St Peter’s Hospital is in the news at present so, for the purposes of this ‘history of healthcare’ here, I’ll pick up the ‘how we got to where we are today’ story at the turn of the century.

In this area, when it comes to undertaking major NHS projects it’s usually very difficult to tell whether failure is due to cock up or conspiracy. More often than not it’s a combination of the two. Here is a ‘could do better’ example:

St Peter’s Hospital in Maldon has served us very well over the years. As most of you know it began life as a the ‘Maldon Union Workhouse’, which opened in 1873. It joined the National Health Service as St Peter’s Hospital in 1948.

There have been repeated attempts over the decades to replace it with a modern purpose-built facility. My first-hand knowledge of what went on started during the era in which the Maldon and South Chelmsford Primary Care Trust (PCT) was in charge of much of healthcare in this area – with ‘Hopeless Harrison’ at the helm. He looked into how much it would cost to bring the existing St Peter’s site up to spec and continue to maintain it … and compared this with the cost of erecting a new purpose-built facility. A ‘consultation’ document’ in 2003 concluded: “The preferred option is to invest approximately £20 million in building a new community hospital within close proximity of Maldon Town, to replace the ageing St Peter’s hospital.

He therefore set about the task of replacing the existing hospital with a state of the art facility on a brand new site. There were endless meetings involving ‘expensive’ people – meetings that didn’t seem to go anywhere. As ever with the PCT, judicious use of taxpayers’ money didn’t seem to be high on the agenda.

In the PCT’s glossy ‘no expense spared’ 2003-4 Annual Review (a copy of which was printed for every household in the area) we read: “The Maldon and South Chelmsford PCT has continued to progress with its plan to develop a new community hospital for Maldon and South Chelmsford. Two preferred sites were identified earlier in the year and discussions commenced with the landowners. Over the past year the PCT has carried out numerous land, environmental, and highways assessments of the two sites. Seasonal assessments for wildlife have also been undertaken including badgers, newts, birds and, currently, bats.

Negotiations and discussions have been going on for a similar period of time with the landowners to purchase options to buy the land. The purchase of the option gives the PCT the right to buy the land at an agreed price within an agreed period of time.

The PCT has received provisional Outline Business Case approval from the Strategic Health Authority. To receive full Outline Business Case approval the PCT must gain Outline Planning Consent and demonstrate with partner health agencies across Mid-Essex that it is able to afford such a new build.

Whilst there have been delays in the purchase of the option the PCT is keen to pursue the development of the new hospital. The new build is scheduled to open sometime towards the end of 2007.”

Needless to say, not a brick was laid. When it began to emerge that the project was going nowhere I asked Harrison how much had been spent on it and he replied: “Nothing.”

I wrote back to him as follows: “The public commitment to build a new St Peter’s was made some considerable time ago and has been repeated on numerous occasions. A great deal of time and effort clearly went into attempting to make progress with this scheme. There were, for example, numerous meetings attended by paid members of staff, by GPs whose locum expenses were met etc, etc. There was also the usual array of “consultants” and people with expertise in this sort of project. Did they all give their time for nothing? And, if they did, in the wake of the collapse of the Essex Rivers Healthcare NHS Trust PFI Project, will they be claiming compensation for the amount of time and effort they put in and the bills they have run up? If so, what sort of costs do you anticipate?

Were there no preparatory reports? Did you not, to give just one example, attempt to assess the effect on wildlife? Surely there would have been some cost involved. It is likely, therefore, that a great deal has been spent on this project and, for this reason, I would again ask you to give me a realistic estimate of the cost to date.”

A few words of explanation: the wildlife comment was tongue in cheek as we already knew funds had been provided from the NHS coffers for this purpose. As for ‘PFI’, this was short for Private Finance Initiative’ – a ‘live now, pay later’ way of building new hospitals. It turned out to be extremely costly – for example, it has been estimated that Broomfield Hospital (initial building cost: £148 million) will cost taxpayers £766m under a PFI contract that runs until 2043. Despite repeated warnings (‘File on 4’ provided particularly good coverage of how the figures were ‘fudged’ to make such schemes look attractive) a number of these ‘initiatives’ got the ‘go ahead.’ The Institute for Public Policy Research think-tank estimated that, overall, an initial £13bn of private sector-funded investment in new hospitals will end up costing the NHS in England a staggering £80bn by the time all contracts come to an end.

Getting back to the correspondence that took place at that time, on the 19th of July 2006 Harrison wrote back to say: “About £250,000 has been spent to date on preparing business cases and plans for the new St. Peter’s Hospital. The costs include monies to cover project management costs; professional advice; financial advice; clinical design; estate matters; transport issues; and legal fees.

The present position is that we are discussing with Maldon District Council how we can take the project forward and the best possible site. Inevitably, as a result of the vendor of the Limebrook Way site not being able to prove ownership, a small proportion of the foregoing costs will have been wasted on examining that site. However, the majority of expenditure will still be used to develop the current plans for the new hospital.”

My rule of thumb when dealing with estimates of expenditure provided by Harrison was that, if you multiplied them by two, you got much closer to the true figure. One problem with the arithmetic, then and now, is that no attempt is ever made to factor in the in-house costs – how much is spent on members of staff … i.e. the NHS employees working on any given project. For this reason there is never a clear idea of how much scarce NHS resource is being wasted. Another problem, needless to say, is that there is no accountability.

Bringing us up-to-date (and skipping merrily past all the bungling in between) – there have been intermittent efforts to move forward. I am aware of at least four business cases since then. Over this period there have been several reorganisations and with these come changes in the Project Director – and every time this happens we seem to go back to square one again. It’s rather like a game of snakes and ladders in which there are snakes at every turn and no ladders. Every new Project Manager expresses unbridled enthusiasm and declares that the mistakes of the past will not be repeated. New appointments are made to the team – and off we go again. I have sometimes wondered if a new St Peter’s could have been built with the money (supplied from the public purse) that has been wasted thus far.

I am not the only one who thinks that the way this project has been handled is shambolic. David Wilkin wrote a scathing critique of the catastrophic failures he observed – and this pretty much mirrors my experience.

As I write we await the outcome of the latest attempt to move this forward. Let’s hope that at long last something happens – but, given the track record, we must not raise our hopes unduly.

Dr John Cormack