Trust’s ‘new hospital’ bid replaced with upgraded unit

Instead of the initially promised wide-ranging infrastructure investment for Cornwall worth several hundreds of millions of pounds, the government has instead only committed to a smaller development.

The new plan would instead see a doubling of funding for a new women’s and children’s unit at Royal Cornwall Hospital, which had already been announced.

This smaller scheme was announced by Boris Johnson as one of 20 “hospital upgrades”, two months before the “40 new hospitals” programme was launched.

HSJ understands Royal Cornwall Hospitals Trust’s initial plans included a wider overhaul of Royal Cornwall Hospital’s estate (going beyond the creation of the new women’s and children’s unit), a new electronic patient record and modernisations across Cornwall’s community hospitals.

Many other trusts in the hospital building programme are planning projects whose cost projections range from £400m to £1.2bn.

HSJ can also reveal that up to 10 schemes, dubbed “agile”, could see their funding and building work accelerated, to take place alongside what was expected to be the first batch of trusts seeking approval for major hospital redevelopments. All 40 schemes in the programme’s scope have now been categorised into “phase 1, phase 2, phase 3 and phase 4” (see below).

“Hospital upgrade” becomes “new hospital”

In early August 2019, prime minister Boris Johnson announced 20 “hospital upgrades”, of which the largest was a £99.9m allocation to RCHT for a new “women’s and children’s hospital” (described by the trust in its 2020-21 annual report as a “women’s and children’s unit”).

Nearly two months later – in late September 2019 – Mr Johnson launched the government’s Health Infrastructure Plan at the Conservative Party conference.

The HIP listed RCHT among 27 trusts which would receive seed funding to submit plans for major hospital building projects.

However, documents released to HSJ through the Freedom of Information Act reveal RCHT’s HIP scheme to be the women’s and children’s unit previously announced by the PM as a “hospital upgrade”.

HSJ understands the scheme’s inclusion in the government’s building programme means the funding allocation has risen from £99m to £186m and will enable a much greater transformation of women’s and children’s services at the trust, but it falls far short of the costs of projects being planned by other HIP trusts.

A spokeswoman for the Department of Health and Social Care did not respond when asked why RCHT’s scheme had been changed, but she added: “The exact scope of any hospital is always subject to change.”

RCHT said the increased funding for the unit would enable a full “reprovision of all women’s and children’s services, as well as the decanting of services including the trust’s cardiology service and some pathology and pharmacy services to make way for the new building”.

A spokeswoman for the trust referred HSJ to DHSC when asked why its scheme had been changed. She said the trust would make funding submissions for schemes which would have ”previously been part of our HIP programme” in future waves of the government hospital building programme. 

Trusts’ schemes put into different phases

Four categories — or phases — have been established by DHSC to balance its HIP schemes’ readiness with the potential benefits of running similar schemes at the same time.

Following our FOI request, the DHSC released a spreadsheet (see below this story) to HSJ detailing which scheme is in which category.

The RCHT women’s and children’s unit is one of 10 schemes which has been placed into the “agile” (also called phase 2) category of the government’s building programme. According to DHSC, the agile schemes are “smaller in value and flexible in delivery timeline”.

RCHT said being placed in this category was an “indicator” that its project was anticipated to start construction between 2022 and 2024, with completion planned some time between 2024 and 2026.

Two other “agile” schemes – in Plymouth and Nottingham – also aim to start construction starting during 2022 or 2023, according to their trusts’ spokespeople.

This means the “agile” schemes may start sooner or alongside the eight “pathfinder” trusts, whose schemes have been earmarked for funding before 2025. Pathfinder trusts’ schemes are “larger in scale with advanced plans”, the DHSC said. These trusts are in phase 3 of the programme.

HSJ revealed last month how these trusts have been told to submit plans for cheaper hospitals as part of the planning process, with £3.7bn in funding having been confirmed for the building programme up to 2025.

Five of the agile schemes are in Dorset, where health chiefs plan to refurbish several community hospitals and transform the acute providers’ estate. One of the schemes (Dorset County Hospital) was not mentioned in the initial HIP programme announcements.

Stephen Killen, programme director at the Dorset Integrated Care System, told HSJ: “As an ICS we collectively prioritised Dorset County Hospital as the first scheme to be addressed in Dorset and we are now working with the [government] to understand the “agile” timescale for our other schemes.”

Phase 4 trusts, also known as “full adopters” will “fully benefit from the knowledge and experience in delivery of the earlier schemes in the programme”, according to the DHSC.

Eight projects are included in phase 1, dubbed “in-flight”. These are projects which are either already in construction or due to start construction shortly. All but one of these schemes (Royal United Hospital Bath Trust) were announced before the “40 new hospitals” programme began.

The Bath scheme was, like RCHT, initially placed among the 27 HIP trusts but neither the trust or DHSC have confirmed whether being placed in phase 1 has changed the trust’s plans.

Finally, phase five of the programme comprises eight schemes which have not yet been selected. Trusts submitted bids this month to be in this category. The category is likely to be filled with a mix of mental health and acute trusts.

HSJ revealed last month that a communications “playbook” for the government’s NHS building programme issued to trusts stated that major refurbishments and new wings/units which are part of the scheme “must always be referred to as a new hospital”.