Submission - Our Hospital Project Outline Business Case and Funding Review - J Pinel - 06 September

Dear Scrutiny

I am writing in regard to the consultation on the funding for the Hospital project;

• The proposed budget of £804.5 million is appropriate for Jersey and for this project

I think that this is a ridiculous sum to spend on the hospital. The responsibility to pay for this will be put onto today's young people, yet they will have huge costs in dealing with future problems such as the issues which climate change will cause. It is immoral and simply wrong to burden the young with these costs.

Recognising that we have an aging population for the next 20 - 30 years, after that, it is highly likely that population levels will fall. An adequate population policy to control immigration, will assist in this. Most population increase is driven by immigration, we need to invest in our young people to avoid the hidden cost of growing our economy by driving inward migration.

There is evidence from all over the world that a hospital of this size, for this sized community does not have to cost so much.

• The UK is currently tendering for new and refurbished hospitals - how will those costs compare with this price?

• France has built hospitals at a fraction of the cost of this proposal for, it would appear, a larger community.

Every effort should be taken to reduce costs;

• A site should be found which doesn't require the huge cost of a new road eg. Warwick Farm

• The huge atrium and unnecessarily flamboyant design should be reconsidered and redesigned and a simpler building should be provided.

• A competitive tender, a competition (or just about anything) could be held to seek a simple, sustainable design and build, instead of the unnecessarily elaborate current design.

What is more appropriate is to invest in people's health and wellbeing, educating and encouraging people to make healthy choices, and reducing levels of poverty. We have food banks in Jersey - this is shocking, no wonder people are unhealthy if they cannot afford to live here. A happy, healthy population will be less ill and will need a smaller hospital.

There are no firm plans for the building, and the proposed building does not appear to adequately replace the services provided by the hospital that we have. There is no doubt that we need a new hospital, but at what price? A review of the design must be considered to determine if costs can be reduced.

• £756 million of that budget should be borrowed by using public bonds

If that can be raised, then I imagine that this would be a reasonable way of funding the project, but the key consideration is to redesign and re-site the building so that it costs less to build.

The risk of a rise in interest rates does not appear to have been considered, and how the SOJ will repay the bonds does not appear to have been considered. This is another burden for future generations, which we should be addressing today with an affordable and sustainable design for the new hospital.

What if COVID or another pandemic, or climate change impacts require further spending on top of the current cost of the COVID pandemic, how will the bonds be repaid?

• Borrowing of this scale should be used to finance a new hospital

Absolutely not - the project is too expensive for Jersey. A site which does not require these costs should be found and a building of lesser flamboyance should be built.

If borrowing is required, then it should be capped at a reasonable and sustainable proportion of the anticipated costs, which should be reduced from the current, astonishing price.

• The investment returns of the Strategic Reserve should be used to pay debt financing costs, management and administration costs

Of course they could be used to support these costs, but not at the expense of everything else. Again, we are simply taking from future generations, when we should be building a sustainable hospital, without unnecessary costs, including the road. Find a new site which doesn't need a new road, and build a smaller structure.

There should be greater transparency of this funding and on the impact of reducing the strategic reserve on future generations. It is a 'rainy day fund' for emergencies, this is a capital project which should be using a sustainable funding model.

Every capital project has gone over budget, and it is likely that there will be further, unconsidered costs.

Climate change will definitely be bringing us emergency costs in the very near future and this is what the strategic reserve is for, not for financing capital projects.

• The proposition adequately addresses the economic risks or benefits • The conclusions of the Outline Business Case are reasonable

I disagree. There is no sustainability appraisal. The world will be a different place in 30 years time, when we will still be paying for this enormous building. Climate change impacts will be costing us millions in adaptation costs, and none of this is being considered in the risks.

We don't even have a population strategy to determine how many people will be using the hospital.

There is no 'green' travel plan for accessing the proposed new hospital.

The build alone will increase Jersey's emissions considerably when we are seeking to be carbon neutral. We will be paying carbon offsets for it, on top of the costs of the building.

There is no reasonable argument to build on top of a hill, with all the landscape and environmental impacts which remain unconsidered in the business case.

There should be greater transparency on where this money is being spent and what it is being spent on. Where is the breakdown of costs?

Fundamentally, this is too expensive for Jersey and it must be redesigned to reduce costs. If any States member is brave enough, they should put forward a well defined proposition to reconsider the site. Not building the road alone will reduce costs.

We will have future, currently unknown expenses, and whilst we cannot account for the 'unknown, unknown' costs, we have to accept that with climate change, there will be many.

• The Outline Business Case provides sufficient evidence to support the scale of the proposed project

I cannot see that it does. We don't even have a population strategy to determine how many people will be using the hospital.

It is simply too grand! We need a future proofed, smaller scale, functional hospital with community facilities and a health promotion unit to help people avoid sickness in the first place.

If we invested 100th of this sum in 'Putting children first', then they will be happier, healthier and won't need to be paying for this huge white elephant for all of their lives.

We currently have problems recruiting enough health staff to staff our current hospital, the issues of the high cost of living in Jersey and our ability to attract trained staff in health care do not appear to have been addressed.

What are the running costs of this new facility and how will we fund its maintenance?

• It is sensible to use the Strategic Reserve [Rainy Day Fund] to manage debt and funding of the Our Hospital Project

Yes, if it is an affordable project. As it is, it is not affordable in its current design and the island's 'savings' should not be spent on it.

There should be greater transparency of this funding and on the impact of reducing the strategic reserve on future generations. It is a 'rainy day fund' for emergencies, this is a capital project which should be using a sustainable funding model.

Today's young people will need the 'rainy day fund' to pay for climate change mitigation and adaptation projects, in addition to other impacts. We did not plan for COVID and it has cost millions.

What key issues you think States Members should consider when they debate the funding proposal?

1. The design of the building - is it over elaborate?
2. The location - surely a location that doesn't require a new road will be less expensive?
3. Is it sustainable?
4. How will the costs impact the island in 30 years time when we will need large sums to pay for climate change adaptation?

 What further information, if any, you need about the proposed funding for the Our Hospital Project?

1. I would like to see a design specification and plans for the building in order to understand what we are being asked to pay for.

2. I would like to know what the population strategy projections being used to determine the scale of the design are.
3. I would like to know which States members have shares or other interests in the construction companies bidding for the project.
4. I would like to know which States members have shares or other interests in the construction companies who will be involved in the road building scheme.
5. I would like to know what consideration has been made on climate impacts on Jersey over the next 50 years which influence the design and use of the building.

Has it been designed to deal with 40o centigrade temperatures?

Has it been designed to deal with future pandemics?

Can it produce its own energy without fossil fuel use for emergency situations where storm damage has broken our electricity links with France?

Can it withstand extreme storm events on top of that hill, when climate change impacts cause more frequent and severe storms here?

6. I would like States members to bear in mind that those houses which have been purchased can still be resold, so just because we have invested so much in the white elephant, it is not too late to change the project.
7. I would like a review of the design to be considered to determine if costs can be reduced.
8. I would like to know how we will fund other projects such as the new crematorium and Cyril Le Marquand House?
9. What services currently provided free of cost to the patient will be moving to a 'user pays' service when the new hospital is built?
10. Will the Les Quennevais school site remain as a health care facility after construction of the new hospital and if not, why not?
11. What proportion of the cost will be to fund office and administration space, and why can't this can't be provided elsewhere?
12. What is proposed for the existing hospital site when it becomes redundant?

John Pinel