Hospital chiefs and health commissioners look set to back a bid for major investment at Watford General Hospital.

The West Herts Hospital Trust and the Herts Valleys Clinical Commissioning Group have previously indicated they intend to bid for £350 million of NHS funding later this year.

They today (Thursday) agreed on an 'emerging way forward’ – backing a proposal that would concentrate investment on the crumbling Watford General site in Vicarage Road, but retaining St Albans and Hemel Hempstead hospitals for planned surgery and medical services.

They will not formally decide the details of that bid until the boards of each organisation meet independently on July 11.

But for the first time they have shared architects images of how the new sites could look.

Under the preferred proposal – known as ‘option one’ – there would be two new clinical buildings on the Vicarage Road site, including a new theatre suite, a new women’s and  children’s unit and a new ward block.

The existing Princess Michael of Kent building would be refurbished and there would be a purpose-built car park. A portion of land at the site would be sold off for housing.

Meanwhile as part of the plan St Albans City Hospital would be refurbished to become an enhanced surgical facility – for planned surgery and cancer care – with an additional two operating theatres.

There would also be significant improvements in diagnostic services – including new MRI and CT scanners – with the hospital providing a one-stop-shop from diagnosis to surgery.

At Hemel Hempstead Hospital the existing Verulam building would be refurbished to offer medical services for conditions such as rheumatology, diabetes and respiratory conditions.

Meanwhile the existing Urgent Care Centre would move to a different building. And land for up to 250 homes would be sold off for development.

Backing the proposal at the meeting, CCG chief executive Kathryn Magson recognised that it was a “compromise” – in order to stick to the £350 million threshold.

But she said it had been helpful that the regulators had been clear about that theshold.

West Herts Hospitals Trust chief executive Christine Allen highlighted the “real urgency” for investment.

She acknowledged that Watford was the “most challenging” of the three hospital sites and the one where most patients were seen.

But she said ‘option one’ still offered the scope to retain and enhance facilities on all three sites – ensuring all patients and staff would see the benefit

Backing option one, she said: “It’s not a perfect solution. I think it ensures better facilities that are severely needed at all three sites.”

And hospitals trust medical director Dr Mike van der Watt said that from a clinical point of view this was the option that gave “more bangs for the buck”.

He said that this option would mean the experience for a greater number of patients would be improved

In recent months the Trust and the CCG have been looking at four different options – which were all evaluated at Thursday’s meeting.

At the heart of all the proposals is a drive to ensure hospital buildings are fit for purpose and to enhance the separation of emergency and planned care services – as well as delivering services that are affordable.

In highlighting the current state of hospital buildings, the report to Thursday’s meeting highlighted recent leaks of waste water in Watford’s A&E department,  the use of ambulances to move patients when lifts break down and ‘umbrella’ watercatchers to stop rain water dripping on to patient beds in St Albans.

All of the four options considered included some level of investment at the Watford General Hospital site, which would continue to be used for emergency and specialist care.

But that investment would depend on whether planned care would be delivered at one or two other sites – which could include St Albans City Hospital and/or Hemel Hempstead Hospital or a new purpose-built facility.

Option one would see £298 million invested at Watford General and a further £52 million shared between the St Albans and Hemel Hempstead sites.

The option of a new purpose-built, single-site hospital was ruled out earlier in the process, as being too expensive.

Hospitals trust deputy chief executive Helen Brown said that over the past two years the trust has been told consistently by the regulators to keep the costs down.

And, she said, the trust had been told that asking for significantly more than turnover would reduce the chances of the scheme being approved.

Whether any building work goes ahead at the hospital will ultimately depend on whether a bid for NHS funding is successful.

If this option is agreed as the basis of the bid by the hospitals trust and Herts Valleys CCG on July 11, it will be passed to the Hertfordshire and West Essex Sustainability and Transformation Partnership and submitted to regulators at the end of July.

Funding could be considered as part of the Comprehensive Spending Review in the autumn.

And if all goes to plan, according to the presentation to the meeting, building work could start as early as 2023.

Liberal Democrat county councillor Chris White was the only public speaker to address the meeting.

He told the members of the governing bodies that he believed option one would be the most advantageous for the west Herts area and for St Albans itself.

He said St Albans City Hospital was well regarded by the local community. And he outlined concerns that – should it close – facilities would be lot and that transport options would make it difficult for residents to access services elsewhere.