming  months  by  the Minister and his senior Health and Social Services Department leadership team. It has resource implications that would need to be resolved.

It should be noted that the projects have consistent  project  infrastructure  and documentation,  that  the  Leads  meet regularly to ensure integration of plans and identification of programme-wide risks, and that the Leads participate in one another's Steering Groups.

Findings

Comments

9

The Sub-Panel's adviser assesses the future hospital project as Amber at this stage, meaning that: "Successful delivery  appears  feasible  but significant  issues  already  exist requiring  management  attention. These  appear  resolvable  at  this stage  and,  if  addressed  promptly, should  not  present  a  cost/schedule overrun".

Agreed. It has been accepted by the Sub- Panel  and  its  adviser  that  the  Concerto review, by necessity, was not a full gateway review,  which  will  be  completed  by  the project team in due course, but the outcome is not unusual for a project of this sort.

10

Disruption  to  staff  and  patients during  the  demolition  and construction phases  of the hospital should  not  be  underestimated. Comprehensive  planning  will  be needed to mitigate the disruption.

Agreed.  This  is  recognised,  and  a comprehensive programme of engagement with clinicians, staff, neighbours and other stakeholders is underway and will continue to inform detailed technical proposals based on  experience  of  doing  this  in  a professional  and  exemplary  manner elsewhere.

11

The  timescales  for  the  future hospital  project  are  tight, particularly  its  initial  stages  which comprise  the  decant,  design, planning,  refurbishment  and relocation activities.

Agreed. The Sub-Panel and its adviser are aware of the comprehensive experience, in the UK and on-Island, which has informed the planning of the preferred option.

12

There may have already been some slippage in the target date for freeing up the preferred site in readiness for the start of demolition.

Not  agreed. There  is  no current  slippage from  the  timescale  shared  with  the  Sub- Panel  on  which  the  States  Assembly decision on the preferred site was taken.

13

In order to free up the preferred site it  is  necessary  to  vacate  and  then refurbish  Westaway  Court  and complete  other  critical  works. Although plans are progressing well, it is still too early to be assured that the target is achievable. The ability to  deliver  £11 million  of refurbishment  activities  within  the planned period is also a significant challenge.

Agreed. There will be increasing levels of certainty as the project proceeds, and the timescale is still on programme.

14

The preferred site is only viable if supplemented  by  acquisitions  in Kensington Place. This represents a critical risk to the project.

Agreed. This risk is being actively managed by  good  engagement  with  local  tenants, owners and the neighbouring community.

Findings

Comments

15

There is likely to be limited parking provision  at  Westaway  Court.  The distance  between  Westaway  Court and Patriotic Street car park is such that  it  may  require  a  transport solution for out-patients.

Agreed.  A  solution  for  this  is  in preparation,  built  around  extensive provision  for  drop-off  and  pick-up  for patients and parking for those with mobility issues prioritised.

16

The  footprint  of  the  proposed building  on  the  preferred  site  has been reduced by 50% from an ideal 20,000 m.2  to  approximately 10,000 m.2.

Agreed.  The  preferred  site  report  and proposition  approved  by  the  States Assembly set out how an excellent hospital could  still  be  delivered  on  a  reduced footprint  by  employing  existing infrastructure.

17

The preferred site challenges usual planning requirements. The reduced ground-floor  footprint  has  meant that  the  building  will  need  to  be taller  than  guidelines  currently suggest as appropriate. In order for the  successful  delivery  of  the hospital on the preferred site, height guidelines  established  by  the Planning Department will need to be relaxed.

Agreed. The detailed design is to follow. The Planning Authority and Architectural Commission have identified that this will be  a  challenge,  but  not  that  this  will  be impossible to resolve.

18

The  Waterfront  option  has  a marginally  lower  cost  than  the preferred option.

Agreed.

19

The  Waterfront  option  has  a marginally  lower  risk  profile  than the preferred option.

Agreed.

20

Both  the  Waterfront  site  and  the preferred site offer similar benefits.

Agreed. However, the Waterfront site has less good patient access and parking.

21

The Sub-Panel's adviser found that the evaluation of the Waterfront site and  the  preferred  site  had  been carried out in a fair, consistent and comprehensive way.

Agreed.

22

A comparison of the Waterfront site and  the  preferred  site  has  been difficult  to  achieve  because  the evaluations of each site have been undertaken  on  a  sequential  basis without evident comparison.

Agreed.  However,  the  like-for-like  basis has been retained, as acknowledged by the Sub-Panel's Finding 21 above.

Findings

Comments

23

An  important  reason  why  the Waterfront site option was not taken forward as the preferred site, even though  it  ranked  highest,  was because it was seen by the Council of  Ministers  as  politically undeliverable.

Agreed. This was acknowledged, not just by the Council of Ministers, but also by the majority  of  States  Members  who participated in workshops held during the period  before  the  States  debate  on  the preferred site.

24

Ministers  consider  that  a  housing development  earmarked  for  the Waterfront  site  could  generate significant income.

Agreed.

25

Although  the  Council  of Ministers considered  the  Waterfront  site option  as  politically  undeliverable, the possibility of using the site for the  future  hospital  has  never  been brought before the States Assembly for debate.

Agreed. However, the Amendment to the Preferred Site Proposition was debated and rejected  comprehensively  by  the  States Assembly.

26

The  differential  cost  between  the preferred site and the Waterfront site is  approximately  £20 million  as identified by Gleeds.

Agreed.  The  precise  number  has  been provided.

27

The  cost  of  the  preferred  site  has been  reduced  by  approximately £20 million as a result of planning for a smaller sized building. No such work  has  been  carried  out  at  the same level of detail on other options.

Not agreed. The nature of the preferred site means  that  different  assumptions  can  be taken, as explained to the Sub-Panel and its Adviser, so the like-for-like assessment is not informed by a further level of detail.

28

There  are  no  relocation  costs  in relation to the Waterfront site. The approximate costs necessary in order to make the Waterfront site possible are  approximately  £23 million compared  to  required  relocation costs  of  the  preferred  site  of approximately £44 million.

Not  agreed.  These  were  provided  to  the Sub-Panel in response to  its draft report. Relocation  works  include  relocating  the current  Waterfront  car  park,  drainage works, and Les Jardins de La Mer.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

1

Ministers should carefully consider the suggestion  made  by  Concerto  to appoint a suitably experienced Project Director at this stage, and not discount the  suggestion  merely  because  the construction project is in its planning stage.  The  Sub-Panel  recognises  the experience and strength of the present team,  but  the  project  could  benefit additionally from high-level expertise at the earliest opportunity.

CoM

Accept

See the Minister's response to Finding 7 above.

Q1/2017

2

The  Sub-Panel  endorses  the importance of an independent adviser to  provide  challenge  and  act  as  a critical friend to the Project Board. As the  project  develops  through  all  its stages, Ministers should ensure that the Project  Board  is  always  assisted  by such  an  adviser  with  relevant knowledge and experience.

CoM

Accept

This may be more than one as the project develops.

Q1/2017

3

The  Health  and  Social  Services Department  should  look  into establishing an appropriately resourced Programme  Management  Office  to support the needs of the programme, the dependencies between the projects and provide a consistent framework to manage change across all projects.

HM

Accept

See the Minister's response to Finding 8 above.

Q2/2017

4

The  Minister  for  Health  and  Social Services should clarify the role of the Director  of  System  Redesign  and Delivery and take any necessary steps to  formalise  responsibilities  in  this area.

HM

Accept

The responsibilities are clear; the Director of System Redesign and Delivery has been the Corporate Director with responsibility for P.82 since its inception.

Q1/2017