Mr Birch is correct to highlight the shift in approach as our regulators (who hold the purse-strings and control the approvals process) have switched priorities between cost and timescale over the many years we have been pursuing funding. Various financial limits and target completion dates have been set. Presently, the New Hospital Programme completion date is 2030 but we hope to deliver new and better buildings before then.

In terms of cost, we are tasked to present ‘the most economically advantageous’ option whilst balancing the now urgent need for significant improvement. This is why a completely new site option with its risk of failure and high number of uncertainties was ruled out in favour of building a new hospital on land next to Watford General Hospital. The proposed site can be purchased with relative ease, benefits from good transport links, has a new multi-storey car park and doesn’t require major roads to be re-routed. In addition, our plans have outline permission. This option will deliver in the shortest time.

Mr Birch claims that the slippage against previously published construction and completion dates shows that there really can’t be any urgency. Not so. In fact, the opposite is true. The slower the national programme moves the worse our buildings become, with the result that the urgency increases and the need to choose a deliverable, certain site option grows ever stronger.

Mr Birch mentions the size of our planned new buildings and we will share this when we have the latest guidance which will inform our plans. We have been working closely with the central team over the last few years looking at our demand and capacity modelling (to determine the size of our new facilities), the repeatability and standardisation in terms of design, net zero carbon, digital facilities and modern methods of construction.

He is right to say that tall buildings have some inherent costs but there are also benefits from co-locating linked clinical services which improve the experience of patients and staff.

He mentions full digital integration, the costs of which were excluded (as per guidance at the time) from the redevelopment plans. They – and other costs – must now be included and this is one of the factors that has pushed our estimated costs up.

Mr Birch’s comparison with the Princess Alexandra Hospital (PAH)or a new site in Harlow does not state the key difference; we have a site for a new hospital on land next to our current site in Watford whereas the size of the PAH site has forced its hoped-for move.

Finally, whilst Mr Birch may not agree with our proposals, it does not follow that our redevelopment team lacks skill and experience. I could easily count at least a century or so of experience in the internal team leading this project and double that within the external designers, project managers and cost consultants who we are fortunate to have working alongside us.

We are now looking to submit our Outline Business Case towards the end of 2022 or early in 2023. However, this is determined by the New Hospital Programme who are currently in discussion with HM Treasury about the appropriate costs and timescales for the programme as a whole. Our trust board will be approving the preferred options for redevelopment at Watford General, Hemel Hempstead and St Albans City hospitals at the May 31 meeting. The options will be in the board papers on our website in early May. We invite all readers to find out more at our next update presentation on the redevelopment at 12.30pm on May 10. Visit www.westhertshospital.nhs.uk/redeveloment and go to ‘Our redevelopment plans’ and ‘Meetings’ for the Zoom meeting link.

Helen Brown

Deputy Chief Executive,

West Hertfordshire Teaching Hospitals NHS Trust