Our Hospital Review 2022

Our Hospital Review

Here we publish the scope and process and recommendations for the review into the Our Hospital Project. The review is part of the Chief Minister's 100 Day Actions.

The Our Hospital review was announced on 1 September 2022 and concluded on 1 November 2022.

Objective 

The construction of a new hospital is one of the most important tasks faced by the incoming government and has been a subject of public and political interest for some time. The complexity of the approach, requirements, timescale for delivery, cost and financing has meant that the project has seen a number of iterations, none of which have achieved the construction milestone of a modern, affordable, value for money, fit for purpose, and efficient hospital for Jersey. 

The case for new hospital facilities has been established and accepted by the public. As such, the Chief Minister has outlined the requirement for a review that will allow the Government of Jersey to make properly informed decisions about the future of the project. The aim is to provide evidence based recommendations for the future of the project and to consider whether there may be options to deliver a more affordable and appropriate alternative, it will not seek to rerun or critique decision making of the project to date. 

Scope 

The review: 

• assessed the affordability of the current project in light of recent global events that have considerably altered the financial climate and fractured international supply chains
• considered the state of the existing hospital and associated heath and care facilities, including an assessment of the measures required to ensure that they remain fit for purpose pending the delivery of new health and care facilities
• considered measures currently being undertaken to improve and transform Jersey’s health service during this period
• examined various options from a scope, operational efficiency, cost, programme and local economic impacts perspective, including, but not limited to: 
• a scheme at Overdale
• a scheme on the existing Gloucester Street site, utilising adjacent sites, such as Kensington Place
• opportunities for a longer term phased development at Overdale or Gloucester Street
• the opportunity to use secondary sites to complement the delivery of health and care from a primary hospital location. 

A new site assessment process is not part of the review, as this would not enable the delivery of a new hospital within the required timescale. 

Care was taken to ensure that the development incorporates provision of delivery space for an appropriate range of health and care service for Jersey, contributes to a whole system of healthcare, addresses future care needs, is aligned to evidence based models of care and includes opportunities to exploit innovation and digital methods of care delivery. 

Process 

The review was informed by: 

• a review of key project documents and sources of challenge and / or scrutiny, pertaining to various iterations of the project 
  
• evidence from a range of stakeholders 
  
• visits to completed hospital projects elsewhere in the British Isles 

The review was led by the Minister for Infrastructure and supported by a Principal Expert Adviser with extensive experience of large-scale capital projects in health and care. 

The review and advice provided by expert adviser(s) was presented to the States Assembly by the Minister for Infrastructure, no later than 20 October 2022.

Conclusion

The review found the current plan for a new hospital at Overdale is no longer achievable within the £804.5 million funding approved by the last States Assembly, and that it would cost between £70 million and £115 million more under current market conditions.

It found a simple relocation of the current plans to the existing hospital site at Gloucester Street would also be unaffordable and would face significant other challenges, including planning, and risk arising from working within and adjacent to an operational hospital site.

It recommends the plan be replaced with a phased development across two or more sites, including Overdale, Kensington Place and the existing hospital site at Gloucester Street.

The review found this offered the best opportunity to make the scheme more affordable and appropriate, and to manage the risk of costs rising significantly once the project is underway.

The report noted that it is challenging in the current uncertain financial climate to give precise figures in relation to the extent of saving that can be achieved. But it identified the following potential savings at today's prices from a phased development over two or more sites:

• up to £50 million from the reduced need for new road infrastructure and land acquisitions
• up to £30 to 60 million from separating the scheme into smaller constituent parts, opening up procurement, including to more local contractors and enabling more competitive bids
• up to £15 to 30 million from future digital healthcare services delivery
• up to £15 to 30 million from modern methods of construction for some buildings
• up to £15 to 20 million from the market value of healthcare sites no longer required
  

The review noted that a phased development would open procurement to smaller contractors, which would lead to more competitive bids and make it more possible for local contractors to participate, keeping more of the money spent within the Jersey economy.

The review recommended the following schedule:

• phase 1, development at Overdale to be commenced within 24 months with a 36 month programme to completion
• phase 2A, development at Kensington Place or Overdale to be commenced within 36 months with a 36 month programme to completion
  
• phase 2B, development at the current hospital site at Gloucester Street to be commenced within 72 months, with a 24 month programme to completion
  

The review found that mental health services could be established at a separate standalone location and recommended a review of the requirements to commence immediately, with proposals on site within 36 months and a 24 month construction programme to completion.

The review recognised that the existing Jersey General Hospital must be kept safe whilst the various developments are constructed and noted that additional funding is currently being made available for this in the event that it is required.

Following the review, a number of practical steps will now be taken, including the necessary design and decision making to put these proposals into effect.

A review of the Our Hospital Project