Department of Health: The Paddington Health Campus Scheme

part two2.28 Public support for the scheme in the Harefield areawas limited by two factors:nnThe scheme involved the transfer of clinical servicesfrom Harefield hospital to the Paddington Basin siteand the consequent closure of Harefield hospital; andSupporters of Harefield hospital were not happywith the integrity of the consultation process. Thepublic consultation on specialist acute services(including those at Harefield hospital) closed inNovember 2000. But the OBC was developed beforethat date, a planning application for the Campusscheme was submitted in June 2000, a ProjectDirector was advertised for in July 2000 and theOBC approved in October 2000.2.29 Supporters of Harefield hospital created the Heartof Harefield group in July 2000 to take forward theiropposition to the closure of Harefield and, later, theescalating cost of the Campus scheme. The campaign tosave Harefield hospital provided a continual check andchallenge on the viability of the Campus scheme to theBoard of the Royal Brompton and Harefield Hospital NHSTrust and to the scheme.Policy risk2.30 Policy risk is a particular risk for public sectorprojects and relates to changes outside the control ofindividual organisations but which may have a materialimpact on the organisation and investment scheme. Suchrisks are common to all NHS schemes so, while theyshould be recognised as an additional risk, they cannotexplain the failure of the Campus scheme on their own asother hospital building schemes have overcome similarhurdles. Against this it should be recognised that theDepartment is currently reviewing how the commissioningof major capital schemes through PFI can be reconciledwith long-term affordability and policies on choice,Payment by Results and the movement of care away fromacute hospitals to the primary care sector. 82.31 The main relevant NHS policy change affecting thedevelopment of the campus was consumerism whichincreased space in patient areas to improve the dignity andprivacy of patients. This guidance, although not mandatory,had a considerable impact and was a major factor in theincrease in size of the scheme between 2000 and 2003.Further draft guidance on the proportion of single roomsin a hospital was issued for consultation in 2004. Theproject team was assessing the potential impact of this draftguidance on design and space requirements prior to thescheme’s collapse but the May 2005 Addendum did notmeet the standards in the draft guidance.2.32 Three other policy changes affecting the affordabilitycalculations for the scheme were the introduction ofprivate and NHS Treatment Centres, Payment by Resultsand choice at the point of GP referral. These policiesemerged after the scheme started in 1998. TreatmentCentres and choice increase the potential that patients willchoose to attend other hospitals or providers for electivecare. Payment by Results ensures that money followspatients and sets a fixed price for hospital activity. Thereis a potential opportunity as well as a risk for Trusts if theycan attract additional patients and make a financial surplusout of treating them but uncertain income increases therisks for new schemes with higher than average costs.2.33 The underlying risk from choice/Payment by Results isthat it is a new and different funding regime for NHS Trustsand is therefore very difficult to forecast, especially overthe very long time horizons of PFI contracts. Each Trustwill need to make their own assumptions as to how patientchoice and Payment by Results will impact on their futurerevenues but they have no track record on which to basethose assumptions.8 Our health, our care, our say: a new direction for community services, Cm 6737, Department of Health, January 2006.20The Paddington Health Campus scheme