Our Hospital Outline Business Care and Funding Review (S.R.13/2021): Response of the Chief Minister

Findings

Comments

1

The  Government  communication  and consultation undertaken as part of the Our Hospital Project has done little to reassure Islanders about the cost of the project.

There is no conclusive evidence to support this view.  The  Panel  received  134  responses  from members of the public as part of its review. There is no analysis of the demographics and, as the respondents  were  self-selecting,  the  views expressed  are  highly  unlikely  to  be  a representative sample of islanders.

In  contrast,  the  number  of  visits  to  the  Our Hospital website has been 25,600 since November 2020 and that includes in excess of 9,000 visits to the three virtual exhibitions. In addition, the team have responded  directly  to  just  short  of  1,600 emails. Further analysis of public opinion is being carried  out  through  independently-run  focus groups  which  will  provide  a  more  balanced picture of views across the whole population. The consultation  has  been  extensive  and  included meetings with a range of stakeholder groups.

Although  there  is  a  large  amount  of  detailed factual information available in the public domain (via the various propositions, the Our Hospital website  and  a  range  of  other  sources),  the

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communications team have had to respond to a high level of misinformation.

In respect of the 134 responses to Scrutiny, the following points are of note:

• many did not address the questions posed by the Panel and some focused instead on site preferences

• the  majority  offered  opinion  without providing any evidence

• the  total  number  of  responses  to  the Scrutiny review was approximately 0.1% of our Island's population

Soundings, the specialist the company leading the consultation  have  noted  the  high  level  of community  engagement  for  the  Our  Hospital project.  The  engagement  exercise  has  been extensive,  thorough  and  highly  accessible. Multiple channels of communication have been offered  during  the  course  of  the  design development from the earliest stages. Islanders' thoughts  and  feedback  have  been  gathered  by phone, through handwritten submissions, online via virtual exhibitions and digital feedback forms accessible from computers and smart phones and through email correspondence to the community inbox'. All forms were well used as the numbers show. In addition, multiple, purpose-built forums that were structured to engage those most directly impacted,  (Overdale  and  Les  Quennevais Neighbour's Forums); community organisations, amenity  groups  and  businesses  (Community Liaison  Group)  and  medical  workers  (Health Workers' Panel) greatly helping to evaluate and feedback on the evolving design at all stages.

Soundings  have  stated  that  these  levels  of consultation are well in excess of the engagement for projects of this type in the UK.

Given the pace and importance of the project, it is essential  to  continue  with  responsive  and informative  communication.  Further  work  to explain the cost and financing of the new hospital is planned and will be published imminently.

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2

Significant  delays  occurred  in  the provision of the information requested by the Panel's advisers on the Outline Business Case (despite the assurances of the Our Hospital Political Oversight Group's  intention  to  positively  and constructively engage with the Scrutiny process') and have caused subsequent delays to the production of the adviser's report and this report.

All requests for information had been fulfilled by 24th  September,  as  confirmed  by  Scrutiny Officers. Many of the requests related to specialist detailed information. Some information requested by the Panel's advisers was not held in the format requested and had to be created anew. This caused additional  work.  The  advisers  set  a  24-hour turnaround for some requests, compared to the expected five-day response time set out in the Code of Conduct.

3

The  original  date  of  the  debate  was moved from 14th September 2021 to 5th October 2021 to allow nine weeks for the Scrutiny Process.

This change was made at the Panel's request to allow Scrutiny additional time to undertake its work.

4

The Panel received minutes of meetings of the Our Hospital Political Oversight Group held since April 2021 on 24th September 2021. This contradicts the Our  Hospital  Political  Oversight Group's stated intention to positively and  constructively  engage  with  the Scrutiny process'.

The papers for all meetings from April onwards were shared in a timely manner, often within a few days of the POG  meeting at which they were considered. In addition, the Panel has received regular briefings to ensure its members are up to date with project progress.

Staff  resource is  limited  and  at  times  of  peak requests - received not only from the Panel but from fellow Assembly Members, pressure groups, the public, media and other stakeholders – this has an impact on response times.

The  POG  will  continue  to  positively  and constructively engage with the Scrutiny process and  have  worked  in  a  spirit  of  cooperation throughout, hence the decision to delay – at the Panel's request - the date of the P.80/2021 debate on budget, financing and land assembly.

5

The political timeline imposed on the Our  Hospital  Project  has  constrained the work of the Our Hospital Project Team and had a subsequent detrimental impact  on  the  work  conducted  by Scrutiny. It is noted that this timeline is one year behind the schedule laid out in R.54/2019 New Hospital Project: Next Steps.

The Our Hospital Project is working to a clinical timeline not a political one. The 2026 target date is based entirely on the need to provide adequate health services for islanders.

As set out in P.123/2021, a six-facet survey was carried out in 2015 and updated in 2016 assessing the  condition  of  the  current  hospital  estate established that the current hospital estate fell far short of acceptable and regulatory standards. A subsequent review in April 2020 of the current hospital's required maintenance established that

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there is effectively a tipping point around 2026, where the cost of maintenance escalates sharply with the cumulative cost estimated to be £51.6 million.  In  addition,  clinicians  have communicated the challenges for patient safety and experience, efficient service delivery and staff recruitment and retention that would be created by having an inflexible, tired and deteriorating estate built, in the main, 60 years ago to the requirements of a now outdated model of care.

The clinical timeline is challenging for the Our Hospital  Project  Team  (OHP  Team)  and  has meant aspects of the project have had to be run in parallel.

R.54/2019 set out an ambitious yet achievable timetable for the project, which at that stage had yet to identify a site. That timetable could not foresee:

• the  COVID-19  outbreak  which  meant additional testing was required to confirm potential Design and Delivery Partner's resiliency in a pandemic situation.

• the  additional  four  months  required  to prepare  for  and  debate  P.167/2020 triggered  by  the  first  amendment  to P.123/2020.

6

The  Outline  Business  Case  is  non- complaint with the UK HM Treasury Green Book Standard.

We  strongly  disagreed  with  this  opinion.  The Green Book provides guidance for business cases and is not a prescriptive rulebook. The Panel's advisers  interpreted  the  use  of  HM  Treasury Green Book Guidance differently. Had the project followed Green Book guidance in the manner the advisers suggested, the outcome would not have been any different.

The introduction to the Green Book itself states:

1.2  The  Green  Book  is  not  a  mechanical  or deterministic decision-making device. It provides approved thinking models and methods to support the provision of advice to clarify the social – or public – welfare costs, benefits, and trade-offs of alternative  implementation  options  for  the delivery of policy objectives.

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It is important to note that the Our Hospital Project follows the Jersey Public Finances Manual. Some decisions  about  the  project  were  taken  at  an advanced stage for the preparation of the Strategic Outline Case (SOC), so there was no need to revisit these in the Outline Business Case (OBC):

• Site  approved –  the  States  Assembly voted  37  in  favour,  6  against  and  1 abstention.

• Significant engagement with clinicians to establish the brief and service model

– this was needed to inform site selection and  has  informed  the  Functional  Brief which was approved at SOC stage.

• Procurement  of  Design  and  Delivery Partner – early appointment of a design and delivery partner has had a number of advantages for the project and took place prior to the conclusion of the SOC stage.

• Jersey-specific context –unlike hospitals in mainland UK or Europe, Jersey cannot use the business case to consider options to provide services at other hospitals in the area: Jersey only has one hospital and needs  appropriate  services  to  avoid compromising service quality and patient

safety.

7

In  contradiction  to  the  commitment made  in  R.54/2019  –  New  Hospital Project: Next Steps, in relation to the adoption of the Green Book Five Case Model, the five cases all have instances where best practice guidance and the requirements of the standard have not been  followed,  or  lacks  detail  and evidence.  This  contributes  to  an assessment  that  the  Outline  Business Case is not robust.

This  finding  is  largely  based  on  a misunderstanding of the process of the project. As noted previously in this response, much of what the  Panel's  advisers,  Currie  &  Brown,  were looking for had been addressed at an earlier stage of the project (in preparing the Strategic Outline Case) so there was no need to revisit these in the OBC.

The commitment in R.54/2019 – New Hospital Project: Next Steps was to adopt the Green Book Five Case Model. This model was followed and the OBC was subject to independent review by Mott  MacDonald,  an  expert  business  case consultancy,  who  provided  feedback  which ensured the business case was robust.

8

Insufficient rationale has been provided for  departures  from  Treasury  Green Book principles.

A rationale for each of the departures has been provided to the Panel's advisers and to the Panel during the Public Hearings. The principles of the

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Green Book guidance have been followed and the timing of certain activities have been dictated by Jersey's specific needs in relation to this project.

9

Justification for the scale of the project has not been evidenced in the Outline Business Case.

The scale of Our Hospital originates from clinical need and has been established through extensive clinical consultation. Our Hospital will be a larger building than the current Jersey General Hospital at Gloucester Street as it will include more health services and allows for future expansion to enable the building to be flexible to the requirements of future  health  care  models  after  it  becomes operational.

The RIBA2 report sets out the concept design and work has been ongoing to look for efficiencies to reduce  the  size  of  the  building  without compromising patient safety or experience.

10

The Outline Business Case is not robust enough to support P.80/2021.

We strongly disagree with this opinion. On page 21 of their report to the Panel, advisers Currie & Brown  concluded  that  the  costs  provided presented for RIBA Stage 2 design are realistic and robust'. The justification for the size of the hospital  has  been  reinforced  though  constant dialogue with Jersey's clinicians who have helped develop a Functional Brief appropriate for and specific to the Island. The clinical view has been constructively and robustly challenged to ensure the  project  team  can  justify  the  scale  of  the hospital.

It should be noted that even if the areas of the OBC  that  the  advisers  felt  need  strengthening were addressed now, the outcome would not be different. It would not be acceptable to allocate additional time and public money to revisiting work that has already been undertaken at an earlier stage in the project or to undertake work that is already scheduled be completed in a later stage of the project. This would essentially be an academic exercise based on a difference of interpretation. Neither the clinical timeline or the project budget should  accommodate  additional  unnecessary work.

11

The  Outline  Business  Case  strategic case includes the majority of the core

Jersey's Island context is critical. We have only one hospital and certain services must be provided

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content  recommended  in  the  Green Book  and  Better  Business  Case guidance;  however,  it  does  not adequately articulate the core scope of the project, proposal to develop a new hospital  of  circa  67,000m2,  a  figure which has not yet been finalised, or the minimum  service  requirements  that need  to  be  met.  This  has  led  to confusion over the size and scale of the proposed development.

so that we do not compromise care quality and safety, and to ensure we do not have to send more patients off-island for their treatment. The size of Our Hospital has been established via rigorous process of clinical consultation. There has been constructive challenge to clinicians on their stated requirements in order to ensure Our Hospital is the right size for Jersey's needs.

Additional services are included in Our Hospital that  were  not  included  in  previous  hospital projects or provided in the current Jersey General Hospital building. Clinical input and best practice in  hospitals  has  informed  inclusion  of  these services:

• Mental Health – clinically led decision to co-locate,  no  health  without  mental health'

• Kitchens – nutritional benefits of fresh cooked meals to support patient health and recovery

• Theatre Sterile Supply Unit – improves efficiency

• Knowledge Centre - more training can be delivered on Island to save travel time and costs,  improve  learner  experience  and investing  in  staff  development  thereby supporting  with  staff  recruitment  and retention

The  current  Jersey  General  Hospital  is  circa 40,000m². To merely bring what we already have up to modern standards would take it to circa 55,000m² but this would not allow for changes in health  care  model  or  the  inclusion  of  the additional services in future. The Future Hospital (v.4 as at August 2018) stood at circa 53,000m² which is not sufficient for current needs in 2021, let alone 40 years into the future. Our Hospital (OBC cost plan 2021) stands at circa 69,000m² and  the  iterative  design  process  has  led  to efficiencies  that  can  reduce  that  size  without affecting patient safety and experience.

12

The  Outline  Business  Case  does  not demonstrate alignment between the Our Hospital  Project  and  key  strategic programmes, especially the Jersey Care

This  comment  by  Scrutiny  shows  a misunderstanding of the relationship between the hospital building and the Jersey Care Model. The new  hospital  has  been  designed  with  flexible

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Model,  and  appears  to  have  been formed  in  isolation  to  other Government priorities and strategies.

interior spaces so that it can accommodate various care models that may emerge over the lifespan of the building.

The  key  strategic  programmes  have  been referenced in the Outline Business Case, where the interface with the Our Hospital project has been explained:

• Jersey Care Model – Chapter 3, section 3, sub- para 3.1.1 - 3.2.4, pages 28 - 33

• Digital Strategy - Chapter 3, sub-para 3.2.5, page 34 – 36

• Policy Review – Chapter 3, sub-para 3.2.8, page 38

13

The long list of options does not fully explore all potential options including hospital size, scope and location.

In  short,  it  does not  need  to.  Size,  scope and location have already been explored at a more advanced  stage  of  the  project  –  the  Strategic Outline Case (SOC). The long list was approved as part of the SOC process. Revisiting these to introduce additional options at OBC would serve no valid purpose – it would merely increase cost and cause delay and risk to the project.

It  is  understandable  that  the  Panel's  advisers might not fully appreciate the background to the Our  Hospital  Project  as  we  are  in  a  unique situation. However, we know the need for a new hospital was identified as long ago as 2012 and that need had emerged years before the debate of P.82/2012 Health and Social Services: a new way forward  took  place.  Previous  iterations  of  the project have foundered – at significant financial cost to the public purse. There has also been a human  cost  for  patients  and  staff  visiting  and working  in  a  tired  hospital  estate  that  cannot support modern health care practice.

We maintain that the site selection process was detailed, thorough and robust with considerable community and professional input.

14

The shortlisting of options has not been undertaken  in  line  with  Green  Book 2020.

As is normal under the Green Book, the initial shortlisting exercise took place at SOC stage in February 2020 and an extensive range of long listed options were considered. At the outset of the  OBC  process,  the  shortlisted  options  were reviewed and validated.

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The Scrutiny review highlighted the fact that an Option Framework Filter was not used to present the results of the shortlisting exercise but it does not acknowledge that the Our Hospital Business Case has followed the principles of the filter. It is the principles of the process rather than the format of output that is important. The five key elements of  the  Option  Framework  Filter  (i.e.  Service Scope,  Service  Solution,  Service  Delivery, Implementation  and  Funding)  were  all considered.

It should also be noted that the version of the Green Book referred to was not published until November 2020, i.e. after the SOC short-listing process  had  been  undertaken  (February-March 2020).

15

There is no Business As Usual (BAU) option which is required to provide a true baseline against which to compare options.

This  was  examined  at  the  early  stages  of  the project and discounted. Islanders have expressed frustration with the lack of progress and expense of previous iterations of the hospital project, so it was  not  felt  to  be  appropriate  to  include  a suggestion that had already been established as unacceptable.  There  were  no  truly  credible comparators as the need for a new hospital is overwhelming. On that basis, a do minimum' option was used as a baseline comparator.

16

No facilities management and utilities revenue  costs  have  been  included  to identify  the  financial  impact  of  the options  compared  to  the  existing arrangements,  the  Outline  Business Case therefore fails to evidence that the proposals  provide  the  best  value  for money.

We know the current facilities management costs and  estimates  for  lifecycle  costs.  A  facilities management business case is being developed. A more efficient and effective hospital building will bring benefits and savings in a range of ways. The question of whether  Our  Hospital  is value for money is wider than just facilities management costs.

17

No facilities management information will be available before the debate of P.80/2021.

The debate of P.80/2021 was specifically about capital  funding  -  not  ongoing  running  costs. Current  facilities  management  and  utilities revenue  costs  are  known,  as  are  the  forecast lifecycle costs, and work is ongoing to establish robust  estimates  of  these  costs  from  2026 onwards.

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18

The  Outline  Business  Case  does  not include  fully  evidenced  consideration to other potentially viable options nor a Business As Usual comparison, which is  unacceptable  for  a  project  of  this scale.

This finding does not take account of Jersey's specific needs nor the complex background to this project. P.82/2012 established the need for a new hospital  for  Jersey.   A  true  business  as  usual (BAU) option is not viable as the Jersey General Hospital  cannot  continue  without  increased maintenance and would very quickly fall far short of providing the  basic health care required by Islanders. A decision was made when drafting the Functional Brief at an earlier stage of the project that  it  would  be  unacceptable,  and  somewhat disingenuous, to put forward an option that was known to compromise patient safety and medical care.

Therefore a do minimum' option was used for the baseline comparator.

19

The  Outline  Business  Case  does  not provide  benefit  monetisation  and therefore  fails  to  provide  evidenced value.

Information on benefits monetisation is provided and shows that the benefits of the preferred option are anticipated to be significantly greater than that of the baseline comparator. A sensitivity analysis is provided that shows that this remains the case even if the benefits for the preferred option are not all realised. This information evidences the value of the preferred option. Monetisation of benefits may well have strengthened the case for a new hospital,  but  lack  of  monetisation  does  not undermine it. The work on benefits describes the value of a modern, fit for purpose hospital that meets  the  health  needs  of  Jersey's  population, supports modern working practices and supports staff training, recruitment and retention.

20

Although the Economic Case is lacking information  and  is  not  HM  Treasury Green  Book  compliant,  cost calculations  are  generally  within expected  levels  and  reasonably calculated. However, there are elements that  are  costed  at  the  higher  end  or above expected benchmarked pricing.

We do not agree the economic case is lacking information or that it does not comply with HM Green Book. We are pleased to note the finding that cost calculations are within expected levels and reasonably calculated'.

The project team has benchmarked Our Hospital with like-for-like hospital projects and established that the cost is within an acceptable range.

The  Scrutiny  advisers'  benchmarking  exercise acknowledges  that:  At  this  stage  of  early  cost estimating, this margin of cost variance is not unusual and is not significant within the overall

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scale  of  the  project  and  can  be  seen  as  an opportunity to target cost reductions through the robust  target  value  design  approach  being implemented by the project team.

The advisers agree with the project team that there are additional elements that account for additional costs such as the unique circumstances associated with constructing a hospital on an Island. This includes additional costs of materials and labour, and importation of plant and machinery.

21

Future revenue costs to the Island of Jersey  of  the  Our  Hospital  Project proposals  have  not  been  calculated, risking additional constraint on public finances.

Although bigger than the current Jersey General Hospital, Our Hospital consolidates a number of services currently spread across the Health and Community  Services  (HCS)  estate  thereby creating efficiencies through  improved clinical adjacencies. Further efficiencies will be gained by using newer technology and through reduced maintenance of the existing old buildings. A separate Facilities Management business case will  outline  costs  for  managing  and maintaining the new hospital.

The HCS  department  has  an  existing facilities management budget that will transfer to the new hospital building.

22

The Commercial Case of the Outline Business Case is not compliant with the Green Book requirements.

The Panel's report suggests there were queries about the process that has been followed. As has been  explained  previously,  the  procurement strategy for the project highlighted the benefits of early contractor involvement. The detailed work on  the  procurement  approach  took  place  in advance of the Strategic Outline Case (SOC), is fully described in the SOC, and is summarised in the Outline Business Case. See responses 23 and 24  for  additional  points  relating  to  the Commercial Case.

23

There is no evidence that the investment to  construct,  operate,  maintain,  and staff  the  private  patients  wing  will provide commercial returns by income from private patients.

It is important to note the proposed dual function of this area within the new hospital. COVID has shown the need for a space that can be adapted to provide extra capacity or an isolation area - such as a pandemic hot ward' - to make Jersey more resilient  to  future  emergencies,  including  any pandemic. This may remove the need to lease a Nightingale Hospital in the event of any future

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pandemic. For that space to be financially viable, it needs to have a function outside emergency situations. Therefore, it is entirely appropriate for it to be utilised for private health care and to generate  income.  This  function  would  cease during an emergency situation.

A significant proportion of Jersey's population has private medical insurance, according to the Jersey Opinions and Lifestyles Survey 2018:

• 44% working adults, 18% retired, 24% of adults  not  working  (e.g.  education, homemaker, unable to work)

• 86% of adults working in finance

• 57%  of  adults  with  private  health insurance said their insurance also covers

family members.

There is an opportunity to generate revenue to offset HCS costs and enhance the provision of public  services.  Work  on  the  private  patient strategy continues to progress and Scrutiny are being briefed on progress.

24

There is  little  evidence to  indicate  a strategy on how benefits, such as job creation, will be achieved.

A Social Value Strategy was drafted and shared with the Panel on 6 December 2020. This strategy considers anticipated social, economic, health and environmental benefits for the project and maps them to Government of Jersey strategic priorities whilst  providing  specific  objectives  and monitoring periods. The finalised Social Value Strategy for the main hospital will be included in the Planning Statement and can be viewed by the public  on  the  Government  of  Jersey  planning portal once the Planning Application has been submitted.

25

The Management Case of the Outline Business  Case  is  broadly  compliant with  Green  Book  requirements however it is lacking elements to allow for  understating  of  Risk  and  Change Management.

As the Panel's advisers note, the OBC sets out a robust  management  case.  The  Project  Manual, which is an appendix to the OBC, provides more information on Risk and Change management and the Panel's advisers were made aware of this. The Project Manual is regularly updated.

26

The  need  to  gain  States  Assembly approval  for  additional  expenditure over  and  above  the  £804.5  million budget is unlikely to act as an effective

The POG are unanimous that the project must remain at the cap of £804.5 million or below. As stated in response to earlier points, the Panel's

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control on costs, especially in the latter stages  of  the  project,  as  the  choice facing  Members  will  be  between agreeing  or  accepting  an  unfinished project.

advisers agree that this budget is appropriate for a hospital of this size and specification.

27

Detailed  capital  and  revenue  running costs  should  have  been  clearly formulated  and  stress  tested  before funding solutions are considered.

Detailed  capital  costs  were  provided,  as  were lifecycle  costs  for  the  new  facility.  Given  the clinical  timeline  for  the  project,  the  work  on running costs was not available. Work has had to be undertaken in parallel to ensure that the 2026 completion date is achieved.

28

Bond finance is a sensible approach to this scale of borrowing if there is full confidence  in  the  asset  (hospital) specification  to  service  demand  and needs and robust cost construction.

The case for P.80/2021 has been built on the basis that financing the project through borrowing and a  bond  issue  the  most  sensible,  cost-effective mechanism for taxpayers over the longer term. Total construction costs were clearly set out in P.80/2021and  these  led  to  the  request  for  a maximum  borrowing  requirement  of  £756 million, which has been approve by the States Assembly.

29

A reduced budget would allow for an alternative  funding  solution  to  be sought.

A  reduced  budget  would  require  a  complete review of the services provided in a new hospital and would result in fewer services available to Jersey  patients.  Alternative  funding  solutions have been explored for this project. Whatever the budget, the number of financing options for a project of this size remains limited.

Recommendations

To

Accept/ Reject

Comments

Target date  of action/ completi on

1

The   Deputy  Chief Minister,  prior  to  the finalisation  of  the  Full Business  Case,  should identify  elements  of  the Jersey  Care  Model  that relate to the Our Hospital Project and these should

DCM

Reject

The new hospital has not been designed around the current Jersey Care Model. It has been designed with flexible interior spaces  so  that  it  can  accommodate various  care  models  that  may  emerge over the lifespan of the building.

Recommendations

To

Accept/ Reject

Comments

Target date  of action/ completi on

be clearly set out in detail in the form of a clinical strategy.  This  should articulate  how  hospital services are expected to change in the future and how  service transformation  will impact  on  capacity, clinical  adjacencies  and hospital design.

This  recommendation  sits  with  the Health  and  Community  Services department  team  which  has responsibility  for  the  clinical  strategy and  service  delivery  as  it  evolves  in future.

2

The   Deputy  Chief Minister  must  ensure  a robust option appraisal is undertaken  and  a  value for money is evidenced if progressing  to  Full Business Case. This must include:

• Consider  a  full range of options for  inclusion  in the  shortlist  to include  both location  and scope  of  the proposal  to address  the priority investment objective.

• Include  the Business  As Usual  option  in the shortlist.

• Include  a  less ambitious preferred  way

DCM

Partially accept

The work described in the final bullet (on running costs) is being progressed and will continue. However, there would be no clear benefit to revisiting the work completed at SOC and OBC stage on options  (including  BAU  and  an alternative  preferred  way  forward'). Undertaking  economic  analysis  again would  increase  costs  without  clear benefit.

Recommendations

To

Accept/ Reject

Comments

Target date  of action/ completi on

forward option in the shortlist.

 Undertake a full quantified assessment  of costs,  risks  and benefits  of  the shortlisted options  to identify  the NPSV  (net present  social value)  of  each option,  in  order to  support  the identification  of the  option offering  greatest value for money to society.

Costs should include the ongoing running costs of the  hospital  including staffing  and  facilities management services.

3

The   Deputy  Chief Minister  must,  prior  to the finalisation of the Our Hospital designs, out-line predicted  revenue  costs of the proposed changes in healthcare provision.

DCM

Reject

The work on revenue costs is ongoing but cannot be reprioritised to meet the Panel's proposed time frame and is not necessary specifically at this stage.

4

The   Deputy  Chief Minister  must,  prior  to final design of the private ward,  provide  to  the Assembly  a  fully evidenced  business  case to  justify  the  additional spend  and  space

DCM

Reject

The work on a private patient strategy is ongoing but due to the constraints of the clinical  timeline  cannot  be  completed within the Panel's proposed time frame.

Recommendations

To

Accept/ Reject

Comments

Target date  of action/ completi on

allocation  to  private services  in  the  new hospital.

5

The   Deputy  Chief Minister  should  publish full details of the change management plans for the transition  to  the  new hospital and provide full detail of the project risk register prior to accepting a Full Business Case.

DCM

Partially Accept

The current risk register was included in the OBC. It will continue to be updated throughout the project.

A  change  management  plan  will  be developed  for  transition  to  the  new hospital in 2026 but will not be complete for  the  Full  Business  Case  which  is anticipated in 2022.

6

The  budget for  the  Our Hospital  Project  should be reduced to £550m to include  optimism  bias, site-specific  costs  and contingency.

DCM

Reject

The States Assembly have rejected this recommendation which was proposed in the second amendment to P.80/2021.

7

The scale of the cost and borrowing  should  be reduced to limit exposure to financial risk.

DCM

Reject

Every effort will be made by the Our Hospital Project team to achieve value for money and reduce cost where this is achievable  without  compromising patient  safety  or  experience.  The Political Oversight Group will continue to provide challenge to the project team to ensure value for money is achieved

8

Overall borrowing for the project should be reduced to  £400  million  and Treasury  should  explore other  options  including the use of the windfall' payment  of approximately  £40 million  resulting  from JT's  sale  of  its  IoT business and other asset disposals opportunities.

DCM

Reject

This recommendation is not considered prudent  given  the  advice  we  have received.

9

To preserve the integrity of the Strategic Reserve

DCM

Reject

These  proposals  would  require amendments  to  the  Public  Finances

Recommendations

To

Accept/ Reject

Comments

Target date  of action/ completi on

Fund,  a  specific  Our Hospital Fund should be created  to  improve focus'.  Included  in  this recommendation  is  that accountability is imposed on  the  Project  Senior Responsible  Officer (SRO) for the delivery of the  project  within  the revised  approved  cost envelope.

(Jersey) Law 2019. The project has a robust governance structure set out in the Project  Manual  to  ensure  effective accountability for the delivery of Our Hospital.