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Some time in 2026 the redevelopment of the Royal Sussex County Hospital in Brighton might be finished – several years late and considerably over budget.

HSJ understands the first stage of the work is not now likely to be completed before the autumn of next year – more than two years later than scheduled. The trust is not disclosing how much the entire development is now projected to cost but it is far more than the £485m projected in the full business case.

Assuming the trust does get the money it needs to finish the redevelopment – the remaining parts of which are rather ominously being “updated” with the national new hospitals programme team – what will it mean?

First, of course, Brighton and the wider catchment area will have a first-class building which should enhance the care on offer to patients, hopefully allow some repatriation of work which currently goes to London and produce some efficiencies.

However, the likelihood is that University Hospitals Sussex Foundation trust, which now runs the hospital, will face some extra bills, even if the government funds the overspend through public dividend capital.

The trust would, of course, endeavour to increase income and cost improvements to counter this. But the full business case from 2015 suggested mitigations could include omitting high cost elements of future service developments; withdrawing from unprofitable services; consolidating the trust’s estates by vacating some rented sites; and making “global changes” to its cost base. In the event of longer than expected construction, omitting service development costs was in the firing line.

No one wants it to happen, but the board of UHSussex may have to make some unpalatable choices over the next two to three years.

Nowhere to go

The pressures of delayed discharge have been growing since the spring but are still lower than pre-covid, according to data seen by HSJ.

The number of hospital bed days occupied by people who are medically ready to be discharged has been growing steadily and is now higher than in the winter, but is substantially lower than before the pandemic.

Since spring last year, there have been measures and funding in place to speed up discharge, to keep more hospital space free. The main initiative is known as “discharge to assess”, for which government funding is due to run out at the end of September

Senior managers and clinicians who spoke to HSJ about the current pressures called for it to be renewed. They said some of the increase in long waits for discharge was due to the growing numbers of non-covid admissions since the spring, increasing acuity (seriousness of illness), and pressure across the health and care system growing over that period.