The recent engagement event on the future of a ‘new’ hospital for West Herts raised more questions than answers. After years of wrangling it now appears that decisions have to be made in a very tight timeframe and to a budget much lower than anybody anticipated. It is clear that limiting the available capital funds to £350m, equivalent to the annual turnover of West Herts Hospital Trust (WHHT), will not be enough to create a brand new high-spec hospital in either a new or existing location. In addition the Trust’s Medical Director outlined that he expected 40 per cent of hospital visits to be moved to a community setting over the next few years without any real clarity of how that would work or whether the funding for that would stay with the acute Trust or move into the community thereby reducing the acute Trusts income and potentially the affordability of the revamped hospitals.

HVCCG, which controls the commissioning, offered no insights into how future funding would flow so maybe it is time for a wider look at how to deliver the NHS 10-year plan throughout Hertfordshire. The NHS 10-year plan moves away from the competitive environment where Trusts compete for services and instead is moving towards a more system approach. Everyone agrees that shifting work from acute hospitals into the community is better for staff, for patients and for the public finances.

One option might be to consider merging Hertfordshire Community Trust (HCT) with the West Herts Hospital Trust. This brings community expertise and infrastructure into the WHHT and will ensure closer working between the two to encourage the roll out of community initiatives to reduce hospital admissions.

Financially HCT is sound and a merger would provide a combined turnover of about £500m; a much better sum to use as a baseline for building new facilities. A merger would also reduce the proportion of debt held by WHHT from 15 to 10 per cent of turnover, immediately improving their financial position. Both Trusts have issues with estates and rationalising these sites could lead to land sales and savings that could be further invested in developing the services offered. Streamlining of senior management teams, ensuring that a focus is kept on community work to avoid it being swallowed into the black hole of acute care, will again increase efficiency and produce a revenue saving that can be invested in service development.

Being a county-wide provider HCT will be able to lead on a holistic approach to community care across Hertfordshire bringing in the other partners as needed; it already works very closely with the Hertfordshire Partnership NHS Trust and local government. An idea such as this would need the agreement of both boards and HCT might feel it is not for them but with HVCCG recently awarding a Hertfordshire adult care services contract to a Central London Trust it may be time for services in Hertfordshire to join together to fight for local services and to have a true cohesive link between the community care we crave and the acute services we need.

Gary Murphy

Leggatts Way, Watford