Report details serious flaws in hospital site decision process

Thursday 23 November 2017

The handling of a process to decide the best location for the £466 million Future Hospital - a project comparable in relative scale with the UK’s HS2 - was flawed, the Comptroller and Auditor General has concluded.

As Jersey’s largest ever capital project, plans for the Future Hospital have come under close scrutiny by political officials and members of the public alike.

Most contentious was the decision over where to base the new premises. The old St Saviour’s Hospital, the Waterfront, People’s Park and a ‘dual-site solution’ were hotly debated over four years, but Ministers decided to build close to the current site in 2016.

That £5.5million process was analysed in detail by Comptroller and Auditor General Karen McConnell, who has today published her conclusions.

She criticised Ministers and Chief Officers over what she branded “confused” decision making, which appeared to ignore expert opinion on certain matters and led the States to spend hundreds of thousands on advisers’ fees due to a failure to provide them with the correct information in the first place.

Pictured: The report was written by Comptroller and Auditor General Karen McConnell, who authored the damning report into the ill-fated Innovation Fund.

Despite claiming that “political leadership is vital” in a project of this sort, the report tells a tale of continuous uncertainty over who was supposed to oversee the process, and explains that there were no clear arrangements in place for how the Council of Ministers were supposed to bring forward proposals for a new hospital development or how they would report back to the States Assembly on this.

It equally exposed that a long list of 24 potential sites were identified before the task group had actually decided on the criteria for a new hospital site. Once they did, that criteria was found to be vague. One had been ‘affordability’, but Ms McConnell claimed that there was no suggestion of an upper ceiling on pricing or what should be considered an acceptable return on investment.

She equally identified an “absence of strategic plans” about how mental health and out of hospital services should fit into the equation.

There were also hints that political obligations occasionally took precedence over the practical. In July 2012, the Esplanade was identified as the second best site out of a top four sites by a Technical Adviser. That idea was thrown out, however, when Ministers concluded that no other area could be found for the planned International Finance Centre complex.

Pictured: Ministers were advised that the Esplanade would be a good location for the new hospital, but no other site could be identified for the IFC.

“I recognise that decisions may be made that depart from previously agreed criteria for essentially political reasons. In such circumstances it is even more important that the decision to depart from criteria and the reasons for the decision are documented clearly,” Ms McConnell wrote.

She added that there had been poor levels of engagement with top clinicians working at the hospital “despite their knowledge and the need to secure their buy-in to the site selection.” Moreover, once they had been consulted on the chosen General Hospital refurbishment solution, Ms McConnell found discrepancies in the way in which their response was reported in comparison with the true nature of their feelings. “The Project Team asserted that the General Hospital site option that was identified as preferred in August 2016 was not causing undue public concern and that clinicians were pragmatic about the risks associated with the option. However, interviews with hospital staff identified significant concerns.”

But perhaps most damning were Ms McConnell’s findings over the use of external consultants, with a bill rocketing to £2.6million. However, these costs were pushed up, she found, by advisers having to do extra work because they were not provided with all the data they needed to do their jobs.

In one instance in 2014, the States were forced to fork out £752,000 to alter the services to be provided by the lead adviser because “robust service plan information was not available.”

“This experience demonstrates that key information that should have been available when the Future Hospital project commenced was not available. Its non-availability had both cost and time implications,” Ms McConnell wrote.

Pictured: Senator Andrew Green, Health Minister, said that many of the issues addressed in the report had already been addressed.

While the report relates to decisions already made, Ms McConnell says that she hopes that political officials will be able to learn from her findings. In future, she recommends clearer lines of accountability and record-keeping.

Nonetheless, the Health Department claim that much of this has already been done. Health Minister Senator Andrew Green commented: “We welcome the C&AG’s report into the decision-making process on selecting a site for our new hospital in the period up to February 2016. We acknowledge the historic issues that the report raises, and we are pleased to confirm that we have addressed them over the past 21 months, as the C&AG has herself acknowledged. 

“This is a project of unprecedented size and complexity for Jersey, and we accept that in the early phase we did not have as clear governance and oversight as we do today, and that this contributed to some delays.”

He added that he is now “confident” that the project team will be able to start work in early 2018 on delivering a new hospital “that will serve our island for generations to come.”