The New Hospital Q&A online

The question and answer session was very good last night, and the strongest answers surely came from Ian Gorst and Tom Binet. 

Lyndon Farnham attempted to criticise the Scrutiny process for the delays which meant the old Overdale project lost out on low interest rates. However, he has since lodged a proposition asking for comparison costings between new and old which itself will act as a delay. Somehow he doesn't seem to see the inconsistency in this.

Ian Gorst was very clear - firstly, the Scrutiny process is a necessary part of Government and was conducted professionally, and it is wrong for Lyndon to attack it for unnecessary delays impugning those members as purely playing political football with the hospital. Secondly, a major delay (which I don't recall being mentioned in Lyndon's attack) was the pandemic which probably did more to delay matters than anything else.

One persistent red herring was the criticism that this Government was overturning the democratic decision by the previous government. The history of the hospital project shows this keeps happening, and in fact the last government - with Lyndon as the figurehead of the new project - was rejecting the previous administration's decisions!

Ian also made a strong case for the financial situation having changed considerably since the last iteration of the hospital project. The Overdale plan - as passed by the States - no longer exists in that the States passed it based on particular financing from debt which is no longer feasible. The figures do not add up. The level of borrowing agreed would have increased considerably and therefore the States would still have to ratify the situation again. 

Indeed in his manifesto, he flagged up warnings on this:

"I am very concerned at the proposed cost and borrowing for the hospital and will work for rigorous controls on spending to ensure the project is delivered as efficiently as possible and at no more than the £800 million projected spend."

No more than the £800 million projected spend for an agreed Overdale is no longer viable. Interestingly, Lyndon does not address the cost aspect in his manifesto.

The cavalier way in which the previous administration put finances at the bottom of their agenda is also dealt with in Ian's manifesto:

"I have been a minority, often singular, voice on the Council of Ministers. Spending has increased by £200 million in the past four years, excluding Covid. That is unprecedented and unsustainable. The Island has now committed itself to £1.7 billion of debt. I have brought two propositions to reduce debt, with only partial support from the Council of Ministers."

It is clear then that far from positively assenting to the previous administrations plans - in essence, a "Trussonomics" spend and borrow approach on Overdale - he has wanted for some time to introduce better financial controls. And with freight, materials, and associated building costs rising, now is surely the time to leave a failed spend and borrow on a massive scale. We saw the results of doing that recently in the UK, and the backlash and instability was not pretty. 

As the review noted:

"When the funding model for the Our Hospital (OH) project was first revealed, Jersey was hoping for an average return on its £1bn strategic reserve fund of 4.6% (2% above the Fiscal Policy Panel’s long-term RPI assumption) over a 40 year period, and borrowing costs to be fixed at 2.5% for the duration. The financial markets environment has changed considerably, and a return to stability may not be achieved any time soon. The strategic reserve will not reach its target this year and the cost of borrowing is considerably higher."

This has not been addressed by Lyndon Farnham, and it will be interesting to see where he gets his revised figures from.

Turning to Tom - Tom Binet set out a very good case for a multiple site approach, although as Overdale moving to Les Quennevais was already on the cards and signed and sealed, that would happen anyway. Essentially it is a two site solution, and as he pointed out, construction noise at the back of the existing hospital - the Kensington road sites - would happen if it had gone ahead for housing anyway. The phased approach also means workstreams can overlap, and more local construction can be used. 

As the review noted:

- phase 1, development at Overdale to be commenced within 24 months with a 36 month programme to completion
- phase 2A, development at Kensington Place or Overdale to be commenced within 36 months with a 36 month programme to completion
- phase 2B, development at the current hospital site at Gloucester Street to be commenced within 72 months, with a 24 month programme to completion

He didn't mention, but I do remember, several large scale projects where a major contractor has gone bust. The Queen's Valley site was a notable example - a large project, delayed and with considerable loss to the public purse - when the single contracting company went bust. 

There was also an honesty to his approach. While new builds like Samares Ward could be saved, he said that it did depend on the best plans for the two site option and until that was the case, he could not make firm commitments. The road superhighway plans, and the demolition of perfectly good new houses, the destruction of the bowls club - these he could guarantee cancelled with the new proposals.

He also said that part of the problem of repeating cycles was that previous governments had gone back to scratch with a site selection process, and they had deliberately avoided that, and the significant delays that would introduce.

Not mentioned was the slurs which have been made by Lyndon Farnham who has criticised Tom as "uninformed and inexperienced.". On the contrary, Tom brings considerable business expertise from many years as a successful businessman, capable of handling finances and projects and as his manifesto notes "developing businesses in agriculture, retail/services and property.". It is in fact Lyndon - elected and in the States since 2002 - who has been inside a States "bubble" for 20 years with only marginal experience of that kind.

There were a lot of consultants and clinicians present, most of whom did seem fairly unhappy with the two site option, but relatively few nurses. In fact the one question on Slido which came from a nurse was about reforming the administrative structure which is "top heavy" with "too many chiefs and not enough Indians". I don't think Karen Wilson really addressed this at all. There was some general waffle about reviewing and reforming the administrative structure but it was a rather feeble answer.

The clinicians questions about the viability of a two site system were mainly about staffing and staffing cover and the ease of moving staff in a single site when needed. While there would be a timing delay, I am sure that the communications issue with electronic communications for logistics can address this in a way that would not have been possible, say, ten years ago. Incidentally the review did note that "some adjacency of service are absolutely essential and these will provide a ‘critical mass’ of departments that should stay together."

What they didn't address interestingly was the inefficiencies of a paper system which is still in place, with files requested and brought out by staff from an antiquated storage system in the current hospital. When I see my GP, they can see my entire health record from other doctors in the practice, online, instantly - and at different locations. 

Perhaps a push towards the 21st century by clinicians would help matters and is surely now a vital part of a two site option.

The review did note that "revisiting the scheme requirement allows consideration of future digital healthcare services delivery (such as remote monitoring and online consultations) to be incorporated into any revised proposal and thus future space requirements."

Addendum 1

"Consultant gastroenterologist David Ng was among those to speak, warning of the unintended consequences of reopening some facilities at Overdale, which he said had taken physiotherapists out of the General Hospital, adversely affected patient discharge times, leading to bed-blocking and cancelled procedures." (Bailiwick Express)

I have a great deal of respect for Dr Ng, but the reopening he is referring to must be Samares Ward, which was a decision taken by the last assembly before the election, and against the Council of Ministers - in particular Richard Renouf - because Plemont Ward - the preferred option by Deputy Renouf was not fit for purpose. 

A video which can only be described as propaganda, sought to allay fears, by using staff to present the facilities as if some were patients, and no patients appeared in it giving their views. As Andy Jehan and Steve Pallett demonstrated, the decision to use Plemont as a stroke rehabilitation centre was misguided and led to poorer outcomes for rehabilitation. A question must be asked: why did Dr Ng not mention Samares ward was the facility re-opening by name? The only answer I can see is that it would severely weaken his argument.