Report - Review of the Future Hospital Site Selection Process - 13 November 2020

Review of the Future Hospital Site Selection Process

Future Hospital Review Panel

13th November 2020 S.R.9/2020

CONTENTS

1. Executive Summary............................................................................................................... 1
2. Key Findings .......................................................................................................................... 3
3. Recommendations ................................................................................................................. 7
4. Introduction .......................................................................................................................... 12 Background and Context ....................................................................................................... 12 The Panel's Review ............................................................................................................... 12 Methodology .......................................................................................................................... 13 Appointment of Advisors ........................................................................................................ 13
5. The Need for a New Hospital .............................................................................................. 15 Background on previous hospital project .............................................................................. 15 What is being proposed - Main Proposals of the Our Hospital Project ................................ 16 R.54/2019 New Hospital Project: Next Steps' to the States Assembly ............................... 16 R.116/2019 – Our Hospital Programme, update to the States Assembly ............................ 18
6. How was previous information used to inform decisions for this process? ............... 20
7. Timeframe ............................................................................................................................. 22 Proposed Timeline for pre-building ....................................................................................... 22 Potential Future Expansion ................................................................................................... 23
8. Site Selection Process ........................................................................................................ 26 Methodology and Site Selection Criteria ............................................................................... 26 Step 1 - Call for Sites............................................................................................................. 26 Step 2 - Clinical Criteria for Site Assessment ....................................................................... 26 Site Selection Document ....................................................................................................... 27 The Appendices ..................................................................................................................... 27 Citizens Panel ........................................................................................................................ 28 The Site Selection Criteria ..................................................................................................... 29 Exclusion of Sites from 82 to 39 ............................................................................................ 29 South Hill ............................................................................................................................... 30 Peoples Park ......................................................................................................................... 31 Exclusion of Sites from 39 to 17 ............................................................................................ 35 Exclusion of Sites from 17 to 5 .............................................................................................. 35 Critical Success Factors ........................................................................................................ 37 Exclusion of Sites from 5 to 2 ................................................................................................ 39 The Final Site ......................................................................................................................... 40

Hurdle 2 ................................................................................................................................. 40

9. Stakeholder Engagement ................................................................................................... 43 Engagement with the Public .................................................................................................. 43 OH Project Team Engagement Process ............................................................................... 46 Third Sector/Healthcare Provider Engagement .................................................................... 49 Mental Health Integration ...................................................................................................... 50
10. Ministerial Lines of Accountability .................................................................................... 52 Political Oversight Group ....................................................................................................... 53 Senior Officer Steering Group ............................................................................................... 54 The Partnership Board Prince 2 Senior Supplier .................................................................. 55
11. Relationship of the Future Hospital and the Jersey Care Model ................................... 56
12. Costs ..................................................................................................................................... 61 Projected Costs for Current Project....................................................................................... 61 Contingencies ........................................................................................................................ 62 Previous Project vs New Project ........................................................................................... 63 Contract.................................................................................................................................. 66
13. Business Case and Functional Brief ................................................................................. 68 Procurement .......................................................................................................................... 69
14. Next Steps ............................................................................................................................ 71 Appendix 1: Panel Membership and Terms of Reference ..................................................... 75 Panel Membership ................................................................................................................. 75 Terms of Reference ............................................................................................................... 76 Appendix 2: Advisor's Report ................................................................................................... 77

1. Executive Summary

The process for selecting a new hospital site began with site elimination based on size. Fifty-five potential sites were rejected where 9 of the 55 met the minimum size set within the site selection criteria. It is unclear why these sites were deselected during the first round of elimination. The People's Park site, which made the final 2 shortlist, should not have been selected beyond the initial site selection process as it would have been considered below the size requirement within the site selection criteria.

Following this process, a Citizens' Panel consisting of 17 unnamed islanders was established and with the assistance of an independent unnamed facilitator; 24 item selection criteria were created to reduce a list of 17 sites to 5.

The Citizens Panel did not appear to use SMART objectives or Critical Success Factors (CSFs), as advised in the HM Treasury Green Book. The methodology adopted was a Yes, No, Maybe' Matrix' using Red Amber Green (RAG) ratings. The Our Hospital (OH) Project Team has confirmed that the 24 criteria were applied in a sequential fashion and not weighted. Supportive documentation was not provided to advise how the chosen criteria were priority sequenced'. As SMART targets were not identified this could result in the outcomes being considered subjective.

The Scrutiny Review Panel has concerns around the 40–50 year life cycle of the hospital plan. There is no clearly defined, projected timeline and there appears to be an absence of hospital specific analysis documentation. A single document is required to detail how a plan has been incorporated for expansion to suit a demographic 40-50 years for the future. Also, how this will suit the future needs of the hospital specifically utilising the adjacent site.

The Government of Jersey (GoJ) development and approval of the Strategic Outline Case (SOC) is due to be published in November 2020 which will be after the States Assembly debate the selection of the preferred site. This is considered unusual.

£44.5m has already been spent as of April 2019 which likely has increased significantly due to the recent work carried out by the OH Team and the Delivery Partner (Contractor).

The contract proposed between the GoJ and the Delivery Partner is a target cost contract with financial risks being shared between the GoJ and the Delivery Partner in an agreed proportion.

The construction cost of the hospital in isolation is currently set at £412.2m. Based upon the understanding that the eventual size of the hospital will be approximately 70,000m2 this is a cost of £5,888 per m2. This represents an expected benchmark cost for this type of hospital, excluding premiums for building in Jersey versus the UK. Having said that, there is an additional £254 million for non-site-specific costs which bring the overall cost to circa £800 million.

There is no finalised schedule on which all capital cost and program is predicated upon. Before any assurances about maximum costs can be understood, this is required to enable it to be used as an audit tool and baseline for the project as it develops.

The GoJ has an appropriate level of contingency for this project. The level of contingency held by the Delivery Partner is considered likely insufficient given the complexity of the scheme.

Once the initial design of the hospital is established, a detailed cost review should be undertaken in to ensure GoJ are receiving value for money. In addition, when the Delivery Partner cost plan is agreed, a review should be carried out to assess the process of approval of changes within the contract.

2. Key Findings

Key Finding 1

There do not appear to be SMART objectives to link what previous information was used to the current project. Without this information, it is challenging to make objective decisions to measure what, if any, costs have been reduced and what information was actually used.

Key Finding 2

There does not appear to be any inclusion for unforeseen setbacks within the process. This could cause the project to go off track and cause costs to spiral.

Key Finding 3

The Panel has concerns around the 40–50-year life cycle with no clearly defined, projected timeline and the absence of hospital specific analysis documentation. The OH Project Team has defined two areas of expansion:

• 15% additional area within the ground floor, providing flexibility for the foreseeable future until 2036. Effectively a 10-year post project completion allowance.
• Provision of an adjacent site as set out in the site selection criteria for future expansion. This has been proposed to allow expansion of all areas of the proposed hospital for a period of 40- 50 years. Without focus on new models of care and transfer of activity from hospital to community, the hospital (and the site) will come under pressure within about 12 years.

Key Finding 4

The Panel understands a topographical survey report was carried out for the 5 sites on the shortlist later in the selection process and questions if this should have been applied to the 17 sites prior to meeting the crucial stage of the Citizen's Panel criteria.

Key Finding 5

South Hill was eliminated at stage 1 due to being unable to meet either of the options due to size. The site was in fact large enough to accommodate both options and if the set criteria had been applied, it should not have been eliminated at this stage.

Based on the set criteria, People's Park, should not have been considered due to being insufficient in size. The Panel is of the opinion that, should the criteria have been applied, the site would have been eliminated at stage 1 due to being unable to meet either of the options.

Key Finding 7

The advisors have raised 9 sites that were eliminated at the initial stage for being unable to meet either of the options regarding size. It is clear, however, that based on size, all of these 9 sites meet the criteria and could accommodate either option.

Key Finding 8

The risks associated with the Compulsory Purchase Order (CPO) surrounding Overdale have not yet been confirmed. It may be likely the process to obtain the required land and properties for the hospital project would not necessarily take any less time to acquire than some of the sites that were discounted at the timetable criteria stage.

Key Finding 9

The RAG matrix could be considered confusing in using the results with green and red signifying a result of both yes/no.

Key Finding 10

The facilitator for the group is not named and therefore the Panel, or its advisors are unable to comment on whether the facilitator had suitable experience and knowledge in working with the group to develop Critical Success Factors (CSFs) as advised in the HM Treasury Green Book.

Key Finding 11

The criteria did not use weighting and could be considered subjective and open to interpretation. Key Finding 12

It does not appear the Site Selection Panel had access to technical advisors prior to the selection process. The Panel is of the opinion that should technical advice been obtained prior to this process, the site at Five Oaks would not have met the criteria based on its location lending it to having access problems with the approach road and would have been eliminated at an earlier stage.

There were no operational clinical staff or end users on the Site Selection Panel, who would have had a more detailed understanding of the potential location, particularly regarding the patient population and services to be delivered.

Key Finding 14

The site selection process had many areas lacking objectivity and was not balanced. Sites were excluded whilst others remained in the process when the criteria was not met.

Key Finding 15

The decision as to what homeowners were directly affected by the Overdale site was subjective and did not take into account the full impact of the highways. It appeared that homeowners not directly affected by the site had not been communicated with initially and only those with properties that would require CPO had been contacted.

Key Finding 16

Health and Community Care, Primary Care and the Voluntary Sector had not been engaged with according to the list provided by the OH Project Team.

Key Finding 17

The Panel is alarmed at the lack of engagement with healthcare providers from the OH Project Team.

Key Finding 18

Although it has been discussed that mental health facilities will be an integral part of the new hospital build; it is unclear if this will be in the main building or adjacent premises.

Key Finding 19

The lines of accountability should be defined regarding responsibility for the Strategic Outline Case (SOC).

Key Finding 20

The Panel is concerned the key message and deliverables of the Jersey Care Model (JCM) may have been compromised due to the haste in finding a suitable site for the hospital.

If the care in the community concept within the JCM is not implemented as envisaged, the hospital site will come under pressure within approximately 12 years.

Key Finding 22

There has been a lack of clarity as to how the JCM will directly impact the development of the future hospital, which has resulted in a lot confusion amongst States Members and members of the public.

Key Finding 23

The level of contingency held by the delivery partner (Contractor) of £14.7m, represents 3.5% of £412.2m (being the construction cost of the hospital) and is considered likely insufficient given the complexity of the scheme.

Key Finding 24

Within the documents disclosed it is undefined whether there is an additional cost or premium being allowed for building in Jersey compared with the UK.

Key Finding 25

In the absence of a defined SOC it is considered "somewhat optimistic" to deliver the new hospital within the proposed budget at this stage of the project.

Key Finding 26

NEC3 Option C is a target cost contract with activity schedule where the out-turn financial risks are shared between the client and the contractor in an agreed proportion. The client being GoJ.

Key Finding 27

To enable good management of the project and for it to be delivered on time and within the proposed budget, it is imperative that key personnel involved in the project should have knowledge of the NEC3 contract suites, not just the delivery partner.

Key Finding 28

It is considered best practice for the SOC to be produced and approved at a much earlier stage in the project and there is a risk that should the SOC not be approved when presented, decisions made on site selection could unravel.

3. Recommendations

Recommendation 1

The Council of Ministers should ensure the OH Project Team provide the Panel with a list which clearly defines which previous information was used and how it informed the site selection decision making criteria. This should be provided within 3 months from the presentation of this Report.

Recommendation 2

The Council of Ministers should provide the calculations for all project cost including; non-works costs, equipment costs, non-medical costs (including the whole life transport solution), VAT, inflation, optimism bias, a clear split of all project contingencies, the premium costs for materials and confirmation that all "current exclusion" are subject to at least the latest provisional sums. This should be provided prior to lodging any proposition seeking the Assembly's approval of the Outline Business Case.

Recommendation 3

The Council of Ministers should ensure the OH Project Team provide a document detailing how the plan has been incorporated for expansion to suit a demographic 40-50 years for the future. In addition, how this will suit the future needs of the hospital specifically utilising the adjacent site. This should be provided without delay.

Recommendation 4

The Council of Ministers should ensure the OH Project Team undertake to provide a hospital- based analysis single document specific to the project in order to test resilience of the planning assumptions. This should be presented to the Panel without delay.

Recommendation 5

The Council of Ministers should undertake post Covid pandemic planning and establish impact on sizing and configuration of the hospital without delay.

Recommendation 6

The Council of Ministers should ensure the OH Project Team provide the Panel with reasoning as to why topographical surveys were only carried out on the 5 site shortlist. This should be provided without delay.

The Council of Ministers should ensure the OH Project Team provide the Panel with further details of how the "maybe" criteria was applied and why it was not defined within the site selection documents. This should be provided without delay.

Recommendation 8

The Council of Ministers should ensure the OH Project Team provide the Panel with reasoning behind why the risks associated with the CPO around Overdale were not taken into consideration as a risk when applying the criteria at Step 3 – Clinical criteria for site assessment' – timetable. This should be provided without delay.

Recommendation 9

The Council of Ministers should ensure the OH Project Team provide, in absolute confidence to the Panel, the experience of the facilitator advising the Citizen's Panel in order for the Panel's advisors to make an informed decision as to understanding the knowledge the facilitator had in developing CSF's in line with Green Book standards.

Recommendation 10

The Council of Ministers should ensure the OH Project Team provide the Panel with valid reasons as to why the site selection criteria was not always applied. This should be provided without delay.

Recommendation 11

The Council of Ministers should ensure the OH Project Team implement an open and transparent communication and engagement process with the residents affected by the Overdale site without delay and a communication strategy supplied to the States Assembly. More work should be undertaken via social media on an ad hoc basis and monthly updates in a newsletter/email to encourage full participation. This should begin immediately.

Recommendation 12

The Council of Ministers should ensure the OH Project Team engage with the third sector and public health providers without delay.

Recommendation 13

The Council of Ministers should ensure the OH Project Team undertake wider engagement with the public and clinicians to share the current picture, and regular dialogue should be carried out. This should be carried out immediately.

The Council of Ministers should ensure the OH Project Team improve the level of engagement with the public and healthcare providers to share the current position, plus establish regular ongoing communication channels. This should happen immediately.

Recommendation 15

The Council of Ministers, together with the OH Project Team, should ensure a small and appropriate group (to include relevant stakeholders) is charged to consider the feasibility and functionality of the proposed mental health facility. This will include whether it can be integrated into the singular building or more likely that it is a standalone facility either on the proposed site or at an alternative location. This should be fully costed and transparent and provided to the Panel within 3 months of presentation of this Report.

Recommendation 16

The Council of Ministers should ensure the OH Project Team have a clear approvals process with agreed and/or delegated authority for each group. This should be set out in relation to approvals to prove due process has been followed and best practice is met. In addition, a single set of performance standards should be established and agreed and should be implemented without delay.

Recommendation 17

The Council of Ministers should ensure the OH Project Team peer review all plans and designs with workforce requirements established. This should be undertaken prior to the agreement of costs.

Recommendation 18

The Council of Ministers should ensure the OH Project Team undertake and provide a full review of the performance standards to include the 2036 capacity. This would include ongoing monitoring of the JCM care in the community concept and targets and should be implemented without delay.

Recommendation 19

The Council of Ministers should ensure the OH Project Team provide the Panel with the project schedules and the block plans using @1:200 scale drawings. These should be created and approved ahead of budget sign off to enable resolution of any outstanding issues.

Recommendation 20

The Council of Ministers must ensure and evidence that the contingency level for the delivery partner (Contractor) has been increased to the considered normal, appropriate level of approximately 10%, which represents £41.22m. This should be put in place without delay.

Recommendation 21

The Council of Ministers should ensure the OH Project Team provide documentation detailing how an additional cost or premium is being allowed. This should be provided without delay.

Recommendation 22

The Council of Ministers, together with the OH Project Team, must ensure any Guaranteed Maximum Price (GMP) should not be applied until there is alignment between the clinical 2036 strategy*, the technical specifications (that match the Schedule of Accommodation (SOA) as drawn), the cost plan (including any Jersey island premium), project non works and mapping to the construction programme. Only then can there be a cost of reasonable certainty that can be used as an audit tool and baseline for the project as it develops. This should be undertaken without delay.

*The planning upon defining the new "our hospital" model has worked to ensure that the States of Jersey model of care and clinical strategy is right sized for demographic and non- demographic forecasts and aligned to clinical spatial areas up to the year 2036.

Recommendation 23

The Council of Ministers, together with the OH Project Team should ensure the capital costs include, not only major medical equipment that is detailed and specific, but also building services, IT and digital platforms. This should be undertaken without delay.

Recommendation 24

The Council of Ministers, together with the OH Project Team should undertake, once the initial design of the hospital is established, a detailed cost review in order that GoJ are satisfied they are receiving value for money. This should be undertaken once the initial design process has been signed off.

Recommendation 25

The Council of Ministers, together with the OH Project Team, should ensure a system of regular reviews at project milestones is implemented to check the project is on track and progressing

within the set budgets. This should be shared with the States Assembly by the Council of Ministers prior to each project milestone.

Recommendation 26

The Council of Ministers should ensure the OH Project Team understand key risks and costed and detailed mitigation plans put in place. This should be implemented without delay.

Recommendation 27

The Council of Ministers should instruct the OH Project Team to implement the relevant training for Senior Officer Steering Group (SOSG) and members of the Our Hospital team to ensure they are familiarised in the operation and use of the NEC3 suite of contracts without delay.

Recommendation 28

The Council of Ministers, together with the OH Project Team, should engage a suite of client-side independent technical advisors that should be contracted to hold the Design and Delivery Partner to account and ensure the needs of the GoJ are being met. This should be undertaken as soon as practical.

Recommendation 29

The Council of Ministers should ensure the OH Project Team provide the Panel with a Risk Register which is developed fully and maintained including full potential costs of risks and their mitigation. This should be provided without delay.

Recommendation 30

The Council of Ministers should ensure the OH Project Team implement a clear approvals process with defined levels of delegated authority published. This should be implemented immediately.

4. Introduction

The Future Hospital Review Panel is undertaking a review of the next steps towards the build of a new hospital, as set out in a report published by the Chief Minister in May 2019 - R54/2019 'New Hospital Project: Next Steps'. The Panel launched its review on 29th September 2020 focusing on the decision-making process in determining the final site recommendation and whether the process was fair and transparent.

Review Panels are set up with the agreement of the Chairmen's Committee to review particular proposals, issues or projects. They are made up of States Members who are not Ministers or Assistant Ministers.

Background and Context

On 15th January 2019, Proposition P.5/2019 Future Hospital: rescindment of Gloucester Street as preferred site was lodged by Deputy Russell Labey . The Proposition asked the States Assembly to rescind its decision to build on the current hospital site and to reconsider alternative sites. The Proposition was debated on 13th February 2019 and was adopted by the States: 39 pour, 7 contre and 2 abstentions.

On 13th May 2019, the Chief Minister presented a report to the States R.54/2019 New Hospital Project: Next Steps' (R.54/2019). R.54/2019 proposed a new, phased approach to the development of a new hospital. Firstly, it proposed to establish the agreed clinical requirements of the new hospital and secondly, to use the outcome of this to scope the size and shape of a new hospital to inform the shortlisting of potential locations.

The Government of Jersey (GoJ) announced a shortlist of 5 sites in July 2020 having gone through a sequential test and a prioritised series of criteria. In October of this year, a single site was announced as Overdale and on Tuesday 6th October 2020, P.123/2020 Our Hospital Site Selection – Overdale', (P.123) was lodged au Greffe by the Council of Ministers. The Proposition is due to be debated by the States Assembly on 17th November 2020.

The Panel's Review

The Report firstly provides the background on the previous hospital project and the need for a new hospital leading up to the lodging by the Chief Minister of R.54/2019. The Report then examines what exactly is being proposed and makes reference to R.54/2019 and R.116/2019 Our Hospital Programme: Update to the States Assembly (R.116/2019). The  next chapter considers how previous information was used to inform the decisions undertaken and the timescale for the project. It then goes into the methodology and site selection process highlighting key areas of concern for the Panel. Public engagement follows together with excerpts from public written submissions. The Report goes into the area of the new hospital project and the Jersey Care Model (JCM) detailing how these are integrated. The following chapter on costs highlights the set budget for the current project and compares it with the project undertaken previously. The Report concludes with governance covering the Business Case and Functional Brief and goes on to detail the Panel's next steps.

Methodology

Since launching its review at the end of September, the Panel has gathered evidence in several ways including:

• public hearings with the Deputy Chief Minister;
• written views from relevant stakeholders (all submissions were published on the States Assembly website);
• private briefings from relevant Ministers and officers;
• documentation provided to the Panel, upon request, by Ministers and Government officers in relation to the proposition;
• documentation in the public domain.

Transcripts for the public hearings can be accessed via the States Assembly website.

Appointment of Advisors

Following a full tender process, the Panel engaged K2/Archus as advisors to provide expert technical assistance during the review.

They were engaged to:

• Undertake a technical analysis of the Future Hospital Preferred Site Option and of any supporting documentation provided to the Panel by the Health and Community Services;

• Provide technically informed analysis/interpretation, of relevant submissions received by the Panel from key stakeholders or other interested parties;
• Assist the Panel in preparing for Public Hearings by providing specialist advice on areas of questioning;
• Complete a final report in October for the Panel's consideration.

5. The Need for a New Hospital

Background on previous hospital project

In 2011 the existing General Hospital located in Gloucester Street, St Helier, was considered to be insufficient to meet the needs of health care services of the Island in the future. Certain elements of the hospital were considered dilapidated and it was found that the hospital would require complete refurbishment or rebuild in the next decade.

The Government of Jersey (GoJ) appointed a number of external professionals to undertake;

1. a review into how existing health services were provided and the steps required to ensure Jersey could offer quality care;
2. a Pre-Feasibility Spatial Assessment and Strategic Outline Case (SOC) which also formed the initial evaluation of site options;
3. design of the proposed hospital to submit to the Planning Department.[1]

In June 2013, the outcome of a Ministerial Oversight Group (MOG) considered that a phased redevelopment and expansion of the existing Jersey General Hospital in Gloucester Street was the preferred solution. However, in 2019, following 2 rejected planning applications and a proposition (P.5/2019) to rescind the decision to build the new hospital on the current site, the States decided the project needed a new direction. An amendment to P.5/2019 was brought which effectively stated that should the States undertake a further site selection process in the future, it should be done in a fair and transparent way. This amendment was adopted by the States Assembly.

The Panel's advisors, K2/Archus have made the following comments to illustrate what, in their experience, the risks and benefits would be with utilising the Gloucester Street site based on the updated clinical requirements for the new hospital: -

• Firstly the ability to recreate a modern health campus to the proposed SOJ brief for 2036 and beyond (70,000sqm²) means substantial change in existing site layout on a congested existing site, with little room to easily expand and meet the clinical and environmental standards would be extremely difficult.

• Secondly, the costs and speed of building additional facilities, refurbishing existing facilities becomes both slow to develop and high risk to meet cost parameters.
• Finally, for buildability contractors also need adequate space to develop and decant on a busy hospital site. In our experience with the amount of building work required versus the return on investment and matching the clinical brief, this site was understandably excluded from the shortlist.[2]

The original process took over 8 years with a considerable financial commitment in excess of £40 million. This is discussed later in this Report under the  "Costs" section. A vast amount of documentation and supporting evidence exists which determine the conclusions about the overall need and physical area for the new hospital at that stage.

What is being proposed - Main Proposals of the Our Hospital Project R.54/2019 New Hospital Project: Next Steps' to the States Assembly

On 13th May 2019, the Chief Minister presented R.54/2019. This report outlined a new phased approach to deliver a new hospital as follows: -

• firstly, establish the agreed clinical requirements of the new hospital;
• secondly, use the outcome of this to scope the size and shape of a new hospital to inform the shortlisting of potential locations;
• thirdly, involve a thorough process of Island and stakeholder communication and engagement on those locations, alongside technical and financial assessments of deliverability, in order to identify a preferred site for the Government and States Assembly to consider and approve.

There were 4 key areas of difference listed within the report from the previous approach to the project and are documented below.

1. We (the Government of Jersey) are being more inclusive in involving and engaging States Members, staff, stakeholders and Islanders in the process, including through the use of Citizen Panels, and through working closely with Scrutiny.

2. We are taking the opportunity to review the model of health care delivery, under the leadership of the Minister of Health and Community Services, to ensure that the current clinical requirements take account of changes since they were originally scoped in 2012.
3. We will bring in a construction and development partner earlier in the process, to help drive down costs.
4. We are building on all the experience of what went before, to ensure that we learn from it, embracing the best of what was achieved before and avoiding repeating past mistakes.[3]

R.54/2019 states the new project would draw on relevant information that was gathered for the previous hospital project, supplemented by new insights and requirements arising from the development of the Jersey Care Model (JCM) since the previous work was carried out. This is discussed further in this Report under the section "How was previous information used to inform decisions for this process".

The report from the Chief Minister also explained how the political oversight of the project would be initiated. It discussed the need for a Political Oversight Group (POG) and the necessity of engagement with clinicians to establish the requirements that would be considered essential in developing a new hospital. It was also stated as part of this early phase, to procure appropriate specialist skills to support the project to include:

• Project Director
• Health Planner/Clinical Lead
• Clinical Design Team
• Specialist legal/Procurement Advice
• Communications and Engagement Lead
• Financial and Economic Appraisal Advice
• Site Assessment Advisers.

There was also a drive for more engagement as it was recognised this may not have been carried out appropriately on the previous hospital project. "...There wasn't enough engagement last time round. Engagement wasn't conducted properly, and required staff to be revisited with the final plan..."[4]

Additional proposals included:

• Engagement with children who are regular users of the Hospital;
• The ability to engage with staff anonymously;
• Engagement with possible contractors, including UK, French and Polish;
• Regular engagement with politicians;

• Regular briefings with a monthly e-mail update the minimum level of contact which would reduce once building has begun;

• Engagement to enable staff and the Public to know the progress being made and the decisions being taken on a regular basis.

It was recognised there was a need to carry the Public along with the project throughout the build. "...Can't just drive project through without engagement..."[5]

It should be noted that R.54/2019 also stated the need to understand the limits of engagement and whilst clinicians should be involved, "they would be experts in their subject but not in building (comparison to asking teachers about building a school). However, involvement with clinicians should mean spending time in Departments to gain a full understanding of needs."[6]

R.116/2019 – Our Hospital Programme, update to the States Assembly

On 11th September 2019, the Minister for Economic Development, Tourism, Sport and Culture ( Deputy Chief Minister and political lead of the Our Hospital' project) presented R.116/2019 – Our Hospital Programme, Update to the States Assembly'. The purpose of this report was to set out the progress that had been made in relation to the Our Hospital' Project over the 4 months since the presentation of the Chief Minister's report (R,54/2019). The Deputy Chief Minister advised:

It shows that the project has established appropriate governance at both a political and officer level; that it has secured approval for the initial funding needed to get the project started; that the process for recruiting and procuring the team has been approved and is underway; and that the work has been carried out to develop an updated Jersey Care Model, which is due to be considered by Ministers in October following more than 40 engagement events with clinical and health staff, the wider health community and the voluntary sector.[7]

The report also stated that the Government was "mindful of criticisms by the Comptroller and Auditor General over governance and decision-making in the early stages of the previous Future Hospital Project, the first few weeks of the new project focused on establishing appropriate governance and ensuring that all involved understood their accountabilities and responsibilities."

The report went on to describe the details of the various groups to be involved in the Our Hospital' process. These groups included the Political Oversight Group (POG), Senior Officer Steering Group (SOSG), Clinical Group and Delivery Group. These groups are discussed in more detail later on in this report under the section "Ministerial Accountability".

6. How was previous information used to inform decisions for this process?

Within R.54/2019, the Chief Minister proposed "the new project will draw on any relevant information that was gathered for the previous project, supplemented by new insights and requirements arising from the further development of Jersey's health care model since the previous work was carried out. Furthermore, wherever possible, the work that has already taken place on the Hospital project will be re-used, reducing immediate future costs, without prejudicing a fresh start on a project burdened by its long and complex history"[8]

The total amount of funds spent on the original hospital project, as at April 2019, totaled £44,461,500.

The Panel was keen to understand what, and how, previous information had been used to inform the decision-making process of the new hospital project. The Panel received the following response via email:

we do not have a central log of the use of previous work, which would be a time-consuming process given the web of work being undertaken in different workstreams. However, work undertaken by the Future Hospital Project' is regularly referred to and used as the project progresses. As you note, there are references to the reuse of work throughout project documentation including but not limited to:

• Work of Gleeds
• Work of WS Atkins
• Development of the site selection process
• Previous site selection long list
• MJM Health Planner work
• Consideration of the Planning Inspector's report from the previous Public Inquiry
• Previous site technical assessments
• Hospital Policy Development Board Report

There will also be further opportunities to reuse work undertaken as part of the Future Hospital Project in design phases, for both clinical and non-clinical areas. Of course, the Our Hospital Project will make good use of this valuable resource, however, we are not yet at this stage in the project. So, there is a substantial amount of previous work which we are unable to use at present, but will once the project moves past the site selection stage"[9]

7. Timeframe

Proposed Timeline for pre-building

In early 2020, POG were provided with information[10] from the Our Hospital' Project team that outlined:

• The increasing costs of the planned backlog maintenance programme for the current hospital estate at Gloucester Street;
• The statutory, clinical and operational safety challenges associated with a deteriorating estate.

On this basis, it was agreed that the new site should be operational by the end of 2026, which was noted as a tipping point when costs to keep the existing facilities operational would rise significantly.[11]

A key part of the site elimination criteria was whether or not sites could be made available and would be ready for 2026. This is discussed in more detail under the section "Site Selection Criteria". Within R.54/2019, the initial timeframe is stated as follows:

It is estimated that it will take at least 20 months to secure an agreed outline design, cost plan and delivery plan for a preferred option, along with a business case and a draft planning submission that links to the new Island Plan. However, the next nine months will be critical in assembling the new team, putting in place the key governance arrangements, establishing effective engagement with politicians, hospital staff, stakeholders and Islanders and agreeing the shortlist of credible sites for detailed assessment, in order to prepare an Outline Business Case by early 2020" The report goes on to say that whilst the proposed timeline is ambitious, it is firmly believed that if everyone supported the process, and there were no further delays, it would be possible to deliver the new hospital within 20 months. It requires us collectively to agree that this is a priority, and to work together; but if we do, we can still deliver a completed Hospital in a similar timescale to that of the previous scheme.[12]

In a written question to the Deputy Chief Minister, the Panel asked whether the 2026 deadline for delivering the new hospital was achievable. The Panel was advised that  "based on the information available at this early stage of the project and pre-design, and the advice of the Delivery Partner, it is achievable..."[13]  The response went on to say that although the timetable being worked to was realistic, it did not include allowances for unforeseen setbacks which would require  the  exploration  of  "the  use  of  phasing  and  phased  planning,  modern  methods  of construction including off-island fabrication and, as a last resort, parallel commissioning activity."[14]

Potential Future Expansion

In 2013, the original data for spatial requirements carried out by WS Atkins was projected from 2010 to 2040 - a 30-year future plan. The Panel raised this projection with the Deputy Chief Minister at its public hearing in October and asked what the current projected plan was. The Panel was informed: -

Clinical Director, Our Hospital:

The projection for this is what we would need for 2036. The current timeline for the hospital, as you know, is to be built by December 2025 but commissioned by 2026, and then we will look 10 years ahead of that[15]

The Panel is aware there is flexibility for expansion within the proposed plans. However, in a written question to the Deputy Chief Minister, the Panel asked for more specifics on what the current projection would be and how long before the new hospital could no longer accommodate the needs of the Island. The Panel received the following response:

The needs of the island, as far as can reasonably be foreseen, will be met until at least 2036 with a further expansion ground floor area of 15% and flexibility in design to allow for changes in the delivery of health care beyond that. Although the possibility of expansion has been built into plans, this does not necessarily mean there will be a need to expand. Best practice health and care models may continue to evolve based on more community and closer-to-home care. It is therefore important that the site is flexible and has the option for expansion. Thus, it is expected that the preferred site put forward by the Council of Ministers will be able to accommodate the needs of the Island for at least 40-50 years[16]

As far as the Panel is aware, there is no one single document which provides analysis specific to the Our Hospital project projection and planning assumptions. Whilst the Panel understand the hospital is one part of a wider health system, it raised with its advisors the future flexibility allowed within the proposed hospital build. It was advised that "there was a strong link in early documents but this became more tenuous in later documents which were very hospital specific. Although 15% flexibility is built in, population growth on the Island is forecast at 1% per annum so this flexibility wipes out after 15 years (less allowing for compound growth). So unless there is a focus on new models of care and transfer of activity from hospital to community the hospital (and the site) will come under pressure within about 12 years."

The advisors have also stated "It would be correct to have a hospital-based analysis specific to the project in order to test resilience of the planning assumptions. However, the hospital is one part of a wider health system and some care (diagnostics and consultations) can be transferred to community/primary care settings."[17]

Key Finding 3

The Panel has concerns around the 40 – 50-year life cycle with no clearly defined, projected timeline and the absence of hospital specific analysis documentation. The OH Project Team has defined two areas of expansion:

• 15% additional area within the ground floor, providing flexibility for the foreseeable future until 2036. Effectively a 10-year post project completion allowance.
• Provision of an adjacent site as set out in the site selection criteria for future expansion. This has been proposed to allow expansion of all areas of the proposed Hospital for a period of 40-50 years. Without focus on new models of care and transfer of activity from hospital to community the hospital (and the site) will come under pressure within about 12 years.

8. Site Selection Process

Methodology and Site Selection Criteria Step 1 - Call for Sites

In December 2019, to ensure that all possible locations for Jersey's new hospital were considered, Islanders were invited to suggest sites where they thought the building could be located. This resulted in a total of 82 distinct sites as potential locations for the Hospital.[18]

Step 2 - Clinical Criteria for Site Assessment

Site area Health and Community Services (HCS) colleagues and the Our Hospital' project's Clinical Director reviewed the necessary clinical adjacencies and floor areas required for each clinical service to be delivered in the new hospital, as part of the development of the draft functional brief. The work was informed by best practice in hospitals in other jurisdictions and established the clinical services that would need to be located on the ground floor of any hospital to best deliver clinical care.[19] It was concluded in order to meet the clinical requirements on the ground floor, 2 options would be proposed.

The 2 Options

Option 1 - main site ground floor arrangement that would be supported by separate site facility alongside the main building, housing appropriate clinical and support services with. This ancillary site would be directly adjacent or up to 50m away and would provide non-clinical essential support services.

• Essential ground floor hospital area requirement (including external circulation areas) = 23,243m2
• Adjacent site = 8,504m2 • Car parking – 800 spaces over 2 x floors = 9,219m2 or existing parking capacity

Option 2 – main site, including basement that could support the functioning of the hospital. This allows the total ground floor area to be marginally smaller than Option 1 and enables essential support services to be co-located within the new hospital building without the need to increase the building's height to incorporate an interstitial service floor. Option 2 retains the need for a separate facility alongside or close to the main building, but this site could be further away – clinicians are agreed that some services could be up to 15 minutes' walk from the main building.

• Essential ground floor hospital area requirement (including external circulation areas) = 22,890m2 • Nearby site = 3,590m2
• Car parking – 800 spaces over 2 x floors = 9,219m2 or existing parking capacity

Table 1 below, Future Hospital Size Requirements, specifies the differing areas in m2 of the existing hospital, WS Atkins Spatial Assessment which was carried out in 2013 and the States of Jersey Current Criteria, Options 1 & 2.

Table 1

* Approximately 9% increase to original site area ** Approximately 7% increase to original site area *** Approximately 8.5% increase to original site area

Site Selection Document

In July 2020, the "Our Hospital Site Shortlisting Report" was produced to "outline the approved methodology to establish a long list of potential sites for a new hospital for Jersey and identify a shortlist of sites. The steps that have been taken to agree criteria that would be applied to this long list of sites, including clinical and community involvement"[20] The Document includes a number of Appendices which are reviewed in this document and explained in more detail under the "Site Selection Criteria" subheading.

The Appendices

• 2.1b Appendix I - List of sites
  • Listed the 82 initial sites

• 2.1b Appendix II - notes on each site (FINAL)
  • This is an assessment of the 82 suggested sites against the footprint requirements of the new hospital (using the 2 options) and the existing uses on the site that would need to be relocated to create a development site
• 2.1b Appendix III - Outcome Matrix (FINAL)
  • Assessment of sites large enough for Option 1 or Option 2 and potentially available in timeline
• 2.1b Appendix IV Citizens' Panel agreed criteria (FINAL)
  • List of 24 criteria questions as approved by the Citizens Panel

This document illustrated the 24 criteria questions used by the Citizens Panel to establish and identify a shortlist of sites. This process resulted in the 5 site shortlist. Topographical surveys were carried out on all sites included on the 5 site shortlist.

Citizens Panel

On 11th November 2019, the Government of Jersey invited Islanders to give their views as part of the process of delivering a new hospital for Jersey. The Our Hospital' project announced it was setting up a Citizens' Panel as part of its engagement process, to help provide a representative voice from a wide cross-section of the community. The role of the Citizen's Panel was to make sure that the views of Islanders were taken into account by the project when considering where the new hospital might be built. The Panel would be asked to reach a consensus view on the criteria that the Our Hospital' Project Team would then use to determine where the new hospital could be built. It is worth noting that the Citizen's Panel was not asked, at any point throughout the process, to give its view about where the location of the hospital should be.[21] On 9th March 2020, a statement was made by the Deputy Chief Minister on the "Our Hospital Project" and stated the Citizen's Panel (made up of 17 islanders) had met 3 times and were working on the criteria and the sequence of questions.

The Citizen's Panel had Terms of Reference and were accountable to the Our Hospital' Team. The Terms of Reference included: Purpose, Objective, Responsibilities, Scope, Meeting Frequency and Confidentiality. It was agreed that the members of the Citizen's Panel would remain anonymous. The Terms of Reference can be found on the Government of Jersey website.

Following the initial deselection stages applied in 1 and 2, a criteria of 24 questions was created by the Citizen's Panel. This criteria was applied by the Site Selection Panel to the remaining 17 sites which reduced the shortlist to 5. This is discussed in more detail in the next section of this Report titled "Site Selection Criteria".

The Review Panel met, via Microsoft Teams, with 4 members of the Citizen's Panel on 30th September 2020. The meeting was held in confidence and gave the Review Panel the opportunity to ask the Citizen's Panel questions about the overall process and where, if any, areas they thought could be improved. The Citizen's Panel fed back that overall, they found that the process was well organised, independent, professional and focused on problem solving. The members also explained that they were comfortable in just setting the criteria and were not involved in any way in the selection process. The members went on to say they did not feel there was enough engagement with the Public as to the role of the Citizen's Panel and explained that one of the reasons for them choosing to remain anonymous was to avoid any public discontent resulting in a blame situation against the members.

The Site Selection Criteria

Once the call for sites had been finalised, the selection criteria was applied to the 82 sites in the following order:

• exclusion based on size (being unable to meet option 1 or 2);
• timetable – hospital to be operational by 2026 therefore sites had to be available for construction by 2022;
• criteria by the Citizens Panel (sequential test criteria consisting of 24 questions).

Exclusion of Sites from 82 to 39

The application of the minimum site size requirements as stated in option 1 and 2 reduced the list of sites under consideration from 82 to 39. It should be noted the current hospital site on Gloucester Street was on this list, even though the States Assembly voted in 2019 to rescind the decision to build on this site.

Throughout its review, the Panel has gained an understanding into how the site selection criteria was set to determine how the sites would be eliminated at each stage of the process. The Panel is therefore concerned around 2 sites in particular, namely South Hill and Peoples Park, which do not appear to have met the set criteria. This is discussed below: -

South Hill

The site at South Hill has an overall ground floor area of 30,910m2 and is listed within the Site Selection Document Appendix II as having an adjacent site. As mentioned previously in this Report, there were 2 options being proposed, each with a minimum floor area plus parking.

Option 1

• Essential ground floor hospital area requirement (including external circulation areas) = 23,243m2
• Adjacent site = 8,504m2 • Car parking – 800 spaces over 2 x floors = 9,219m2 or existing parking capacity

Option 2

• Essential ground floor hospital area requirement (including external circulation areas) = 22,890m2 • Nearby site = 3,590m2
• Car parking – 800 spaces over 2 x floors = 9,219m2 or existing parking capacity

According to the Site Selection Shortlist Report,  Appendix II, Notes on the Outcome of Consideration, South Hill was excluded based on size in the initial first stage criteria due to not being large enough to accommodate either option[22].  However, South Hill, with an area of 30,910m2 is large enough and therefore should have met this criteria. When the Panel queried this in a letter to the Deputy Chief Minister, it was advised that the reason for South Hill not meeting the criteria was based upon the uneven nature and steep gradients of the site. It was also stated "the site could not reasonably create the flat area required".[23] The Panel was further advised that the site "would prove impractical to create sufficient level land within the timetable and in summary, South Hill was removed at stage 3 of the site selection process – consideration of whether sites could be deliverable by 2026"[24]

The Panel questions why the site was eliminated at Stage 1 due to not being large enough to accommodate either option, when it did in fact meet this criteria and why, within the letter to the Panel dated 20th October 2020, it is stated that South Hill was removed at a later stage due to being undeliverable by 2026.

At its hearing with the Deputy Chief Minister on 13th October 2020, the Panel explored this area further.

Deputy M.H. Le Hegarat :

Okay, so therefore based on that why was South Hill eliminated due to not meeting the size criteria for either option when in fact it is more than large enough to accommodate?

Development Director, Our Hospital:

There is obviously a difference in figures; I need to see the figures you are referring to there. When South Hill was considered there was the footprint of the site itself but when the detail of topography was looked at it became clear that quite a large amount of that topography was taken up by steep hills and various different things, which meant that the developable area of the site is not the same as the redline boundary of the site. But what figures you are looking at there, I am not sure. [25]

Peoples Park

The site at People's Park, with a ground area of 22,784m2, made the final 2 of the shortlist despite the fact that the ground area is not large enough to accommodate either of the 2 options. When the Panel questioned its observation with the Our Hospital' Project Team it was advised:

People's Park is slightly below the required area to accommodate a version of the hospital but it was considered that some flexibility in design could probably achieve a workable scheme. Any such scheme would include a provision for future growth and as such People's Park did not fail the criteria rather it became a maybe'[26]

The maybe' assessment, referred to in the response to the Panel, is briefly noted within the Site Shortlisting Report, which states:

A concept was developed and approved of a sequential test for site shortlisting, which would screen out less suitable sites from a long list of sites on a pass/fail basis according to a prioritised series of criteria that would be developed by a Citizens' Panel. It was agreed that the sequential test criteria would be framed in question-form and scored in line with HM Treasury Green Book Guidance, which provides for the following assessments-

• Yes (site passes the question/criterion/test)
• No (site fails the question/criterion/test, and does not pass to the next question for appraisal)
• Maybe (site passes the question/criterion/test with a compromise or mitigation) [27]

The Panel does not understand how People's Park managed to pass the first stage of the criteria when the criteria clearly states that sites would be excluded based on size if they were unable to meet option 1 or 2. There is no reference as far as the Panel can see within the documentation that lists Peoples Park as a "maybe".

The concept as described above states the "maybe" process happens at the Citizen's Panel stage (stage 3) (which is when the sites were reduced from 17 to 5) based on meeting the sequential test. The definition of "maybe", although described, is not defined in any great detail and could be applied to any site.

The advisors to the Panel have also raised concerns around the initial elimination process and have highlighted 9 sites which have been deselected whilst appearing to meet the size criteria, including:

...55 potential sites were rejected purely due to size. As noted above, however, 9 of the 55 appear to meet the minimum size criteria. It is not clear, therefore, why the sites in the table above have been deselected purely on the grounds of site area during the first round of reviews...[29]

The advisors went on to discuss briefly how a further 20 potential sites were rejected in the next elimination stage (Step 3 - Clinical criteria for site assessment – timetable) due to there being existing uses on the site which would need to be relocated. It was then assumed that having to do this would result in the programme not being met and the deadline of 2026 for the hospital to be operational would not be met. "...In this instance it is fair to say that some sites with existing occupants could potentially have been considered in the long list and the assumption that the majority of sites could not is subjective. In addition, the Overdale site considered in the short list does have some land acquisition requirements, both for the main site and the highway works. The time it would take to obtain these elements of land would not necessarily take any less time to acquire than some of the sites that have previously been discounted..."[30]

Exclusion of Sites from 39 to 17

The next stage of the test was designed to eliminate those sites that could not be delivered by 2026. Factors that were considered as part of the deliverability criterion were:

• Ownership
• Availability of developable land

Exclusion of Sites from 17 to 5

The criteria for considering sites at the next stage required the involvement of the Citizen's Panel Assessment Criteria. Details of the Citizen's Panel and its role within the project is discussed earlier in this Report. The Citizens Panel were supported by an independent facilitator from the UK and met independently of the Our Hospital' Project Team. A sequential test criteria of 24 questions was composed by the Citizen's Panel which was then applied to the remaining 17 sites. These criteria were reached with the Citizen's Panel working together with the independent facilitator. According to the Our Hospital Site Shortlist Report':

"After some familiarisation sessions, the Citizens' Panel worked together with the facilitator to establish the criteria they thought were important in determining the site for the Hospital. In a session after the workshop their criteria were crystalized into a priority sequenced list and approved by the Citizens' Panel.[31]

The results of the test criteria were then applied to a matrix which used a Red, Amber, Green format (RAG). Traditionally, red would be classed as no and green yes, however, within this matrix, green is also used for no and red is also used for yes. It is not easy to ascertain which site is favourable and in addition, there is no overall total of which site scores highest based on the positives. As a visual aid to the reader, it could be safely assumed the more green the better suited the site, however, this is not the case within this matrix. The results of this part of the selection criteria reduced the sites from 17 to 5.

It should be noted that the original site selection process undertaken by WS Atkins, utilised a point based hierarchical system using a methodology based on current UK NHS space and design standards.

Critical Success Factors

The advisors to the Panel have pointed out that "Critical Success Factors (CSFs) are a small number of criteria used at the long list stage to make strategic choices about options. The purpose of a CSF is to support an assessment of how well an option is likely to succeed across the five dimensions of a business case and deliver SMART objectives. The selection criteria should be developed around key CSFs, such as:

• Strategic Fit/Meeting Business Needs
• Value for Money
• Affordability
• Achievability

There is no mention of CSFs in any of the documentation received. In addition, where it is stated that the Site Selection Panel adopted a form of the HM Treasury's Green Book methodology of Yes, No, Maybe', when the potential site failed the question/criterion/test and should not pass to the next question for appraisal' it appears from the outcome matrix that later criteria were then considered even after a No' result had been recorded."[32] This is discussed further in the advisor's report which is appended to this document.

The advisors also raised concerns around the fact that the criteria had been set using a sequencing system as opposed to weighting and stated "...The lack of weightings meant that the Red  Amber  Green  (RAG)  ratings  could  be  interpreted  differently  according  to  technical understanding,  site  knowledge  and  perception..."[33]  A  weighted  process  would  take  into consideration the varying degrees of importance of the criteria questions with some points scoring higher than others.

The advisors went on to make the point that the 24 questions which formed the criteria are largely subjective, making the marking open to challenge and debate. "...Notwithstanding this, the sequential fashion in which the criteria were applied has driven the outcome. In reality two factors i.e. (1) sites large enough and (2) potentially deliverable within the desired timeframe have been used as pass/fail criteria, resulting in the list of 17 sites. The other 22 criteria were therefore rendered not relevant..."[34]

At its public hearing with the Deputy Chief Minister in October, the Panel raised the issue of the criteria questions, that formed the RAG matrix, having not been weighted. The Panel received the following response:

Development Director, Our Hospital:

"weighting wise; we tried to avoid weightings because previous versions of the project had struggled with weightings being applied. So, in terms of site selection, we definitely took advice from the clinicians on the priorities that we should use in terms of the sequence of questioning, and then with the citizens' panel criteria for the sites we used again a sequence that they felt was appropriate..."[35]

The Panel went on to ask the Deputy Chief Minister in a written question what the struggles were in using a weighting process and the key difference between weighting and sequencing. The Panel was informed that the way the site selection process was undertaken for the previous iteration of the hospital project (Future Hospital Project) was challenged by the Hospital Policy Development Board in its report published in November 2018. Among these challenges, the weightings associated with them were criticised for being too light or too heavy. The Deputy Chief Minister advised:

Weightings are of course a matter of opinion – in seeking objectivity there is a risk of subjectivity. Unless trial calculations are made covering all possible eventualities, opinion may change and require weightings to be updated as the implications of each eventuality becomes known, which can compromise the process as a whole. In order to avoid this situation, the project team instead developed a sequential test for site selection that was approved by the Our Hospital Political Oversight Group.[36]

It was explained to the Panel that the concept of the sequential test would screen out less suitable sites from a long list on a pass/fail basis according to a prioritised series of criteria as was set out in the Site Shortlisting Report. It was also explained that as part of the project is being clinically led, the criteria provided by the clinicians and health care professionals were addressed first.

Exclusion of Sites from 5 to 2

On 4th September 2020, it was announced by the Government of Jersey that the Our Hospital' site shortlist had been reduced from 5 to 2. The announcement stated the 5 sites had been assessed using criteria formed by working with the Our Hospital' Citizen's Panel, medical professionals and from the feedback received during island wide public consultation. The announcement also stated that assessments undertaken in reducing the sites looked at the clinical suitability, location, environmental, economic and social impact. The process for deselecting the sites from 5 to 2 involved the findings of the site acquisition report and the preliminary assessments carried out by the Design and Delivery Partner.

Hurdle 1  

The 5 sites were examined and then 3 deselected as they were believed not to be able to meet the timeline and other technical factors especially their ability to meet planning policy (Island Plan). The three sites deselected were:

• Millbrook – Complex multiple acquisition and the potential for compulsory purchase, together with departure from current planning policy are cited as key reasons for deselection of Millbrook.
• St Andrews Park – Ruled out due to the requirement of a special law to develop the site. It is stated the timescale could therefore not be met. Loss of amenity and access and highways are also key factors leading to its deselection.
• Five Oaks – The site is under multiple ownership and would require significant' land acquisition to facilitate the highways improvements required. Visual impact is also noted as an adverse factor for this site, leading to its deselection. Given these factors it is surprising that this site was not deselected at an earlier stage.

The Site Selection Panel were supported by technical advisors covering:

• Jersey Government Highways and Infrastructure
• Jersey Government Town Planning
• Hospital planning, architecture, and design  

The Final Site Hurdle 2  

The remaining 2 sites were assessed against the full list of criteria which was applied by the Site Selection Panel. The Delivery Partner illustrated the results using a swingometer' to assess the relative merits of Overdale vs Peoples Park. The analysis undertaken by the Delivery Partner was presented graphically. The Panel's advisors have stated "...this analysis does not conclude that there is an absolute winner but shows both sites have relative merits and disbenefits that require careful consideration..." [37] . The advisors went on to state the factors used for reducing the sites from 5 to 2 also appeared to effect the 2 final remaining sites. It is unclear how these sites were not deselected at Hurdle 1 as they too were unlikely to meet the timeline and other technical factors.[38]

• Overdale – this site is under multiple ownership, does not accord with the current Island Plan in its entirety, requires significant highways improvements, effects heritage assets and will impact the Jersey skyline.
• Peoples Park – this site will result in loss of amenity which does not accord with the current Island Plan in its entirety; is smaller than ideal but otherwise would appear to meet the requirements of Hurdle 1. People's Park has an area / size below the minimum required.

On Tuesday 6th October 2020 it was announced the final preferred site, subject to States approval was Overdale and P.123/2020 Our Hospital Site Selection – Overdale', (P.123/2020) was lodged au Greffe by the Council of Ministers.

The Deputy Chief Minister presented a Statement to the States Assembly which outlined the reasons for Overdale as the preferred site summarising the process: -

A thorough site selection process was developed and applied to the most comprehensive long list of potential sites. This long list of sites has then been evaluated according to a set of extensive criteria developed and agreed by clinicians, health care professionals, a Citizens' Panel of Islanders and technical advisers. As such, this process ultimately resulted in a final shortlist of two sites: Overdale and People's Park. Taking that into account, together with all of the clinical, locational, environmental, design, economic, financial and social impacts of the new hospital on the final two sites, the Our Hospital Political Oversight Group and the Council of Ministers have determined to recommend to The States that Overdale is approved as the preferred site for Jersey's new hospital and accordingly, a Proposition is being lodged today to reflect that decision...[39]

The statement also confirmed that the final site of the new hospital was due to be debated by the States Assembly on 17th November 2020.

The Panel's advisors have commented on the decision to choose Overdale as the preferred site as not being fully explained or justified. They state "...of course, the GoJ could justify Overdale as being the best site for the project but may not easily be able to explain and justify how they were able to reach their decision using their own criterion which is generally not measurable..." [40] The advisors  have  also  stated  the  reasons  for  selecting  Overdale  over  Peoples  Park  requires explanation and justification, f the decision is to be fully understood and supported.

Within P.123/2020, it is stated:

• There must be no further delay.

• Taking into account all of the clinical, locational, environmental and economic and social impacts of the new hospital on our final two sites, the Our Hospital Political Oversight Group and the Council of Ministers were in no doubt that Overdale was the best option and would deliver an exemplary hospital, future-proofed for future generation of islanders.

9. Stakeholder Engagement

Engagement with the Public

The Panel held a call for evidence targeting members of the public and stakeholders within the healthcare and third sector divisions. The Panel received various written submissions from the public which are available to view on the States Assembly website. An overview of these submissions is detailed below:

I work at Overdale and have done for many years. During periods of poor weather clinics have been cancelled as patient transport/staff have been unable to safely get up the hill, from any road. Due to the additional time taken to get to the site I suspect that more appointments will be cancelled or missed and a demand for more out of hours clinic appointments as people will not be able to access the site quickly in their lunch hour or throughout the day for appointments41(anonymous)

I reside at Castle View, a development of 5 houses on Westmount Road. At no point have I been contacted or even considered in this process. I have particular concerns in that my neighbours at Castle View will effectively lose their homes and have to relocate elsewhere within the Island. I have concerns that the value of my property will be severely impacted should the plans be approved...[41] (anonymous)

I live in close proximity to Overdale, just off Tower Road at the beginning of Richelieu Park, within 100 metres of the proposed site so the building work and the noise associated with it will seriously impact on our lives as will the future operation of the hospital. Living near Overdale it is blindingly obvious that it is not a suitable site. To place a hospital at the top of an incredibly steep hill is just crazy. I am reasonable fit and yet I still find it a challenge to walk up from town. Westmount and Tower Road are always the first roads to shut in wintery conditions and in the last significant snow to hit Jersey, Tower Road and Westmount were closed for a couple of days. I was horrified to hear the plans to rebuild Westmount Road. I can imagine how the home owners felt to hear the news that their houses are vanishing and the impact it would have on others nearby. The hill itself is has a long history of landslides and instability so will probably end up costing far more than predicted. It has already been acknowledged that it will be challenging and complex[42]

Why is saving the King George cottages more important than saving Hillcrest homes? We live and work in St Helier, pay taxes and support the local economy in many ways. We deserve to be represented too[43]

our houses were being considered in connection with the possible location of the hospital. Whilst possibly a separate issue, my wife and I had our property on the market and had received 2 separate offers to buy. Following some legal advice, we were advised the letter received had to be disclosed to any potential purchasers, which of course we did. Following this, both purchasers stated they were withdrawing their offers until such time as there was certainty as to where the hospital site was to be located. Therefore we have currently lost out on the sale of our property, an issue we will take legal advice on depending on the outcome of this and future decisions.  We, as the owners of [redacted], individually emailed Phil Dawes of D2 Real Estate confirming our position that we would be willing to sell to the States. We understood that having the States purchase our properties, it would be one less boundary issue to worry about and the houses could be used in the interim to house workers associated with the construction of the hospital. It now transpires, that shortly after the letters were issued, someone within the States has changed the position and stated that our properties are no longer required45 (anonymous)

What has seemingly been missed is that the acquisition and subsequent clearing of this land is not as straight forward as simply negotiating with the owners of those three properties. For context, Hillcrest and Castle View essentially form a small estate of 10 private houses, all of which share a single entrance onto Westmount Road. The entrance road, together with several common areas (including a percentage for art fixture beside the entrance), along with essential utilities (including a private sewer system) are in common ownership and there are number of rights enjoyed by all residents of the combined estate over that area. The proposition includes the acquisition of these commonly owned areas, including the sole entranceway to the estate. Therefore negotiation / engagement needs to be made with all 10 of the owners of Hillcrest and Castle View46 (anonymous)

This is an important issue, as it is a requirement of the Outline Planning Guidance issued by the Planning Minister on 20th May 2020 that there should be evidence of consultation with the public. To date (20 October 2020) there has been nothing that is recognisable as public consultation. There was promise of an OH website in January 2020 at a meeting between the Friends of Our New Hospital, the States CEO, DGHCS and the OH Project team, but despite frequent enquiries to ask when it might be published there is no sign of it. However, we are now told that it will go live to coincide with the release of the Functional Assessment on 17th November 2020, which coincides with the States debate on the choice of Overdale as the location of the OH, lodged as P123/2020 on 6th October 2020. In our view the level of engagement regarding the OH project with key stakeholders and the public has been wholly inadequate. Only the States Members can assess the level of engagement they experienced but looking from the outside it would appear they have been kept in the dark along with the public...[44]

The written submissions caused the Panel some concern and they raised the Public's concern with the Deputy Chief Minister to ascertain if negotiation and engagement would be needed from all 10 owners of Hillcrest and Castle View and not just those with homes required under CPO.

Question

As the proposition includes the acquisition of commonly owned areas, including the sole entranceway to the estate, can you confirm you do not need the approval of all owners of the estate/s and not just those required under CPO?

Answer

Yes, this is correct.[45]

The Panel will continue to monitor the possibility of Compulsory Purchase arrangements between the GoJ and the effected residents at Overdale and will recommend the Deputy Chief Minister updates the Assembly regularly.

OH Project Team Engagement Process

At its hearing with the Deputy Chief Minister on 13th October, the Panel asked what level of public engagement had been undertaken, or was due to be undertaken. In particular, with those residents who would be directly impacted by the hospital being located at the Overdale site. The Panel was informed that now that the final site had been announced, "we are starting to make contact with the broader stakeholders"[46]

Within R.54/2019, it is stated that engagement with children who are regular users of the Hospital should take place. At its hearing with the Deputy Chief Minister on 13th October, the Panel asked how this was progressing.

It was explained that whilst there was the social values strategy in place, the strategy document had not yet been shared with POG and, therefore, the level of detail contained could not be discussed at this time. However, the Deputy Chief Minister reassured the Panel that "we are rolling out with the education institutions, at all age levels and qualification levels, general qualifications related to the construction industry that we can roll out"[47]

In written correspondence to the Deputy Chief Minister on 15th October, the Panel asked to be provided with a timetable of when the Our Hospital' Team intended to carry out consultation with members of the public who would be directly impacted by the build at Overdale together with details of which residents they planned to meet.

In a response to the Panel, the Deputy Chief Minister explained they could not provide this information, as it would identify the personal details of individuals. The response went on to say:

...In addition, now that the preferred site has been formally lodged with the States and made public, all the owners and tenants of property adjacent to the Overdale site, who could be impacted by the construction of the new hospital, have been contacted so that any questions and concerns can be addressed. The project will continue to engage with both landowners and neighbours of the proposed preferred site...[48]

The response also explained that any owners of property or land that could directly be affected by Overdale had been in discussions with a property agent from the Our Hospital' Project Team since July when the five shortlisted sites had been announced.

On 20th October 2020, following oral questions in the States Assembly, the Deputy Chief Minister circulated a copy of a letter which had been sent to the residents and neighbours of Overdale from the Our Hospital' Design & Delivery Partners. The letter contained "useful information regarding ongoing engagement with residents in the vicinity of Overdale."[49]

The letter was to give assurance that the approach to neighbourhood engagement was taken very seriously by the Design and Delivery Partners and that the next phase of community engagement would begin. This would include contacting homeowners, landlords and tenants who lived adjacent to the proposed site. The letter also stated that regular neighbourhood meetings would take place around project progress and timelines, details about construction activity, defined hours of work together with providing hotline telephone numbers and contact details.

At the time of writing this report, the Panel is not aware how much of this engagement had been carried out and is therefore unable to comment further. The Panel will, however, continue to monitor this situation and will recommend the Deputy Chief Minister provides regular updates to the States Assembly on the engagement the Design & Delivery Partners are undertaking.

The Panel requested a list of stakeholders with whom the Our Hospital' Team had confirmed engagement with. The confirmed list is below:

• All HCS Staff
• COCG
• Senior Clinicians
• HCS Executive
• Medical Staff Committee
• Citizens Panel

• States Members
• Council of ministers
• Connétable s
• Future Hospital Review Panel
• SOSG
• POG
• Landowners/Neighbouring Properties
• Media
• General Public
• Friends of our Hospital
• Scrutiny Advisors

Prior to receiving this confirmed list, the Panel had received a more detailed and lengthier list of potential stakeholders the Our Hospital' Team was planning to target. This included Health and Community Care, Primary Care and the Voluntary Sector. The Panel is therefore disappointed to find that neither of these 3 key stakeholder areas appear to have been targeted prior to the final site being announced.

The advisors also had concern around the level of public engagement and the need to build public confidence. They write within their report that further public engagement ensuring openness and transparency would have helped. Whilst ongoing Covid restrictions may have hindered public engagement to some degree, digital public engagements, presentations of the 5 sites discussing the evaluation process and dialogue around the next steps may have helped. The advisors also state "...given the importance of audit and public involvement, it is disappointing that some form of public site opinion electronically via social media and email could have been built into the results as we have seen elsewhere which builds public confidence..."[50]

The advisors have stated "whilst different numbers pertain in the PWC report and more recent notes for the project team of some 200 staff have been involved, a number of the meetings have been unusually small according to records for a project of this size" [51]

Third Sector/Healthcare Provider Engagement

As part of its own call for evidence, the Panel targeted the third sector and healthcare providers one of which was Family Nursing and Home Care (FNHC). The Panel provided a list of questions, one of which was "Were you consulted in regard to the proposals contained within the Site Selection Document and, if so, at what stages?"

The response from FNHC was they were unable to answer any of the questions within the Panel's call for evidence as they had not been part of the discussion. FNHC went on to say "In terms of community services, I can confirm that our organisation is ready to expand and develop the delivery of community services and is working with HCS on the Jersey Care model. Equally FNHC would support the development of a new hospital, the services within it and any development of services within the community. This process could have been improved by engaging with community stakeholders such as FNHC who are key in the delivery of services in the community and interface daily with hospital services"[52]

The Panel also received a response from Diabetes Jersey who also stated they were not involved in any consultation and when asked if the engagement process met their expectations to which they replied:

"Since there was no engagement, there were no expectations"

The  Panel  also  asked  what  they  (healthcare  providers/third  sector)  would  change  in  the engagement process if they could, to which Diabetes Jersey replied:

The decision on the new hospital's location should remain a political one, but as soon as the States  Assembly  decides,  HCS  and  the  planners  should  consult  with  the  appropriate elements of the third sector to work in partnership for the benefit of all those for whom the facility is being provided[53]

Mental Health Integration

The Panel questioned if a mental health facility, integrated within the environment of a busy, rapid hospital setting could be unsettling for some mental health patients and a more therapeutic environment should be applied.

The Deputy Chief Minister responded to explain the hospital would be designed to receive any acute patient, whether their ailment is of physical or mental health. This is to ensure parity of care and access for patients with a physical or mental health presentation. It has not been concluded that the mental health facility will be in the same building. Nor has it been concluded that it will be in an adjacent building, rather it will be located on the proposed site. [54]

10. Ministerial Lines of Accountability

The Our Hospital' project has various groups and teams involved. Throughout the Review process, the Panel has questioned the clarity around the lines of accountability. During its hearing with the Deputy Chief Minister on 13th October 2020, the Chair of the Panel questioned the role of POG and its responsibility in the decision making. The Chair was advised by the Chief Executive that the political oversight group makes, on behalf of the Council of Ministers (COM), the operational decisions in relation to the development of the specifications.[55]

The Organisation chart[56] above shows the lines of accountability for each of the groups involved in the project. It should be noted the information in this section is taken from the OH Project Manual which was shared with Scrutiny on 2nd October 2020. The Panel has been made aware the document is a work in progress.

Political Oversight Group

The Political Oversight Group (POG) has been established for the Our Hospital' Project. The POG provides independent scrutiny and oversight to the delivery of a new hospital as well as making decisions and taking recommendations to COM, who they take direction from. They also lead on Communications outside the project team.[57]

The Political Oversight Group was established in May 2019 and comprises 8 members:

• Senator Lyndon Farnham (Chair) – Deputy Chief Minister and Minister for Economic Development, Tourism, Sport and Culture

• Deputy Hugh Raymond ( Deputy Chair) – Assistant Minister for Health and Community Services

• Senator John Le Fondré – Chief Minister

• Deputy Richard Renouf – Minister for Health and Community Services

• Deputy Kevin Lewis – Minister for Infrastructure

• Deputy Lindsay Ash – Assistant Minister for Treasury and Resources

• Deputy Rowland Huelin – St. Peter

• Connétable Philip Le Sueur – Trinity

• Assistant chief Minister, Connétable Christopher Taylor , also attends the Political Oversight Group as a substitute for the Chief Minister*

Also attending the group by standing invitation are the following officers:

• Charlie Parker – Chief Executive Officer

• Caroline Landon – Director General for Health and Community Services

• John Rogers** – Director General for Growth, Housing and Environment

• Richard Bannister – Interim Project Director

• Andy Scate** – Group Director for Regulation (now Acting Director General)

• Stephen Hardwick*** – Director of Communications

• Mike Thomas – Director of Risk and Audit

Senior Officer Steering Group

The Senior Officer Steering Group (SOSG) acts as the PRINCE2 project board to oversee and direct project delivery. It makes decisions within its authority levels on the approach to be taken to deliver the project. It ensures coordination of the project into other government programmes and departments. It is accountable for the success of the Our Hospital' project.[58]

The Senior Officer Steering Group was also established in May 2019 and meets at least monthly, two weeks prior to Political Oversight Group meetings. Membership comprises of:

• Charlie Parker (Chair) – Chief Executive Officer

• Caroline Landon – Director General for Health and Community Services

• John Rogers** – Director General for Growth, Housing and Environment

• Richard Bell – Treasurer

• Andy Scate** – Acting Director General, Infrastructure, Housing and Environment Department

• Stephen Hardwick*** – Director of Communications

• Mike Thomas – Director of Risk and Audit

• Steve Mair – Group Director - Performance, Accounting and Reporting

• The Interim Project Director also attends the Senior Officer Steering Group

The Clinical and Operational Client Group acts as the PRINCE2 Senior User, responsible for specifying the clinical and operational requirements for a new hospital for Jersey. It provides a project-level connection to the wider health initiatives via reporting channels to HCS.

This group is chaired by the Director General for Health and Community Services, meets monthly, and has a broad-based, clinically-led membership. Membership comprises of:

• Director General, Health and Community Services

• Chief Nurse

• Group Managing Director, Health and Community Services

• Group Medical Director

• Group Director Commercial Services

• Interim HR Director

• Chief Pharmacist

• Head of Mental Health and Associate Medical Director

• Chief Clinical Information Officer

• Associate Managing Director, Modernisation

• Associate Managing Director, Care Groups

• Clinical Director, Our Hospital Project (reporting role only)

• Our Hospital Project Director (reporting role only)

• Consultant Gastroenterologist and Hepatologist

• Consultant General and Colorectal Surgeon

• Head of Finance Business Partnering, Our Hospital

• Policy Principal, Employment and Social Security

• Acting Associate Director Health Modernisation

• Interim Director of Health Modernisation

• Associate Chief for Allied Health Professions and Wellbeing

• Head of Communications for HCS

The Partnership Board Prince 2 Senior Supplier

At the time of drafting this Report, the Partnership Board members was being established.

The advisors had made the assumption that the SOC would be approved by the Senior Officer Steering Group (SOSG). Should this be the case, the advisors were keen to stress the importance of the approvals process regarding the SOC and went on to state that due process needed to ensure transparency and appropriate sequencing of approvals to meet best practice.

11. Relationship of the Future Hospital and the Jersey Care Model

In October 2020, the Health and Social Services Scrutiny Panel presented its Report on the Jersey Care Model to the States Assembly (S.R.5/2010). It is important to note the key areas as to how the JCM and the hospital project will integrate.

While not specifically part of the Our Hospital' project, in R.54/2019, the Chief Minister advised that its development was a critical re-condition as it would determine the patient needs for a new Hospital, and therefore the size and shape of the Hospital to be developed. Primarily, the JCM refers to the secondary care model as unsustainable and over reliant on beds, both in and out of hospital.

Within R.116/2019, it is stated the project brief (for the hospital) will be developed, based on the Jersey Care Model being developed by Health and Community Services, including:

• establishing project objectives and measures of success
• drawing up a shortlist of sites for detailed evaluation, based on Planning Guidance that has been requested from the Minister for the Environment
• develop a strategic outline case for the new Hospital

The Jersey Care Model Briefing Paper, R.137/2019 was presented to the States on 31st October 2019 and within it, it was recognised that the future secondary care system should continue to provide many of the existing functions, it also identified key differences to what is now envisaged in respect of the hospital setting, compared to the previous Outline Business Case (OBC) for the Future Hospital. Fundamentally, HCS believed at the time that the new hospital should be smaller in scale than originally proposed. It is believed that by improving length of stay, focusing more on ambulatory services and by utilising out of hospital services as an alternative to bed-based care, the bed base could remain a similar level to the current state and therefore circa 80 beds less than the previous OBC (280 beds were proposed in the previous OBC). In addition to this change, R.137/2019 highlighted further key differences to the previous future hospital plan which included:

• Services such as Physiotherapy, Podiatry, Long Term Condition Management and those outlined in Appendix G [of the JCM Briefing Paper] can be partially or fully provided in an alternative care setting outside the hospital including home focussed community care.

• The Outpatient service is proposed to operate in a different way by adopting virtual Hubs for specialist advice and guidance and continuity in care that connects the entirety of the health and care system. The new approach for planned care management and in particular chronic disease management would see the previous Westaway Court' concept removed from future plans.
• Capacity in the future building should be modular in nature so that clinical environments can be adapted to reflect demographic pressure areas such as gastroenterology, renal or cancer services for example where increased capacity may be needed.
• The new facility should be co-located with a small inpatient mental health unit (Campus model) so that services can be closer integrated. This will ensure clinical and non-clinical support services are concentrated in one campus rather than spread across the Island as they are currently.
• The new facility needs greater ambition for digital optimisation than the previous scheme, which is again anticipated to impact on the physical scale and requirements of the Hospital.
• The new facility needs to operate with confidence that out of hospital primary, community, social and intermediate care services are managing increased activity, therefore protecting the Acute Hospital capacity for true hospital-based care need.[1]

In the Site Shortlisting Report that was presented by the Our Hospital' Team in July 2020, it was advised that an impact assessment of the five proposed sites would be undertaken from a clinical perspective and that the exercise would allow the clinicians to ensure the proposals are clinically led, ensuring the optimum delivery of the brief and alignment to the JCM.

In contrast to what was advised back in 2019 within R.116/2019, the message more recently has been that the Jersey Care Model will inform how the future hospital will function, rather than the size and shape of the hospital, but will not define the clinical and non-clinical design requirements.

At a briefing in August this year, the Health and Social Security Panel was advised by the Group Managing Director of Health and Community services that the Future Hospital would not be informed by the needs of the Jersey Care Model, as work from the JCM would be delivered in the community before the future hospital was completed. Rather, the Future Hospital specification would be determined by the Our Hospital Project Group through its clinical process. It was further advised that the JCM would have an impact on how patients use and move through the hospital, which could lead to redistributed pathways and lead to various new outpatient settings, rather than informing the specification and clinical adjacencies of the new hospital.

The Our Hospital Site Selection: Overdale' Proposition and Report (P.123/2020) states:

...whilst the proposed JCM will inform the development of the functional brief for Our Hospital, it will not define the clinical and non-clinical design requirements

P.123/2020 also confirms that due to constantly evolving models of health and care delivery and the needs of Islanders as treatments and technologies continue to progress, the new hospital will be designed in a flexible way to enable clinical and non-clinical areas to be adaptable with the ability to change in layout and use.

Whilst the JCM Briefing Paper suggested that the future hospital should be smaller in size than originally proposed, it is now anticipated that the future hospital will, in fact, be larger than was considered under the Future Hospital' Project. The spatial assessment reports carried out in 2013 concluded the hospital should be 63,644m2 with a footprint of 21,320m2. The new size has been estimated at 69,004m2 with a footprint of 22,243 with basement and 23,243 without. These sizes form the basis of the 2 different options being proposed for the new site.

The Review Panel was under the impression the larger hospital site would be needed due to most of the necessary clinical services to be delivered in the new hospital building being on the ground floor. As previously discussed in this Report, this was a requirement by the hospital clinicians with HCS Colleagues and the Our Hospital' clinical director using best practice in other jurisdictions. It was established that the appropriate clinical services would be best delivered on the ground floor. We have also been advised that due to an uncertain future (in light of recent pandemics), the new hospital needs to be flexible to deal with anything that arises and also needs to be future proofed for the next 30-35 years.

Whilst the Hospital Review Panel understands that the hospital is one part of a wider health system, it raised with its advisors if the flexibility allowed within the proposed hospital build would be  able  to  meet  the  needs  of  the  JCM. It  was  advised  that  "there  was  a  strong  link  in early documents but this became more tenuous in later documents which were very hospital specific. Although 15% flexibility is built in, population growth on the Island is forecast at 1% per annum so this flexibility wipes out after 15 years (less allowing for compound growth). So unless there is a focus on new models of care and transfer of activity from hospital to community the hospital (and the site) will come under pressure within about 12 years."[59]

12. Costs

Projected Costs for Current Project

As mentioned previously in this Report, considerable costs were incurred during the previous future hospital project. These were in excess of £40 million and are explained in the table below.

63

The projected costs for the new hospital site at Overdale have been proposed at £550m. There are additional site-specific and non-site-specific costs estimated to be £254m, therefore, the total cost being proposed is in excess of £800 million.

"...The Government of Jersey has negotiated a maximum build cost of £550m for Overdale..."[60] These costs do not include non-site-specific costs which are anticipated for decant, demolition, project development, advice and management for works to decommission the current general hospital.

Table from P.123/2020 [61]

*total is correct for rounding

The total of these additional site-specific and non-site-specific costs are estimated to be £254m for Overdale and £220m for People's Park. This breakdown of anticipated cost is set out below in Table 2. It should be noted that the costs outlined below may be partially offset by operational savings realised (to be determined -TBD) – these savings will be assessed as part of the Outline Business Case[62]

The advisors have informed the Panel that in addition to the Delivery Partner costs, this sum of £254.5m which has been identified for GoJ direct costs, including land acquisition, internal costs and optimism bias/client contingency amounts to approximately 30% of the design & delivery partner costs, which is the level expected at this stage of the project.

Contingencies

The Panel has learnt from its advisors that the inclusion of suitable levels of optimism bias and project contingencies within the client budgets appear appropriate for this stage of the project. There is however, a small level of contingency (£14.7m (3.5%)) held within the delivery partner costs and given the complexity of the scheme this is considered to be insufficient. The advisors have state they would expect a contractor contingency of approximately 10% to be included for budgeting purposes.

Previous Project vs New Project

Throughout the Review, the Panel has questioned the costs of the previous future hospital project which was a complete demolition and new build in phases with additional acquired and GoJ sites.[63] The previous project was projected to cost £466 million and as previously mentioned, the current project has a projection in excess of £800 million. The Chair of the Review Panel raised this at the recent hearing with the Deputy Chief Minister and it was explained that like for like comparisons could not be made regarding both projects. The previous project was due to be two sites and the current project is proposed as one site with additional services such as mental health being integrated into the development. The Panel was also made aware that the previous project did not allow for the expansion that was being proposed in the current project. The Chief Executive advised:

Chief Executive:

The estimated costs are more than that that were proposed and we can show that and come back to you on that. But what I was trying to point out is that the current proposed cost estimate is not a like-for-like comparison with the previous cost estimate for Gloucester Street and that is just fact. The £456 million would not have been the final bill for the completion of the health service as we are proposing at Overdale with a single-site solution, it would have been considerably more. [64]

The Panel's advisors have raised the issue of costs within the table in P.123/2020 which shows a cost of £412.2m for the construction of the hospital itself. The advisors explained that "...based upon our understanding that the eventual size of the hospital will be approximately 70,000m2 this results in a cost per m2 of £5,888. We would expect the benchmark cost for this type of hospital to be in the range £5,500 to £6,500 m2. This excludes any premium for building on Jersey versus the mainland..."

Within P.123/2020, paragraph 6.2 states The Government of Jersey has negotiated a maximum build cost of £550m for Overdale'. The advisors have concerns around this figure stating "...it is difficult to understand how such an emphatic statement can be made at this stage. The sum of £550m relates to the affordability limit' to be agreed as part of the pre-construction appointment with the Delivery Partner (FCC/ROK). This in turn will relate to the information upon which this figure is based. With relatively little information upon the design of the hospital, site surveys and information, enabling works requirements and scope of highways works there is significant risk that the final sum paid to the Delivery Partner will exceed the figure stated..."[65]

The advisors go on to say "...To effectively guarantee the costs to deliver the new hospital at this stage of the project would appear to be somewhat optimistic..." [66]

This statement has been further qualified below:

The question relates to us stating negotiated build cost of £550m in proposition. Their statement is correct that we cannot guarantee a cost of £550m at this stage, we have an affordability limit in the PCSA which is a target not to exceed figure that partners are working towards. We do also have a realistic level of optimism bias and client contingency for any changes that we wish to make that are different to the employers requirements. The DP should live within the £550 to deliver the employers requirements. That is why the £550m is challenging and we are very unlikely to deliver below this without compromising the hospital[67]

Contract

The Panel is aware the use of the NEC suite of contracts is being used for the delivery of the project. The advisors have confirmed this suite of contracts would be recommended for major public projects as it promotes strong project management and risk management as well as a collaborative approach between the parties. Whilst the advisors support the use of this contract, it should be noted that the main construction contract is intended to be an NEC3 (Option C) which shares the risk of cost increases between the Employer and the Contractor. As such the Employer (GoJ) should be aware that there is no guarantee that the project will be delivered on or below the currently forecast figure. However, the delivery partner is incentivised to bring the project in on time and on budget.

The advisors have also made the point that in order for the NEC3 contract approach to work correctly and successfully, all key participants should be familiar and trained in the thinking behind the use of the contract. This would include the project manager plus the delivery partners key personnel. The advisors have recommended that the SOSG and Our Hospital team are also familiarised in the operation and use of this contract type. In addition, they also state "we also have a view that in pursuing the selection of Mace and FCC that the Our Hospital Project Team do not have access to a client side' suite of Technical Advisors that can hold the contractors to account and ensure that the client's needs (through the Employer's Requirements) are met. We believe this is a deficiency in the structure that has been adopted and should be rectified."[68]

13. Business Case and Functional Brief

Best Practice for Public Sector Infrastructure Projects

The benchmark best practice for major infrastructure projects funded through government and public sector is the UK Treasury published guidance under the Green Book' or Appraisal and Evaluation in Central Government'. The advisors have undertaken this review in line with this guidance and have reviewed the governance, process and decisions/approvals which has been benchmarked against best practice. The advisors have given background on how this process should evolve:

• The Green Book sets out the evolution and development of the Business Case through three key stages which are documented; these being, The Strategic Outline Case (SOC), The Outline Business Case (OBC) and The Full Business Case (FBC). Each of these cases are, in turn, organised into five separate cases; The Strategic Case, The Economic Case, The Management Case, The Financial Case and the Commercial Case. Each of these cases' are developed in greater detail as the Business Case progresses with a different level of emphasis at each stage. It is also required to undertake an appraisal of alternative options (the option appraisal) to meet the strategy within the SOC.