Select Committee on Health Memoranda

5.3 Hospital and Community Health Services Capital Prioritisation

  5.3.1  Could the Department list the criteria used by the Capital Prioritisation Advisory Group in its assessment of which projects to prioritise for major investment? Which schemes were assessed last year, and which were prioritised for investment? Of these, which have been allocated public and private funding? Could the Department give examples of schemes which have been turned down, and explain why? [4.7]

  1.  Schemes are prioritised on the basis of health service need. CPAG is responsible for developing the criteria against which this is assessed, and reporting to Ministers on each scheme against these criteria. The criteria used to assess health service need are:

    —  For better access to services

    —  For improved clinical quality of services

    —  For improved environmental quality of services

    —  For development of existing services and/or provision of new services

    —  For improved strategic fit of services

    —  To meet national, regional and local policy imperatives

    —  To meet training, teaching and research needs

    —  To make effective use of resources

  2.  CPAG assesses schemes on the basis of information contained in a document known as the Strategic Outline Case (SOC) which is developed by the relevant NHS Trust in agreement with all the key local stakeholders. As part of the assessment each site with a proposed scheme is visited by a member of CPAG.

  3.  The decision on private or public finance does not form part of the prioritisation process. Once prioritised by Ministers the scheme is subject to the normal business case approval procedures. Although it has been demonstrated that PFI offers the public sector value for money, and it is our expectation that the majority of major projects in the NHS will be funded using PFI, each project is assessed on an individual basis. It will have to be demonstrated in a Full Business Case that the PFI option is affordable to the NHS, meets NHS service needs and offers value for money when compared to the publicly funded alternative. These value for money appraisals are carried out by the NHS trust and the Department of Health, not the private sector.

  4.  There has not been a capital prioritisation exercise since the last report to the Health Select Committee.

5.4 Long Term Capital Projects and PFI

  5.4.1  Could the Department provide a table showing all publicly funded capital projects with a total cost above £10 million which are under construction during 2002-03? Could this also show the original and current estimated completion dates along with a percentage figure for any additional time overrun/saving? Likewise, the original total cost and current estimated out-turn cost should be provided along with a percentage cost performance figure.[4.8a]

  1.  The information requested is contained in Table 5.4.1

Table 5.4.1

ProjectInstitution Description of ProjectOriginal Estimated Completion Date Current Estimated Completion Date % Time PerformanceOriginal Estimated Expenditure

Current Estimated Expenditure

% Cost Performance
Hull Royal Infirmary Maternity & Acute Development (see note 1) AcuteMaternity, Gynaecology, Plastics, Theatres, Children's OPD, Admin, Dining, Main Entrance 30/07/200218/10/2002 5.009.449.44 0.00

Newcastle Strategic Review (NSR)—Enabling Schemes (see note 2)
AcuteEnabling Schemes—15 No. various work packages including New Pharmacy Manufacturing & Stores, New Ante-Natal Clinic, Alterations for various Pathology functions, Wards, Psychology, PGEC, Admin, Demolitions 30/09/200231/03/2003 27.2715.3022.88 49.50

York District Hospital, Reconfiguration of Surgical Facilities (see note 3)
AcuteAlterations & Extensions for Adult & Children's Wards, Opthalmology,Theatres, Day Unit, ICU, HDU, Diabetes Centre, Children's Assessment Unit. 31/07/200631/12/2007 15.0016.4417.95 9.18

Gateshead Health NHS Trust
Community/Elderly Reprovision of Elderly Services from Bensham Hospital 30/04/200430/04/2004 0.0015.4715.47 0.00

Pennine Acute Hospitals NHS Trust
AcuteA & E, Outpatients, Radiology, Operating Theatres, Adult Acute Wards, HDU, Pathology, Obstetrics 31/01/2003 (phased)31/01/2003 (phased) 0.0023.8022.80 -4.20

Wrightington, Wigan & Leigh Health Services NHS Trust
AcutePhase IV. Obs & Gynae, A & E, Imaging at RAEI. Outpatients Dept off site. 26/09/200316/02/2004 15.2024.6624.66 0.00

Preston Acute Hospitals NHS Trust
AcuteObs & Gynae, Elderly Rehab, Pharmacy, Orthopaedics, DH, Outpatients, X-ray, Mortuary, Catering, Therapy, Education Facilities. Ward at Chorley 30/09/200331/03/2004 29.0028.6540.84 43.00

Central Manchester & Manchester Childrens NHS Trust
AcuteEnabling works for redevelopment of adults and childrens services. 31/03/200331/03/2003 0.0016.2416.24 0.00

Northern Lincolnshire and Goole Hospitals NHS Trust
AcuteA new womens and childrens unit at Diana, Princess of Wales Hospital. 06/05/200306/05/2003 0.0013.8613.86 0.00

Bath Redevelopment
Acute Redevelopment of general hospital facilities 30/09/200230/03/2003 11.1139.5039.50 0.00

Royal Berkshire & Battle
AcuteConsolidation of Acute Services (including predicted contribution from land sales at the Battle Hospital site, £30.5m). 31/05/200430/11/2004 6.30105.50114.90 8.91

Southampton University Hospitals
AcuteCancer Care Relocation 01/08/200201/10/2002 9.5219.9420.75 4.06

Thames Gateway
Community Sheppey Community Hospital09/09/2002 09/09/20020.0013.56 13.560.00

Brighton Healthcare
Acute Re-provision of Renal Unit30/11/2003 30/11/20030.0011.00 11.000.00

East London & City Mental Health
Mental HealthRelocation of Mental Health Services from St Clements to Mile End Hospital 30/11/200430/11/2004 0.0021.5026.55 23.48

Great Ormond Street Phase 1B
AcuteGOS 2000 and beyond (rebuilding the hospital) 25/11/200425/12/2004 2.5063.1962.50 -1.25

Edgware Community Hospital
Community Phase 3 of the Edgware Community Hospital project 31/03/200327/03/2004 50.9823.8135.70 49.93

Enfield Medium Secure Unit
Mental Health 70 Bed long term medium secure unit07/03/2003 16/06/200320.2712.02 12.675.41

Camden & Islington Adult Mental Health Unit Highgate Wing
Mental Health140 Adult Mental Health Unit, comprising 128 beds in ward areas, 12 bed PICU + day hospital + mental health OPD. 31/01/200313/10/2003 37.0025.0025.20 0.80

Charing Cross Hospital
Mental Health Relocation of Mental Health beds, releasing much needed accommodation for acute use. 28/02/200308/05/2003 13.0014.9714.97 0.00

West London Mental Health NHS Trust
MentalSecurity upgrade at Broadmoor Hospital. 21/06/200221/06/2002 0.0014.8114.81 0.00

Central and North West London Mental Health NHS Trust
Mental HealthMental Health facilities at Woodfield Road and St Charles. 31/08/200521/12/2004 -23.0829.2129.21 0.00
Guy's & St. Thomas' Acute Rationalisation of Acute Services, Women's services and Cancer Services 15/06/200312/05/2004 20.7150.0050.00 0.00

Mayday—New Ward Block
Acute222 Beds and 4 day theatres to replace Victorian stock 01/04/200401/04/2004 0.0022.6022.60 0.00

Royal Wolverhampton Hospitals NHS Trust
AcuteCardiac Unit30/09/2004 30/09/20040.0052.00 52.000.00

Royal Shrewsbury/Princess Royal Hospitals Shropshire
AcuteRoyal Shrewsbury Acute services reorganisation 22/09/200422/09/2004 0.0019.0019.00 0.00

Worcestershire Acute Hospitals NHS Trust
AcuteKidderminster Hospital ACAD (Ambulatory Care and Diagnostic Centre) 22/09/200422/09/2004 0.0014.9014.90 0.00

North Staffordshire Hospital NHS Trust
AcuteIntegrated Education Centre 30/09/200430/09/2004 0.0014.7014.70 0.00

South Birmingham Mental Health
AcuteForensic Child & Adolescent Unit and Womens Medium Secure Unit 30/09/200330/09/2003 0.0019.7019.70 0.00

Southern Derbyshire Mental Health NHS Trust—Kingsway Reprovision (see note 4)
MentalReprovision of mental health facilities, intensive care and community facilities. 31/03/200431/03/2004 0.0014.0014.00 0.00

United Lincolnshire Hospitals NHS Trust (see note 5)
AcuteRenovation and associated works at Pilgrim Hospital, including new A & E department, outpatients and pre-assessment unit, adult wards. 06/08/200306/08/2003 0.0012.0013.51 12.58

Nottinghamshire Healthcare NHS Trust
MentalNew entry building at Rampton Hospital. 16/05/200321/02/2003 -15.5810.8410.84 0.00

Nottinghamshire Healthcare NHS Trust
MentalDangerous and Severe Personality Disorder Unit at Rampton Hospital. 08/08/200308/08/2003 0.0020.7320.73 0.00


  1.  Publicly-funded element of a major PFI scheme

  2.  Increase due to extended briefing of major Pharmacy, Ante-Natal and Laboratories packages and including University Funded Element (£1m)

  3.  A revised Full Business Case has been approved for this scheme

  4.  Subject to approval of FBC by Strategic Health Authority

  5.  The original FB1 cost of £12m has now risen to a forecast out-turn of £13.51m. The Trust will contribute £1,329,825 of this additional expenditure.

5.4  Long Term Capital Projects and PFI

  5.4.2  Could the Department provide a commentary on cases where there are significant discrepancies between original estimates of completion dates and/or expenditures and current estimates? [4.8a]

Newcastle Strategic Review—Enabling Schemes

  1.  The significant time and cost overruns are due to extensive changes by the Trust which have resulted in real increases to the functional content, design and specification of the scheme. These changes, along with additional costs due to inflation, have seen the overall scheme costs rise from an original estimated expenditure of £15.30 million to a current estimated expenditure of £22.88 million, representing an increase of 49.50 per cent.

Wrightington, Wigan & Leigh Health Services NHS Trust

  2.  Delay in completion of an off-site Out-Patients Centre, which was the first stage of this sequential project, was due to the complex nature of the refurbishment and expansion of a Grade 2 listed building. There is no anticipated cost increase to the scheme as a result of this delay.

Preston Acute Hospitals NHS Trust

  3.  There has been a slippage in the programme for the scheme, due mainly to a review of Orthopaedic services undertaken by the Trust. It was not possible to tender for the construction works until the outcome of the Orthopaedic review was known and the scheme subsequently revised.

  4.  When the construction works were tendered in February 2002, it became clear that the overall cost would have to increase for the scheme to be delivered. This was due mainly to building cost inflation over the prolongated business case process and subsequent tender period.

East London & City Mental Health

Relocation of Mental Health Services from St Clements to Mile End Hospital

  5.  Additional scheme costs have been incurred due to the requirement to provide en-suite facilities as part of the Consumerism agenda. Costs have also increased due to additional inflation costs between the FBC and tender stage, along with extra funds following a risk assessment of the scheme. These factors have seen the original estimated cost of £21.50 million rise to a current estimated cost of £26.55 million, representing an increase of 23.48 per cent.

Edgware Community Hospital

Phase 3 of the Edgware Community Hospital project

  6.  The time overrun is due to management decisions to change some members of the design team and to change the procurement route to a two stage tender. The enabling works are now complete and the main contract has commenced following the two stage tender process.

  7.  The increase in costs is due to additional inflation costs, location and site factors, a revised energy/engineering strategy and inaccurate cost advice. The firm providing Quantity Surveying advice to the scheme have now been replaced following poor performance.

Enfield Medium Secure Unit

70 Bed long term medium secure unit

  8.  The original estimated completion date has slipped because the design development period was extended to allow for additional consultation. This meant that the start on site date was delayed, however the contract duration has remained the same.

Camden & Islington Adult Mental Health Unit Highgate Wing

  9.  The original estimated completion date has slipped because the tender period was extended to allow the Trust to negotiate savings from this design and build scheme. This meant that the start on site date was delayed.

Charing Cross Mental Health Unit

  10.  The contract programme has been extended by nine weeks owing to variations on the original construction works. This has resulted in a current estimated completion date of 8 May 2003, which represents a time overrun of 13 per cent on the original estimated completion date.

Central and North West London Mental Health NHS Trust

Mental Health facilities at Woodfield Road and St Charles

  11.  A significant time saving on the original contract programme has been achieved by running phase 2 and phase 3 simultaneously, rather than consecutively as originally planned. The facilities are currently forecast to be completed on 21 December 2004, some eight months ahead of the original schedule.

Guy's & St. Thomas'

Rationalisation of Acute Services , Women's Services and Cancer Services

  12.  The rationalisation of Women's, Children's and Cancer Services at the Guy's site and the St Thomas' site is partly publicly funded and partly funded by Guy's and St Thomas' Charitable Foundation, the £50 million cost identified in the table being the public element. Increases in the cost of the Children's Hospital, funded by the Charitable Foundation, have resulted in £12 million from the public sector element being vired to the Children's Hospital. Women's services are near completion and Cancer services are being reviewed.

5.4  Long Term Capital Projects and PFI

  5.4.3  Could the Department provide details of PFI projects with a capital value of £10 million or over approved since 1992, including their current status? [4.8b]

  1.  Please refer to the answer provided at 5.4.4.

  5.4.4  Could the Department provide tables showing the planned and actual annual contribution to capital from PFI, and the forecast level of investment generated by schemes over £10 million plus an aggregate of those below £10 million, since 1997-98? What revenue or transitional support is being given to support the scheme? Could the Department provide further details of locally agreed arrangements to provide revenue or transitional support to schemes? [4.8c]

  1.  The information requested is provided in Tables 5.4.4(a) to 5.4.4(i)

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Prepared 17 February 2003