Written evidence submitted by Action4Whipps
- We are writing on behalf of Action4Whipps, a local community group, to submit evidence relating to the redevelopment of Whipps Cross hospital in North East London, one of the 8 “pathfinder hospitals” in cohort 3 of the programme.
- Action4Whipps (A4W) is a group of local people who use, or in some cases have worked in, the hospital and local health and social care services. A4W has been in existence for over four years and throughout that time our aim has been to campaign constructively for a hospital which meets the needs of the local community, replacing the current ageing infrastructure with good quality modern buildings. Our membership is drawn from across the Whipps Cross catchment area and the evidence we are submitting is informed by an in depth understanding of the needs of our diverse and growing local population, as well as current experience of the challenges of local health services.
- A4W welcomes the redevelopment of Whipps Cross – it is long overdue. But we were very concerned by many of the findings of the NAO in its 17th July report, including the lack of transparency in governance and available funding and ongoing delays. We have repeatedly challenged the planning assumptions for the new Whipps Cross Hospital, on the grounds that the numbers of beds were too low and are based on assumptions about shifting care out of hospital when there is no clear strategy locally for improving community services. It is striking that this is a criticism made by the NAO of the New Hospital Programme overall. Our specific concerns about the plans for Whipps Cross are set out below.
The new hospital is likely to be too small to meet need in the Whipps Cross catchment area.
- Whipps Cross Hospital currently serves the London Boroughs of Waltham Forest and Redbridge, and parts of West Essex. The population is diverse, with significant areas of deprivation and the population is projected to grow substantially:
- ONS data indicates that the population of Waltham Forest is projected to grow by 24.9% from 2018-2029, and Redbridge’s by 25.5%
- The population of over 65s in Waltham Forest is projected to increase by 53.5% and over 85s by 63% between 2017 and 2050.
- Barts NHS Trust propose that Whipps Cross will specialise in the care of older people. We know that the over 80s have longer hospital stays (3 days on average) than younger age groups.
- The current plans for the new hospital aim for a net reduction of 60 beds, from 560 to 516. Single rooms will increase the net reduction. It is assumed that 108 beds can be reduced against population growth by reducing non-elective admissions (49 beds) and average length of stays (69 beds). But no clear or costed plans are available for the improvement in local community health and social care services, which would be required to achieve this. The ambitions for improving digital delivery are currently vague.
- Whipps Cross already “runs hot” with consistently high levels of bed occupancy. Information provided by Barts Health NHS Trust shows that in the last 18 months, occupancy has been at least 95% for all except two months, and even exceeded 98% for four months. Using the Health Foundation’s 2022 research, which projects a need for an overall significant increase in NHS beds by 2030/31, North East London would need between 547 and 928 extra beds over that period. Instead, current government plans are to cut existing beds.
- A4W is therefore very concerned that current plans fall short and are not realistic in terms of meeting local need. We ask DHSC and NHS England to re-examine the plans for Whipps Cross on the grounds that the new hospital is likely to be significantly too small. A4W has been told previously that there will be flexibility to increase the size of the hospital in future if necessary, but the implication of the MVP approach appears to be that this will no longer be possible.
The Minimum Viable Product (MVP) version of Hospital 2.0 means that important community services, in particular for End of Life Care, are likely to be removed from the hospital site and not re-provided
- The standardised approach implied by the MVP also means that there can be no place for essential community services currently delivered from the Whipps Cross site, in particular:
- The Margaret Centre, the Specialist Unit for Palliative and End of Life care: Whipps Cross currently has an 11 bedded specialist NHS palliative care unit on its site, called the Margaret Centre. The original plans for the new hospital did not include re-providing the Margaret Centre, despite there being no other hospice provision in Redbridge or Waltham Forest, nor any hospice at home service in Waltham Forest. Following our campaigning, North East London Integrated Care Board is now reviewing End of Life care in the Whipps Cross catchment, and the review is due to report in the autumn. But we have serious concerns that the MVP approach and the rigid standardisation it implies will in effect make it impossible to retain any form of specialist palliative care unit as part of the new hospital.
- The Connaught Day Hospital – a unit offering specialist care and day services for the frail elderly, also currently located on the hospital site. Again there are no plans to re-provide it as part of the new hospital and no clarity about how community services will pick up the short fall. This seems a particularly odd decision, given the proposal that the new Whipps Cross should specialise in geriatric care.
- We are very concerned to read that the standardised model of Hospital 2.0 has only been used once before, in order to build a completely new hospital on a green field site in Wales. It appears that the approach has never been deployed in the redevelopment of an existing hospital where services need to continue to be provided throughout the building process. Whipps Cross is of course located in an urban setting, surrounded by residential areas or Epping Forest, and parts of the current hospital date from the late 19th century. It feels as though the cohort 3 hospitals are being used as guinea pigs for an untested form of development which must be high risk. What steps has NHS England taken to assure itself that the standardised model will be deliverable in this context?
There is currently a lack of public information about the funding, timetable and next steps for building the new hospital
- It is striking that there is now no clarity about the timescale for the building of a new hospital to replace Whipps Cross, nor about the amount of funding which will be needed. The NAO’s range for the cost of completion is very wide: from £501m to £1bn. We note that the NHP has been asked to submit a third version of the programme business case by the end of 2023, but it is unclear to us as local residents when the business cases for cohort 3 hospitals are expected to be submitted nor when and how they will be scrutinised locally.
- This situation is leading to a very striking local democratic deficit. It runs a major risk of delivering a hospital which is too small from the start and so fails to meet local need. It also appears that key community services like the Margaret Centre and the Connaught Day Hospital are likely no longer to exist.
- This is a huge missed opportunity and very disappointing for a community which has been waiting so long for a new hospital.
Questions for the hearing on 7 September
- We would like the members of the PAC to ask:
- Given the evidence above that the new Whipps Cross is very likely to be too small, will the Government re-examine the current plans for bed numbers in the new hospital? Can Whipps Cross be used as an example to test the planning assumptions for the MVP version of the Hospital 2.0 design?
- What assessment has been undertaken by DHSC and NHS England of the ability to use the hospital 2.0 design and construction methods on sites with existing hospitals in urban areas? What risks have been identified and how will they be managed?
- When will individual business cases for cohort 3 hospitals be available for local scrutiny and consultation?