Department of Health: The Paddington Health Campus Scheme

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summary21 Ultimately, in addition to the land and affordabilityissues, it was the differing financial and clinical interestsof the two NHS Trusts that led to St Mary’s NHS Trustapproving the revised business case in 2005 and theRoyal Brompton and Harefield NHS Trust declining torecommend it for approval. This reflected, in part, the lackof confidence on the part of the Brompton in St Mary’sability to deliver savings and manage a forecast deficitwithout compromising the Campus vision.22 Throughout the development stage, the scheme washandicapped by the Campus partners’ failure to provideor secure adequate funding to develop the scheme.Available development funding was based on a proportionof the original estimated OBC cost of £360 4 million,not the approximately £894 million it would have cost.The scheme relied on funding from the Strategic HealthAuthority and Primary Care Trusts. However, between2002 and 2005 the scheme was unable to secure sufficientproject funding from them and the Trusts themselves feltunable to find funding from within their own resources.Instead, the continuation of the scheme was reliant on£4.9 million in funding from co-sponsor PartnershipsUK. As a result of the earlier inadequate funding anduncertainty about the future of the scheme, it was severelyunder-resourced in manpower and capability.The strategic support for the PaddingtonHealth Campus vision was unsatisfactory23 The Department provided support andencouragement to the Campus partners – mainly on thefinancial challenges facing the scheme – both through itsmembership of the Principals’ Group and access to thesenior responsible official at the Department. It also setout its assessment of the conditions necessary for successon numerous occasions and offered limited capital andrevenue funding to support the scheme.24 However, the Department had no strategic positionon the desirability to the NHS or ’UK plc’ of a successfulhealth Campus. It did not share the Campus partners’ viewthat this was a scheme of national importance. As a matterof policy the scheme was treated as the responsibility ofthe local NHS to resolve, as budgets had been devolvedto local NHS organisations. The two NHS Trusts,Partnerships UK and Westminster City Council told usthat they had been uncertain whether the Department didin fact want the Campus scheme to succeed, while theDepartment has explained that it was willing to supportan affordable scheme.25 The Department was clear that its two roles inrespect of the scheme were a) to offer advice on schemeparticulars and development and b) to consider the FullBusiness Case. Approval of the 2000 OBC was delegatedto the London Regional Office of the NHS and theDepartment played no role at that stage. The Department,from mid-2004, expressed its concerns as to the viabilityof the scheme. At no point did it ask the Campus partnersto carry out further work on the scheme but it respondedpositively to requests that the scheme be allowed time toexplore new opportunities.26 The Campus partners believe the Departmentplayed a more active role than this suggests. Nosubstantive steps were taken by the Campus partnersfrom April 2004 to May 2005 without the consent of thesenior responsible official at the Department. The Campuspartners believed they had political strategic support foran affordable scheme.4 The development funding was based on the full £360 million cost of the 2000 OBC, but £27 million related to other hospitals and £33 million to equipmentcosts so the capital construction cost of the Paddington scheme was only £300 million.The Paddington Health Campus scheme
ecommendations27 The circumstances under which the PaddingtonHealth Campus scheme collapsed were unique. It facedscheme-specific constraints on site, size and complexity ofgovernance arrangements for three sponsors. Nevertheless,we consider that there are lessons for all NHS capitalinvestment schemes which need to be reflected in anyguidance used by Trusts. We recommend that:abcdThe Department should implement its own CapitalInvestment Manual guidance on reassessing OBCs ifestimated capital construction costs rise more than10 per cent above approved OBC values.No capital investment scheme in the NHS shouldproceed without the formal identification of a singlesponsor, even if this means Trusts must merge priorto starting a procurement.No OBC should be approved where it has beensubject to conditions imposed by an NHS Trustwhich explicitly constrain the development ofoptions or limit value for money that may be secured.Any approval conditions on OBCs should be subjectto a formal review timetable under which theapproving authority will review and document thecontinued viability or acceptability of the scheme.efghiNo scheme should proceed without formalconfirmation from commissioners, who wouldbe expected to support the scheme, and theNHS Trusts themselves, of assured funding for fulldevelopment costs.Third parties negotiating on behalf of NHS Trustsshould only do so under written instructions.The Department should ensure that formal timetablesare drawn up and followed for the identification andtransfer of scheme responsibilities and commitmentsin periods of NHS reorganisation.The Department should ensure that the lessonslearned above are incorporated into the CapitalInvestment Manual.The Department should consider and performancemanage capital investment schemes with a nationaldimension within the context of a national strategyfor NHS capacity planning.The Paddington Health Campus scheme
Page 1 and 2: department of healthThe Paddington
Page 3 and 4: DEPARTMENT of healthThe Paddington
Page 5: Part 3The Campus partners were unab
Page 8 and 9: summary8 While the Campus partners
Page 12 and 13: part onePart oneThere was a strong
Page 14 and 15: part oneThere were strong clinical
Page 16 and 17: part twoPart TwoThe way the Campus
Page 18 and 19: part two2.6 Securing planning permi
Page 20 and 21: part twoRisk management2.14 The NHS
Page 22 and 23: part two2.28 Public support for the
Page 24 and 25: part three3.1 The Royal Brompton an
Page 26 and 27: part three3.12 The PDCL negotiator
Page 28 and 29: part three3.24 All Campus partners
Page 30 and 31: part threeThe changing proposals fo
Page 32 and 33: part three6A comparison of capital
Page 34 and 35: part fourAccountability for the sch
Page 36 and 37: part four4.8 Some of the advice and
Page 38 and 39: part five5.1 Both NHS Trusts contin
Page 40 and 41: glossaryLondon Regional OfficeMemor
Page 42 and 43: appendix oneAppendix oneChronology
Page 44 and 45: appendix one2004 (continued)JulyChi
Page 46 and 47: appendix two7 It was the view of th
Page 48 and 49: appendix fourAppendix fourThe oppor
Page 50 and 51: appendix fiveDepartment of Health:

Department of Health: The Paddington Health Campus Scheme

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