Essential insight into England’s biggest health economy, by Ben Clover.

Great news for ONEL and outer SWL.

With an estimated £500m each, the rebuilds at Epsom and St Helier University Hospitals Trust on the London/Surrey borders and Whipps Cross in Walthamstow are long overdue.

If the prime minister’s recent announcements do indeed prove to deliver a straight half billion quid of taxpayer-funded public dividend capital for ESTH then it will mark the end of a reconfiguration/rebuild row that has been going on for nearly 20 years.

St Helier, based in a deprived area of the London borough of Sutton, is famously crumbly, with vintage boilers, sweating walls and a 1940s look that survived three visits from the Luftwaffe.

Epsom Hospital is more modern and sits in the midst of one of Surrey’s rich commuter zones.

Accident and emergecny and maternity rotas at both sites have been hard to fill over the years and discussions about where to concentrate services are bedevilled by local politics.

Epsom and its environs have been represented in Parliament by figures like Chris Grayling and Jeremy Hunt. St Helier serves three constituencies that have swung between the Conservatives and Liberal Democrats over the past 15 years.

However the stars could finally be in alignment for a rebuild, as trust management have achieved a degree of consensus from MPs - around a likely proposal of a third new site. (the same trust management recently dragged the organisation up to a “good” rating from the CQC)

A formal consultation could get started very soon: No small feat for this part of the world.

A rebuild of Whipps Cross has also been on the cards for a long time. Less politically complicated than ESTH, it has nonetheless been the NHS facility in London that most surprises visitors from overseas. Surprises in a “you deliver care from this building?” way.

If both sites are given dollops of PDC it will be interesting to see how much of already existing draft funding plans are retained.

ESTH had been working on elaborate private borrowing deals (that everyone stresses did not amount to a PFI) to bring the book cost to the Treasury down. Whipps’ management at Barts Health Trust were looking at what land could be sold there for housing to make up part of the war chest.

This was because private funding and housing concerns had been key to the Naylor Review of NHS estate, which was delivered in a different and politically more stable, less splash-the-cash, era.

Sir Robert anticipated that one-third of the £10bn the NHS needed would come from private sources. Pension funds and institutional investors were keen, the Treasury less so.

But that was a different time.

What happens to the rest of London’s, often benighted, estate, remains to be seen.

There is “seed funding” to make business cases for Hillingdon Hospitals and Imperial. We are also led to believe there might be forthcoming good news for the capital’s primary care footprint.

Imperial’s situation at St Mary’s is complicated by the land being owned by a combination of the trust, the charity and the university. But there is no doubt parts of it need rebuilding.

Indeed, in a story that may be apocryphal but has the power of the plausible, the heart of one of generators in the hospital is said to be from a Hurricane – that stalwart of the RAF, circa 1940.

Another big development for London this week was the announcement of plans to directly control how much capital spending foundation trusts can do.

This could be quite significant for one particular big hospital plan: The re-location of the Royal Brompton over the river to St Thomas’.

Although the direction of the wind has changed on whether the centre thinks that is A Good Thing or not, the fact that legislation could only be a few years away might encourage trusts to act while they can.