Management at Whiston Hospital, which only opened in 2010, have applied for permission to install a 2-floored Portakabin in the car park to provide 60 extra beds.

Whiston’s A&E is the busiest on Merseyside, and the St Helens & Knowsley Trust is concerned that sky-high bed occupancy levels can lead to “inappropriate” levels of care on wards and result in a lower rating from the Care Quality Commission.

Whiston was part of a £338 million redevelopment, which also included the opening of the new St Helens Hospital. Just ten years later, having already paid a staggering £462m in unitary charge payments, and with over £2.2bn more to pay on its 42-year Private Finance Initiative contract with runs to 2048, it is too small and resorting to desperate measures to expand capacity.

According to the Liverpool Echo the planning application states that the Portakabins would be in place for “a minimum of five years” in order to “bridge the gap until the more permanent solutions, both on-site and in the community, kick in”.

With no prospect of any extra allocation of NHS capital for expansion until at least 2024 this sounds like wishful thinking.

But even the six new hospitals that have been given the go-ahead since Boris Johnson took over as Prime Minister last July are already faced with the prospect of bed shortages and inadequate capacity – before a brick is laid.

One example is the new specialist emergency care hospital which is to replace most of the front line services provided from 1,048 beds by Epsom and St Helier hospitals in South West London. The CCG will put the decision on where it should be located out to consultation, but have already decided that their favoured option is Sutton.

Downgraded

The opening of the new hospital, which will be very much dominated by the needs of the Royal Marsden Hospital next door, will mean the both of the existing hospitals providing A&E, Epsom General and St Helier in Carshalton would be downgraded to urgent care only.

Six core (major) services, the emergency department, acute medicine, emergency surgery, critical care and children’s beds for the most unwell patients, those who need more specialist care, and women giving birth in hospital would be provided only on the one new hospital site, with just 496 beds.

So even if some elective work is retained at Epsom and St Helier and bed numbers remain unchanged, the big question is how would the new hospital cope with this reduction in front line beds? And is £500m anywhere near enough to provide the mix of services proposed in the consultation?

Leicester is another one on the list of six new hospitals to be built – and another where there are more doubts than certainty on whether the plan is viable or affordable for the money available.

January’s meeting of the University Hospitals Leicester trust Board heard that urgent and emergency care continues to be “extremely challenging,” with a 5.4% increase in emergency admissions in November 2019 compared to November 2018.

But the last detailed plan for health care across the county, the 2016 Sustainability and Transformation Plan, called for a hefty – and unachievable – reduction in bed numbers by 243, 12.5% of the total, by 2020-21.

The most recent winter sitrep reports show that even with 82 “escalation beds” open the trust is consistently running with well over 90% of beds occupied.

In December the trust only managed to see and treat 58.5% of the most serious Type 1 emergency patients, and the lack of beds kept over 2,300 patients waiting over 4 hours on trolleys after a decision to admit them.

Since then an extensive Preconsultation Business Case has reputedly been drawn up under a total blanket of secrecy: rumour has it the document could be as much as 1500 pages long.

But it has not been released for any pre-consultation with the public in Leicestershire, quite likely because health bosses fear the critical eye of local campaigners could swiftly demolish the assumptions and wishful thinking if it were revealed.

Protests demand end to secrecy

We now have the curious situation of a looming deadline of late March to launch the full consultation (which has to precede any business case to release the funds for the new hospital), but no clarity on the extent to which reality has forced a change in the planning assumptions of 2016, and no public discussion having taken place on the “pre-consultation”. Campaigners have begun to protest outside local meetings demanding an end to the obsessive secrecy.

In Leeds there is little pretence that the “new” hospital will add any significant number of beds, even though the latest statistics show the trust’s beds 98% full on January 19, even with 147 extra beds (almost an extra 10%) open. Most of the new buildings will simply be replacing and upgrading what’s already there.

The section on Leeds in the West Yorkshire STP in 2016 made clear the aim was to provide fewer services: “We need to encourage greater resilience in communities so that more people are able to do more themselves. This will reduce the demands on public services and help us prioritise our resources to help those most at need.”

In line with this, the press release on the funding for the new development at Leeds Teaching Hospitals Trust listed the “fantastic new facilities” that the money would be used for, with no mention of any extra beds:

  • expanded critical care services to support the delivery of highly specialist treatments
  • brand-new, state-of-the-art theatres as part of a dedicated theatre suite for day case procedures
  • a high-tech radiology department that will serve other specialties in the hospital
  • one central department for all adult Outpatient services. This will be supported by the latest technologies and key services, including pharmacy
  • a therapies hub
  • a new facility for endoscopy services.
  • KONP Co-chair Dr John Puntis, who lives in Leeds told the Lowdown:

“The Leeds Health Plan as everywhere else of course envisages a reduction in hospital activity as more care moves into the community (here this is called ‘the left shift’). Bed cuts were justified in the past on the basis of ‘a computer model’ which demonstrated our inefficiency in relation to comparator hospitals and therefore indicated we could manage with less beds.

“I could never get out of the managers how this model had been developed and tested – they just accepted it at face value.

“I don’t think there would be many (if any) clinicians who think there is further scope to reduce admissions or that there are currently enough beds.”

No new hospital for Herts

West Hertfordshire Hospitals Trust’s  long-running plan for a rebuild on the existing Watford General Hospital site, finalised last July, is one of the few current plans that is proposing a larger building and another 70 beds. Chief executive Christine Allen pointed out that this would not be a new hospital:

“while we recognise that some communities would like a new hospital, we have chosen the option we believe is most likely to secure funding.”

The West Herts allocation of £400m is higher than the £350m that had previously been assumed to be the most that could be secured, but well short of the £750m estimated cost of a new hospital in the Strategic Outline Case.

However the money must also cover investment to retain some form of hospital services in St Albans and in Hemel Hempstead, although neither of these will have any emergency services. The Trust has 660 beds in operation this winter, plus 28 escalation beds, and was 93% full on January 19.

West Herts is also the only trust to openly mention the question of affordability: “In the meantime, we do know that the funding will be made available on the basis, as expected, that this operates like a loan and there will certainly need to be repayments.”

By contrast the second London project to get the go-ahead, Whipps Cross Hospital, part of the giant Barts Health trust, has made clear from the start that it will be a new, taller building on about one fifth of the site of the present hospital, releasing the remainder of the site for housing.

A glossy promotion pamphlet showing futuristic buildings makes no mention of bed numbers but it’s highly unlikely the new building will have any more beds than Whipps now has to deal with its large catchment population in Waltham Forest and surrounding NE London boroughs and parts of Essex.

Harlow’s Princess Alexandra Hospital (PAH) seems to be one of very few completely new hospitals on the list of new projects: the Trust Board decided after a public meeting last autumn that it did not want to attempt to rebuild on the existing site, but to build on a greenfield site by Junction 7A of the M1.

PAH chief executive Lance MCarthy warned the Board that the new hospital is unlikely to be open until 2025, and that the Trust itself does not have “the required skillset for a project of such size” – so will no doubt be in the market for management consultants as an additional resource to fill in the gaps.

There are still no details on the likely size of the new hospital, although earlier plans have included a 424 bed hospital with a total of 633 “care spaces”. The current one with almost 400 beds is consistently over 90% occupied even with an extra 24 escalation beds open.

Not enough cash

These six newly authorised projects are not the only ones with management wondering if the money they have been allocated is enough to pay for the new buildings they need.

In Shropshire the projected cost of the ‘Future Fit’ plan, to downgrade services at Telford Hospital and “centralise” emergency and specialist services in Shrewsbury has increased by 60%, from the £312m that has been allocated to an eye-watering £498m. Campaigners reckon local health chiefs have probably known for years they’d got their sums wrong – but chose to keep it quiet.

So while ministers continue to boast of the limited extra funding they will be giving the NHS after a decade of real terms cuts, the question is how far short this extra funding will fall, and how trusts desperate to renew crumbling buildings and clapped out kit can draw up realistic plans to deliver adequate capacity for decades ahead – and find the cash they need to make it happen.

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