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Decades of under-investment and neglect mean that every single building making up Jersey’s General Hospital is in breach of statutory requirements and national guidance for health facilities, it has emerged.
With the Government now making the case that only a new build will do, Express analyses what is wrong with the current hospital, how it got here, and why it would cost £140m more than building afresh at Overdale to bring it back up to standard…
In February this year, the Health Minister made an extraordinary speech to the States Assembly, laying bare the state of the General Hospital.
Inadequate plumbing, a roof in need of replacement, a lack of air conditioning, too few single rooms, and cramped space - these were but a few of the concerns he aired to States Members.
Five months on from Deputy Richard Renouf’s admission, the group working on 'Our Hospital' at Overdale, which is spearheaded by Deputy Chief Minister Senator Lyndon Farnham, has released its plan to borrow £800m via two bonds that will have cost the island £1.4bn by the time they're repaid.
They laid out all the reasons, which are analysed below, as to why that unprecedented level of borrowing for what will be Jersey's largest ever capital project will be necessary in a document called the 'Outline Business Case' (OBC), and their argument as to why this will be better than rebuilding what we currently have for £940m.
Jersey’s 40,032m2 General Hospital comprises a large number of buildings across a single site - though its clinical accommodation generally dates from the 1960s, there is one granite block which dates back all the way to 1765.
Pictured: The hospital is composed of a series of interconnected buildings.
The OBC says that this history across the hospital estate creates “constraints” for health services.
“There is a disparate collection of buildings developed over a long time to different health policies, operational practices and construction standards. As a result, facilities are in poor condition with the worst areas of building and engineering infrastructure presenting daily operational difficulty," the document reads.
It states that this age and “piecemeal” structure has meant a “lack of flexibility,” with “ad-hoc development of the hospital historically has resulted in a number of poor adjacencies between departments.”
To investigate the “serious levels of dilapidation”, the Government commissioned a 2015 review to compare it against current UK NHS premises standards.
This 'six facet survey' was then updated in 2019. It found that “substantial backlog spend” of £80.8m was needed between 2019 and 2033 to cover urgent infrastructure issues.
The six areas each building was analysed against were physical condition, functional stability, space, quality, fire risk, and health and safety risk.
Against each of those, each building was given a grade: A (building complies with all statutory requirements), B/F (building in need of work to make it comply), C (building contravening one or more standards which is worse than B), D (buildings below C standard), and X (nothing but a total rebuild or relocation will suffice).
CLICK TO ENLARGE: Four of the buildings are rated 'O', which means they are overcrowded.
Not a single block was ranked A in any area, complying with relevant guidance.
This includes poor space standards, poor separation of clinical and non-clinical flows, a lack of privacy and gender separation, and escalating maintenance costs.
Four of the buildings are rated 'O', which means they are overcrowded.
All blocks bar one are rated ‘C’ for physical condition, meaning that they have a “contravention of one or more standards” where action would be required to amend them. The 1987 Parade Building scored the lowest ranking - D/X - for its functional stability.
Among their most concerning findings about each building were the following:
there are limited means of evacuation on the third floor of the Parade block;
aged water systems pose a risk of contamination from Legionella and Pseudmonas aeruginosa, which can cause serious illnesses;
elements of the hospital’s electrics system are dilapidated and would not meet common hospital standards such as the UK Health Building Notes standards (although new generators have been installed within the existing grounds of the General Hospital and connected to the existing electrical infrastructure);
“weak” medical gases infrastructure, plant and manifold rooms, which would not all meet current UK Health Technical (HTM 02-01) Standards;
the Renal Unit has no piped oxygen or vacuum;
dated drainage “leading to increased blockages and overflow within the hospital,” with previous incidents seeing partial ward/departmental shut downs;
air handling and extract units providing 24-hour conditioned air for the hospital are corroded failing mechanically, and obsolete;
though management plans are in place to keep staff, public and contractors safe, there is “significant asbestos” within the building, making refurbishment difficult.
the numbers of beds available and the provision of single bedroom accommodation does not meet current emergency demand;
and infection control is “hampered” by the lack of isolation facilities.
It was also highlighted that the Maternity Ward has no piped Entonox, a well-established pain-relieving gas mixture taken by some mothers during labour.
Indeed, the facility has been a strong area of public focus recently, with parents sharing concerns and a damning Scrutiny report published earlier this month slamming the facilities as “inadequate and highly unacceptable.”
Pictured: A Scrutiny report recently slammed the General Hospital's maternity facilities as "highly unacceptable."
One parent commenting to the panel noted that it “the unit itself was tired, badly ventilated, incredibly clinical for those of us choosing a natural birth, and just isn’t quite the birthing centre atmosphere that you’d hope for in 2021.”
A planning application for an upgrade to the facility put forward last year has since received the green light and work began in June.
However, some health workers have shared concerns about the two-year building process, saying: “It will be noisy, messy and provide a very poor environment for the women and babies to labour, deliver and recover in."
Another key component of the current health estate, which has also been deemed inadequate, exists outside of the hospital: mental health.
The OBC describes the island's facilities as being in “poor condition with the worst areas of building and engineering infrastructure presenting daily operational difficulty.” The facilities also do not meet Psychiatric Intensive Care Unit standards.
Pictured: Orchard House is spending at least £670,000 for maintenance, but will be closing its doors within 18 months.
Despite Orchard House being scheduled for closure within 18 months, maintenance work is still ongoing.
This includes £670,000 to rectify failings identified by the Health and Safety Inspectorate, as well as another potential £200,000 for fire-stopping equipment and an undisclosed amount for “failing heating pipes.”
Clinique Pinel, which mental health services will be transferring into, is also undergoing a £7.9m refurbishment - in May, it was revealed this development was six weeks behind schedule.
Though the facilities may be some distance from the hospital, they are experiencing many of the same problems, such as legionella risk.
Other issues flagged include poor external lighting, problems with the nurse alarm system, and even a risk to patient and staff safety due to young people breaking into Queen’s House.
To keep, but completely overhaul, the hospital, the OBC claims that it would cost £940m and finish in 2028, based on estimates set out by Our Hospital project consultants, Turner and Townsend - estimates some States Members told Express they were sceptical about.
The main works for this project would be spread across the General Hospital, Five Oaks, Maison Le Pape, 14 Gloucester Street, Le Bas Health Centre and Overdale, and are listed as costing £406m.
Pictured: A breakdown of the total costs if the current hospital was to be refurbished.
Bringing it up to £940m are other aspects such as optimism bias (£113.9m) - cash kept to one side in case estimates are too 'optimistic' and elements of the project end up costing more - and inflation adjustments (£129.5m), which relate to if the costs of products and services needed for the project rise over time.
£80m would be spent on design and professional fees, and £5m would be earmarked for buying land for facilities to use while the build is happening.
But the higher cost alone isn't the only reason the Government says it would rather build afresh at Overdale - the OBC says that trying to renew the hospital while it still continues its day-to-day work would “cause significant disruption to healthcare services during this period."
States Members will be asked to endorse the OBC's findings and overall recommendation to build at Overdale - funded by two £400m bonds - in a vote in October.
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