on location North West London

Published: 22/04/2002, Volume II4, No. 5902 Page 12 13

There is a massive£750m building development in north-west London that the developers hope will soon be the talk of the country - and possibly even the world.

After much debate and planning, Wembley Stadium will at last begin to dominate the skyline of much of the North West London strategic health authority area.

But those working in the local health economy are focused on another building scheme, which they hope will become one of the world's premier centres for medicine rather than sport.

The most recent estimates for the cost of the Paddington health campus project put it at around£800m.Although insiders suggest this figure is likely to come down once the project gets under way, SHA acting chief executive Steve Peacock says it is the biggest challenge facing his organisation.

In many ways this giant private finance initiative project, which will eventually bring together the teaching expertise of St Mary's trust, Royal Brompton and Harefield hospitals, and the national heart and lung institute of Imperial College London, on a very swish canal-side development on the current site of St Mary's Hospital, reflects the tensions and power struggles within this diverse part of London.

From the fleshpots of Soho and the national power base of Westminster, to suburban Harrow and Uxbridge and even semi-rural home counties borders, North West London SHA encompasses a huge variety of challenges for healthcare providers.

But for some, this is part of the problem. How, they ask, can such internationally renowned hospitals sit comfortably alongside relatively small primary care trusts?

And how can the district general hospitals within the area hope to compete with the big boys?

One PCT chief executive in the area argues that PCTs can have little or no influence on what institutions such as Imperial College choose to do. They point out that star-ratings for acute trusts across the patch are generally good, while for PCTs they are poor (see box).

'What is the impact of having so many teaching trusts in our area?'

they ask, and they query whether there is really a need for so many large hospitals on the patch.

In fact, the Paddington project, as its market launch brief says, is partly an attempt to deal with precisely that question. It states that the scheme is 'strategically essential if north-west London is to improve and streamline its health services at the same time as providing excellent teaching and research facilities'.

The reshaping of NHS structures during the Paddington planning process has presented its own problems, with the creation of the SHA, and particularly PCTs, halfway through the planning process.

St Mary's trust chief executive Julian Nettel argues that it has been 'absolutely fundamental' to the scheme that his trust's host PCTs (Westminster, Kensington and Chelsea, and Brent) are central to the scheme's development, and he explains that all three have already begun to make financial arrangements so that they will be able to meet the PFI repayments once the scheme kicks in.

But the shift in the balance of financial power within the NHS has led to more complex problems for the funding of Royal Brompton and Harefield trust.

As a tertiary trust, it holds contracts with virtually every PCT in the country, and seeking agreement from them has been more difficult.

Although the sums of money for more distant PCTs will be lower, a deal has been struck that will see host PCTs take decisions, and others will follow.

Royal Brompton and Harefield trust chief executive Dr Gareth Goodier says that far from dominating PCTs and telling them what to do, the trusts behind the Paddington scheme have been at pains to include the PCTs wherever possible.

The governance of the project has been reviewed, particularly with PCTs in mind, he says, and they now have a seat on the joint project board.

Dr Goodier says a trust like his own has relatively few skills required to develop such a massive project, and he accepts that PCTs are likely to have even fewer.

But he argues that the controversial figure of£5.6m paid to outside consultants for work on the scheme so far should ensure transparency and offer help to commissioners (news, pages 89, 8 April).

'If I were in a PCT, that would give me greater reassurance.'

Mr Peacock argues that the beneficial effect of having the expertise provided by a number of teaching hospitals in the local health economy is a 'no-brainer', and he says that the SHA is working hard with PCTs to improve their performance.

He meets with PCT chief executives once a month and is confident that there will be no zero-starred PCTs in north-west London this summer.

He also argues that PCTs have the levers to ensure their agenda is met, and points out that acute trusts are working closely with PCTs across the patch. 'It is not an adversarial relationship', he says.

But all agree that whatever the current difficulties, once the Paddington health campus is up and running it will be a massive boost for the north-west London health economy.

Mr Peacock says: 'All the effort will have been worth it when we see our vision of the campus realised as a world-class clinical, research and teaching centre for patients in north-west London and beyond.

2003 star-ratings

Acute trusts

Chelsea and Westminster Healthcare 3 Ealing Hospital 2 Hammersmith Hospitals 2 North West London Hospitals 2 Royal Brompton and Harefield 2 St Mary's 3 West Middlesex University Hospital 2

PCTs

Brent 1 Ealing 0 Hammersmith and Fulham 1 Harrow 0 Hillingdon 1 Hounslow 0 Kensington and Chelsea 1 Westminster 1