Picking over Paddington's bones

AGENDA - The dust has settled on the £1 billion Paddington Health Campus and an independent review has examined the remains. Andrew Hankinson looks at what went wrong

IF THE chairman of a football club spent millions planning a new stadium but six years later a site had still not been found and the current facility was crumbling, would the fans be angry?

If the impossible new stadium had constantly been championed by the board, while the team was neglected, despite repeated warnings from various individuals and organisations, surely those in charge would pay the price?

The stands would ring out with 'Sack the board, sack the board, sack the board!' Heads would roll. Positions at non-league clubs would beckon.

But in the National Health Service things are different. Where else could a project last six years, cost ? officially ? £14 million and then fail, but nobody be blamed?

Where else could those in charge waste such vast sums of public money and then commission a review with the explicit order that it does not point the finger?

This week an independent review of the now collapsed £1 billion Paddington Health Campus was presented to the board of North West London Strategic Health Authority, which oversaw the project. Its aim was to improve future major capital projects in the NHS.

Sixty people were interviewed for the review. The only four that refused were Nigel Crisp, chief executive of the NHS; John Hutton, former health minister; Stephen Ladyman, former undersecretary for health; and Karen Buck, MP for the site's constituency.

The much-trumpeted plan had been for a super-hospital combining the facilities of St Mary's Hospital, the Royal Brompton Hospital and the Harefield Hospital at one site in Paddington, west London.

Despite the health authority ordering the independent review panel to apportion no blame, its findings were highly critical.

According to the report the project collapsed because although 'individually the challenges were not insoluble; collectively they overwhelmed the scheme'.

The straws on the camel's back included poor management, an inadequate and incomplete business case, a lack of land and a changing Department of Health policy, making it difficult to predict future funding.

In addition there was friction between the rich Royal Brompton & Harefield NHS Trust and the poor St Mary's NHS Trust.

Shockingly, the review said that from as early as 2002 the project was never going to succeed. In fact those in charge agreed with the diagnosis and decided to terminate the project in October last year and February this year but both times continued with new land proposals.

The report quotes one anonymous source as saying 'the vision was always worth one more try'.

The report said: 'It was surprising that those sponsoring the PHC project didn't realise that either the scheme needed to be canned or that something significant had to give.

'From September 2002 there were points at which the evidence and circumstances would have justified earlier termination for the project and thus avoidance of unproductive work.' Jean Brett, chairwoman of the campaign against the closure of Harefield Hospital, said: 'The review lists six separate occasions when the project could have been stopped, the first being in 2002. Anyone with an ounce of intelligence would know that if you haven't got the land you haven't got a project.' The report found that the reason it was not canned was that there were no checks in place to make sure it was on track and nobody had the clear authority to cancel it.

According to the report the Department of Health clearly stated that it was up to the health authority and the two NHS trusts to terminate the project but some interviewees thought it was more like a 'who blinks first' dance around the decision.

When it was finally cancelled in May this year, it was because the Royal Brompton and Harefield Trust rejected it ? it had already been passed by St Mary's NHS Trust. So if St Mary's, headed by chief executive Julian Nettle, was in charge of the project it would still be ticking over.

It was continually pushed by highly paid NHS executives despite repeated warnings from clinicians, managers, patients, the public, the Office of Government Commerce, the Treasury, the National Audit office and the Department of Health.

In a letter this January, Peter Coates, deputy director of finance at the Department of Health told Mr Goodier, chief executive of the health authority: 'Experience has shown that schemes with a capital value of a multiple of trust turnover prove to be unaffordable.' Mr Coates said he was 'writing to formally request that you and the trusts carefully consider whether you believe progressing with the project remains a viable alternative, bearing in mind the low probability of a successful outcome in the near future'.

Mr Goodier called Mr Coates's comments 'cynical and jaundiced'.

In a letter from Sir John Bourn to three MPs who requested a National Audit Office inquiry, the auditor general said: 'The report provides a catalogue of missed opportunities, inadequate programme management and fundamental weaknesses in how the Paddington Health Campus partners went about this ambitious, critically important and hugely complex scheme.' In particular, the auditor general was concerned that the NAO's earlier recommendation for a single client rather than multiple trusts was ignored, despite it being incorporated into the Capital Investment Manual, which is designed to stop improperly thought-through schemes going to the market.

He continued: 'Any expectation that the project team would successfully address the conf licting goals was undermined by the inadequate resources, skills and personnel secured for and by the project team.

'A recurring issue was the way the scheme proceeded at key stages on the basis of caveats to outline business cases, which meant the project partners avoided making hard decisions.' Andrew Lansley, shadow health secretary, said: 'A whole series of warning signals were not taken up nor acted on. It is a disgrace that no one has taken responsibility for this project despite the tiers of bureaucracy involved.' The health authority tried to justify the money spent on the scheme by saying much of the work done will be used anyway but the report makes it clear that less than £1 million of the £14 million of work is of any use.

Despite the furore over the wasted £14 million the NAO has suggested that the cost will be much more than that. It said that if the project had gone ahead in May in the same form it had reached in October 2003 then that 18-month delay would have added £100 million to the cost of construction, due to a rise in materials costs.

That figure shows how much the price of future development at the three hospitals, which is vitally needed, will have increased. Not only have the hospitals been delayed in redevelopment by nearly a decade but they have also steadily decayed.

The backlog of maintenance work at St Mary's was priced by the trust in 2000 at £33.8 million.

In 2005 prices that would be around £40 million.

It is expected to be around another year before a PFI package for a new development at the hospital reaches the market. The other two hospitals will also be hoping for redevelopment packages over the next couple of years.

But, given the events of the past few years, any contractors wanting to take up the challenge are unlikely to face much of a queue.

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