The long-delayed Midland Metropolitan University Hospital (MMUH) in Smethwick, West Birmingham, is now planned to open on October 6, six years later than planned, and with substantial question marks over the viability of the new hospital once the current A&E departments close permanently.
The hospital, along with the Royal Liverpool Hospital – both signed off under the Cameron government to be funded through the Private Finance Initiative (PFI) – was among the most prominent immediate casualties of the collapse of construction and services giant Carillion in January 2018.
Work on both hospitals was halted in what was supposed to be the final stages of completion, but when the NHS eventually stepped in with public money to rescue the botched projects both required massive remedial work to correct construction failures.
The MMUH was originally costed at £340m and due to be completed by 2018. The PFI project was only made to appear to be value for money because of the assumption that the private sector would take over responsibility for any “risk” in the project – and that this “transfer of risk” was valued at £105m (FBC p142).
But of course the risk transfer has been exposed as a sham. The private sector ‘partner’ proved unreliable and collapsed: all of the biggest risk always laid with the public sector.
The completed hospital now costs almost three times as much as planned, £1 billion, and has only been completed at all because the public sector rescued the project, paying to bring in Balfour Beatty to finish the building.
The new hospital will have 736 beds, 37 more than planned in the Final Business Case (FBC), but 70 fewer than the existing beds in the hospitals the MMUH is effectively replacing – Birmingham’s City Hospital and Sandwell General.
The Sunday Times reports local NHS leaders have been “scrambling to discharge patients and open up 130 beds in nearby hospitals before moving into the new site,” and notes “Experts warn that the wider problem is the result of unrealistic NHS plans drawn up a decade ago, to shift care into the community.”
Those plans were challenged from the beginning by local campaigners from Keep Our NHS Public and Birmingham TUC unions, who published a detailed response to the Final Business Case when it was published in January 2016.
It warned that
“The new hospital will have 135 fewer acute beds than the current Trust provision – a reduction of almost 17%. This is a gamble in an area with a rapidly rising population and above average levels of ill-health.”
“… The plan for the new hospital promotes it as a new specialist hospital and a centralisation of services for increased efficiency. But while the theory of this may make sense, in practice the plan involves use of more intermediate beds, all of them some miles from the MMH site [at Sandwell, City & Rowley Regis] – leaving services far from centralised.”
While the plans included a slight increase in numbers of assessment beds, the FBC showed bed reductions were focused on medical (-94) and surgical (-56) beds, with the new hospital effectively outsourcing its longer stay patients to ‘intermediate’ beds, requiring ambulance transfers.
And many outpatient clinics, too are to be kept at City and Sandwell, raising the question of specialist staff travelling between several sites: the campaigners’ response warned:
“The new hospital also requires the retention of clinic, outpatient services, Treatment Centre and Urgent Care Centre at City Hospital and Sandwell, all rebranded as ‘community facilities’. The redevelopment and backlog maintenance will require additional investment, but no source of funding is identified.”
The new hospital will not even have its own mortuary: the FBC makes clear cadavers from MMUH will need to be transported to Sandwell for the foreseeable future.
Indeed the whole project was based on a series of contradictory assumptions on capacity and income:
“The sums only balance at all because the Trust is assumed to gain an additional £10m of clinical income in 2019/20, and further increase clinical income thereafter (FBC p224).”
It was not explained how this could be achieved in the context of reducing the number of beds, focusing on reducing the number of admissions, and frozen NHS budgets falling in real terms.
The FBC in 2016 assumed an immediate substantial reduction in average length of stay – equivalent to around 100 beds, even though the actual length of stay had been increasing since 2009. Based on increased numbers of patients and reduced lengths of stay, the Trust was projecting significant increases in income every year – alongside a drastic 19% overall reduction in staff, with a reduction planned of 16% in the junior doctor pay bill, while “other clinical staff” pay bills were expected to drop by 27%.
However, the Trust Board’s September meeting heard that the length of stay has increased even further, as a result of problems discharging patients for lack of sufficient support outside the hospital. The Trust is still reliant on a higher-than-planned number of bank and agency staff and keeping extra capacity open. It’s not clear whether the original staffing plans are deliverable.
Obviously the entire scenario has moved on since the FBC in 2016, but the contradictions and concerns over the clinical and financial viability of the new hospital remain.
The FBC revealed that more than three quarters (78%) of the scheme’s proposed cost-cutting “efficiencies” centred on savings on pay, with a near-halving of numbers of non-clinical staff (cutting the non clinical pay bill by 60%).
This includes replacing porters with ‘automated guided vehicles’ (AGV’s). How this works out with nursing and other professional staff remains to be seen, with the September Trust Board having heard that “The testing of AGV capacity has fallen short by circa 30% against plan.”
The campaigners pointed out in 2016 that “automated trolleys – even if they work – need to be loaded up and unloaded, with goods hopefully arriving in the right place. If support staff are not to be employed to do this work, it will fall to clinical staff – mainly nurses – to do it, over and above, or instead of their main clinical work.” This may seem efficient, but it has a cost.
Anyway even if the new hospital’s viability is in doubt we can take cheer from the fact that it is well provided with retail outlets to keep waistlines bulging. The Trust boasts:
“Our retail offering will also include a Greggs, Marks & Spencer as well as an Amazon Market Express. The Winter Garden on level 5 will host our restaurant and complement our numerous coffee shops available across the hospital site.”
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