A hospital trust has not given up on plans for a major rebuild of Watford General - but it is jostling with other trusts for the extra cash needed to make its ideal project a reality.
The Department for Health and Social Care (DHSC) wrote to trusts, including West Hertfordshire, last week informing them they needed to submit redevelopment schemes capped at £400 million, alongside the trusts' preferred and more costly options.
West Hertfordshire Hospitals NHS Trust has been working on much-needed plans to reinvigorate its facilities and secured planning permission last week for a near-total rebuild of its hospital in Watford.
But the scheme, which would involve the construction of three new buildings - including one up to 17 storeys - on a site next door to the current hospital, is esxpected to cost more than £400 million.
The hospital trust remains in line to be one of the first to receive funding as part of Prime Minister Boris Johnson's New Hospital Programme - a "commitment to deliver 48 new hospitals across England by 2030".
But exactly how much the trust will receive to spend on redeveloping its sites in Watford, St Albans, and Hemel Hempstead is unclear.
A DHSC spokesperson said today that its New Hospital Programme "remains on track" but the DHSC has spoken of the need for "financial discipline" across the whole portfolio of 48 hospitals, adding "any potential material growth in cost beyond initial plans will always need full consideration".
Hospital trusts will find out exactly how much they have to spend when a full business case has been approved. West Hertfordshire is expecting to submit its case later this year or in early 2022.
The trust initially planned for a £350 million development, which was then upped to £400m in 2019. Last year, the trust received a letter from the DHSC which indicated there may be up to £540 million to spend in Watford, along with £50 million at St Albans City and Hemel Hempstead hospitals. But now it is facing the prospect of a £400m budget again.
Watford MP Dean Russell told the Watford Observer in light of the DHSC's recent letter, he will be writing again to the New Hospital Programme to "reiterate his support" for the trust's plans.
On whether some trusts are likely to have their allocation capped at £400m in order to finance other more expensive projects elsewhere in the programme, the DHSC has said it is "working closely" with the NHS to plan how and when new hospitals will be built across the decade.
It's understood this includes considering how the DHSC phases the whole hospital building programme so it can work with similarly developed trusts to "maximise the benefits for other schemes".
A Department of Health and Social Care spokesperson said: "We remain on track to deliver 40 new hospitals across England by 2030 to transform services for local communities, backed by an initial £3.7 billion. Together with eight existing schemes, this will mean 48 hospitals by the end of the decade.
"This is the biggest hospital building programme in a generation so we are working closely with the NHS Trusts involved to plan how and when new hospitals will be built across the decade, so new services for patients and staff open on time and within budget.
"As part of our plans to build back better, all the hospitals will prioritise sustainability, digital technology and the latest construction methods to see them built as quickly as possible, to the highest standards."
West Hertfordshire NHS Trust’s acute redevelopment programme director, Duane Passman, said: "At this early stage, we are working with the New Hospital Programme to ensure value for money and no expectations have been set about maximum costs.
"All of the options we are working on are based on retaining our current three hospital sites and will be publicly available when our outline business case is completed later this year or in early 2022.
"Our outline planning application for the Watford site has just been approved by the local council. Our vision is for each hospital to have a clearly defined purpose and to maintain a range of local services."
As part of West Hertfordshire's plans, emergency, inpatient and complex care would remain at Watford General while Hemel Hempstead Hospital will be the site for planned medical care and long term conditions.
St Albans City Hospital will provide planned surgery and cancer care, while urgent care services and some outpatient services will be provided at all three sites.
Mr Passman says diagnostic facilities will be "significantly upgraded" at all three hospitals and the latest digital technology will be incorporated.
The trust rejected calls to build a new hospital on a brand new site that campaigners felt would be more accessible for patients in St Albans and Dacorum.
Steve Day, a spokesperson for campaign group HertsValleysHospital said "the wheels have well and truly come off the bus" after the trusts were asked to submit £400 million plans.
He added: "The opportunity now for the trust and the DHSC is to take stock of what is affordable and deliverable as opposed to the previous decision that inappropriately ruled out building on clear sites and took no account of cost.
"Most importantly, the public can get on board with a centrally located hospital supported by facilities in each of the three main towns."
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