Greenfield, red light

Exorbitant costs when building a new hospital forced one trust to consider using a greenfield site. Then the trouble really began. Alison Moore reports

Few hospital trusts in the crowded South East have the luxury of choosing where a new hospital can be sited.

Suitable sites for hospitals are rare: they need too much land, good transport links and the potential impact on neighbours or the environment can rule out planning permission.

Many trusts are forced to live on a building site as new hospitals are built around old ones, with staff continuing to deliver services throughout.

But a greenfield site for Maidstone and Tunbridge Wells trust's planned new hospital in west Kent has led to a protracted row between the developers, the trust and the local council. It is likely to be resolved by either the courts or deputy prime minister John Prescott, who has been asked to rule on a planning appeal.

The need for a new hospital is undisputed: Kent and Sussex Hospital, which provides accident and emergency cover for much of west Kent and the borders of East Sussex, is on a cramped site in the centre of Tunbridge Wells, with limited car parking and little opportunity for expansion. Women's and children's services, and some others, are at the older Pembury Hospital, outside the town.

The preferred solution for many years has been to sell the valuable Kent and Sussex site and build a new hospital at Pembury, a difficult and expensive task as services would need to continue while building work went on. In the meantime, the trust just took its place in the queue for cash.

But in the late 1990s, a developer came up with a radically different idea. Forget both the Kent and Sussex and Pembury sites - and build on a greenfield site.

Kilmartin Properties - which owns around 100 undeveloped acres on the Knights Park development, slightly closer to the centre of Tunbridge Wells than the Pembury site - says the idea was suggested by a private finance consortium which is no longer involved. Kilmartin would provide the land but says it has no desire to run or build the hospital.

On paper, the plan appeared to make sense. Building work would be quicker and cheaper than working around an existing hospital - and the hospital could be planned with room to expand should needs change.

Kilmartin director David Peck says: 'The vast majority of people would find access better. You can build a new building, designed to complement the requirements and needs of the hospital. It can be designed without being fettered by any constraint. You can build it cleanly and easily.

The costs of building a hospital on that basis would be substantially less.'

He also argues that a new build would allow the existing hospitals to avoid the problems of interrupted service, dust, noise and the general disruption associated with building work.

'In a place like Tunbridge Wells, it is a nightmare. There are hidden costs of staff morale and recruitment, and effects on patient services.'

At first the former Kent and Sussex Weald trust - which comprised only the Tunbridge Wells hospitals - seemed keen on the idea, according to Kilmartin.

But there were obvious planning issues with the greenfield site. It was not allocated for immediate development, though much of the land around it was used for a retail and leisure park. A new hospital building would be visible from and impact on some areas of housing.

The trust, now merged with Mid Kent Healthcare trust to form Maidstone and Tunbridge Wells trust, pushed ahead with its own scheme for Pembury.

All of this was academic until the Department of Health gave the go-ahead for a private finance initiative project to build a new hospital. The trust won planning approval for a new£257m hospital at Pembury, now grown to nearly 600 beds in a sixstorey building with multi-storey car parking, though transport issues were not resolved until earlier this year.

Kilmartin submitted its own application for the Knights Park site, but Tunbridge Wells council said this would be rejected mainly due to the impact on nearby residential areas and the land not being allocated for development. The company sought a judicial review of how the council had handled the Pembury application, while appealing against refusal of the Knights Park scheme. Then trust chief executive Stephen Collinson accused Kilmartin of being a property company that wanted to 'make money'.

The dispute seemed set to drag on interminably until late spring when Kent and Medway strategic health authority called for an independent report looking at the two possible locations.

This said the Knights Park site would be unlikely to get planning permission - but should it do so, it would be significantly cheaper than rebuilding at Pembury, with savings of£15m. Much of the saving was because Pembury would need an expensive multistorey car park and there would be additional costs building around the existing hospital.

In June, the SHA publicly told Maidstone and Tunbridge Wells trust to look at the Knights Park scheme again. Talks started and enough progress was made for the trust, under new chair James Lee, to agree to compare costs and benefits of both sites.

As a planning inquiry into the Kilmartin scheme got under way, the trust withdrew a statement it had planned to make backing Pembury over Knights Park, leaving the council to fight the case alone.

The trust insists it was neutral between the two sites but could not consider the Knights Park plan as an 'option' until planning permission was granted.

Where now? The trust and Kilmartin insist they are working together and making good progress. Comparative business cases for both schemes are being developed, ahead of the decision on the planning appeal and the judicial review. The trust then expects to make a decision between the two sites and advertise in the Official Journal of the European Communities by April next year.

The new hospital is unlikely to be in operation until 2008-09. An appeal on the Kilmartin site will be determined by the Office of the Deputy Prime Minister later this year and, at the moment, Kilmartin is still planning a judicial review of the council's decision to give permission at Pembury.

Whatever happens, the people of west Kent and East Sussex will have to go on using the two outdated hospitals for a few years yet.

Further information lIssues surrounding the siting of new hospitals are addressed in the NHS Estates capital investment manual, www. nhsestates. gov. uk