KOHIN

Keep Our Hospital in Norwich

Miscellaneous

Easier, quicker and cheaper to build on a greenfield site

It is always easier, quicker and cheaper to build on a green field. Builders like it, developers like it, financiers like it.

The New Labour Government has broken its promise

The Labour Government has broken its pre-election commitment to hold a listening exercise on the new N&N Hospital. The Norfolk public has been denied a public inquiry into the new hospital. We have been denied a "listening exercise", promised by the Labour Front Bench before the general election.

This is because Labour wants to promote a hospital at Colney as the first example of a new NHS hospital built using private money.

Ministers have ignored request from Norwich City Council to visit Norwich, view the sites in question and review the scheme. Is this how democracy works?

Keep Our Hospital in Norwich campaigners met Department of Health officials in early July and were told that developers prefer green field sites because they are cheaper to develop than sites in town centres. This is unacceptable as local people will suffer the social, environmental and economic costs of an out-of-town hospital.

It was clear from the meeting that compensation payments in the event of a broken contract are not the overriding factor in the Government's support for Colney as the Norwich MPs claim and they certainly would not run into "hundreds of millions of pounds". (see Denise Carlo's letter to EDP)

Norfolk people call upon the Government to renegotiate the contract with Octagon Healthcare so as to replace plans for an out-of-town hospital by redevelopment of the existing site.

Bankers have yet to agree money

The July edition of the N&N hospital trust newsletter reports on ongoing negotiations with the banking consortium. This revelation contradicts statements made by the trust over the past year that work is about to begin. It appears the money is still not in place.

Continued opposition to Colney may make the bankers hesitate.

What you can do

1. Write to the financial advisers (BZW) and developers (John Laing) stating your opposition to a new hospital at Colney. Ask them to support redevelopment of the N&N in the city centre. Please write to:

Sir Peter Middleton (Chairman)
Barclays de Zoete Wedd
Barclays Plc
54 Lombard Street
London EC3P 3AH

Martin Laing (Director)
John Laing Group
Page Street
Millhill
London NW7 2EP

Similar problems in Chelmsford

We had a similar problem in Chelmsford. The HA was offered the Chelmsford Cricket ground to expand the C&E hospital for peanuts ... they turned it down and built the new hospital out of town at Broomfield (at great expense.) Linking up with the satellite hospitals is a nightmare and my patients have to travel to Chelmsford by bus and then change and get another one out to Broomfield. Any OP appointment takes up the best part of an entire day.
John Cormack
Woodham Ferrers
Essex
30 January 1998

N&N Trust says traffic problems not our problem

A presentation of the new N&N took place on Tuesday 3rd February 1998 at the John Innes Institute for memberof staff at UEA.
The main concern of the audience was on traffic congestion resulting from the construction work on site and from the movement of people to/from the hospital once it becomes functional.
Just a few key issues: Laing Construction Ltd assured that traffic sampling had been undertaken. The construction site will be open 7.30 am - 5.30pm and there are currently 40 men working there (going to 200 by May when construction starts). The traffic will go through Colney Lane. It is likely that during this time the number of cars on Watton Road will double.
Rod Smith ( Project Director of the N&N HC Trust) commented that a proposal was made at the time of the enquiry on the hospital to build a new access road to the hospital off the Southern Bypass but it was refused. At the moment Norfolk County Council and South Norfolk Council are considering a 2 junction loop around Cringleford to reduce the through traffic in that location.
Against the argument that 15-20 minute tailbacks are currently the norm to access the research parks in the morning, the Health Care trust argued that it is not their role to reduce current and deal with future traffic problems; these should be taken up with Martin Shaw at Norfolk County Council (classic buck passing!). Someone argued that improvements to Watton Road and Colney Lane would only be cosmetic and not beneficial to the traffic situation overall: once the N&N is functional, there will be 2,500 staff, hundreds of in/out patients (and all their visitors!).
We are not aware that access may occur across UEA land.
Other concerns voiced:
Side effects of construction work
The spring weather, we are told should keep the dust in the air manageable.
Design and specifications should ensure minimum inconvenience.
Security.
Construction sites and surrounding areas are usually vulnerable.
24hr security will be maintained and will liase with reaearch park security.
Visual and environmental impact.
The N&N was going to be mostly 2-3 storeys high (maximum 4 floors in places) and creamy brick... suggesting a low environmental impact!
Safety of pedestrians and cyclists.
Discussions are in progress with the Highways Authority, but this eemed to be out of their control (note: a pedestrian crossing at Colney Lane will be laid out).
[The more naive amongst us were under the impression that questions of access were of paramount importance in the planning procedures and that they had to be sorted out before planning permission would even be considered. At least that is how it is for more humble applicants - even Mr Body of Colney Hall is having difficulty about access to his cemetry]

"I Don't Believe It!"

May 1996 Richard Wilson writes:- "I was very upset to hear of the problems you have about the closure of your two NHS hospitals in Norwich. If there is anything I can do to help in the fight to keep them, please let me know. I have enjoyed my various trips to Norwich and I realise this must be a very difficult time for the city. I wish you all good wishes in your fight to stop the closures."

Tony Benn's five democratic questions

Whenever you meet a powerful person ask him these five questions:
  1. What power have you got?
  2. Where did you get it from?
  3. In whose interests do you use it?
  4. To whom are you accountable?
  5. How can we get rid of you?

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Norwich Area Transport Strategy 1997 - extract

"Significant travel intensive uses which have a Norwich Area wide or greater catchment population (ie....hospitals..) should be located in the city centre."

The alternative could work

Michael Innes is quoted as saying (EEN 12/6/96): "The N&N site is capable of redevelopment. I am not normally in opposition but what strikes me about this one (the hospital) is that almost everyone you meet is quite indignant that they do not want it moved.
"I think that Colney is an old-fashioned concept and it is far away from being the flagship which it is being advertised as either in terms of design or location.
"There has not been an enquiry into the move since 1988 and a lot has changed since then both in planning terms and the fact that Colney will not now be Norwich's second hospital.
"My ideas are not without difficulties but where there's a will there's a way."

Architect Michael Innes is best known for his role in developing the Castle Mall.
The shopping centre concept was originally cautiously welcomed and initially branded by the City Council a "lovely idea but crazy". But it went on to be recognised as an architectural success.
His track record also includes the South Norfolk Council offices at Long Stratton, completed in 1978 and BUPA hospitals at Colney and Portsmouth.
Mr Innes, who lives at Thorpe, is a senior partner with Lambert Scott and Innes on Cattle Market Street.
A native of Devon, he has been a practising architect in Norwich since the 1960s.
He said he finds himself in an unfamiliar role, opposing a development, not selling it.
"I'm not a campaigner, I'm the one proposing developments, but the more I thought about it the less sense it made.
"Moving the hospital will be a disaster for Norwich and I do believe the public have not had a chance to debate the issue fully".

What Chris Smith (Shadow Health Minister) said before the election

"I understand your concern about the loss of the N&N Hospital site and facilities. It is not clear to me that proper consultations have been carried out with the local community, or whether the benefits of the new site will outweigh the disadvantages of losing the present facilities in the centre of the city.
We have had serious concerns about the operation of the Tory PFI - not least because it has led to needless delays in necessary capital development projects, but also because of the lack of public consultation. We want to make sure the people of Norwich have access to new and better hospital facilities as soon as possible. But we would rapidly undertake a listening exercise with local people before making any final decisions. This should not be used as an excuse for delay - as the Tories claim - but only for ensuring that the right decisions have been taken.
Chris Smith MP
17th March 1997

Hanratty B, Patterso W.
Three quarters of delegates drove to a conference on the impact of the environment on health.
BMJ 1998; 316: 775 http://bmj.com/
"Our experience suggests that if health and local authorities are to lead the way to a healthier nation then transport policies for their own staff may be agood place to start".

Hospital's £1.3bn Rent
Norwich's new district general hopsital at Colney is to cost the tax payer more than £1 billion over the next 60 years, it emerged today.
The annual rental bill will be an average of £22.8 million according to figures revealed today by NHS chiefs.
The news was greeted with shock from opponents of the new hospital although health chiefs insisted it was value for money.
N&N Health Care NHS Trust chief executive Malcolm Stamp said: "Three years ago I said as soon as we concluded negotiations we would release costs in the yearly accounts.
"We have done this.
"The £22.8 million is absolutely value for money and is saving the health service a fortune.
"We could not do a deal if it didn't save money. "The rent includes all services, rent on the building, maintenance, depreciation and information technology. "But at the end of the day this money has to be in perspective as we are a £130 million a year organisation," said Mr Stamp.
Nick Court, spokesman for the NHS Executive, one of the service's ruling bodies, said: "If you look at the bald figures it does look like a considerable sum but it is important to look at it in context.
"The hospital spends a considerable amount each year at the existing site."
June Farrow, of Keep Our Hospital in Norwich campaign, which opposed moving the hospital to Colney from the city centre, said she was horrified at the cost.
"I think people will be appalled at the cost," she said.
"They already have fears about the new hospital and this will make things worse.
"This is certainly too much money to pay. Profit should not be made from health care."
Under the Private Finance Initiative which funded the building of the new £213 million hospital, financiers the Octagon consortium agreed to finance and build the new hospital at Colney as a replacement for the city centre N&N.
In turn the trust agreed to pay back an annual cost to Octagon payable over 60 years - £1.368 billion.
Eastern Evening News
28th August 1998 (Comment)

"The general public does not stand a chance. We have too many of the right people in our pocket."
Philip Roberts, Consultant pathologist at the N&N 1991
In conversation with a KOHIN supporter

Larry Elliott writes in the "Guardian" 26th October 1998 "The need for the private sector to make a profit has been felt in service cuts and job losses. There are signs that the public, and Labour MPs, are starting to wake up to this."

"How big money is stitching up the NHS"
The Observer 13th December 1998. Will Hutton reports:- we're investing millions, but we'll end up with smaller hospitals and fewer beds. Where will the cash go? Private profits, not public health.
The Department of Health is robust in defense of the PFI. A spokesman said the fall in bed numbers, from 300,000 to 200,000 over the past 20 years, must be put in the context of a trend to downsize hospitals. Nor are PFI hospitals more expensive or necessarily smaller than facilities they replace; the DoH cites 15 hospitals where PFI bed numbers are unchanged.
It says the benchmark showing PFI hospitals as more expensive is wrong. Once the typical 18-19 per cent cost overrun on large publicly funded hospital contracts is taken into account, along with the commitment of the private consortium to service the maintenance of the hospitals during the 30 year contract, PFI hospitals are more cost effective than publicly funded hospitals.
But the DoH is being disingenuous with the truth.
Bed numbers have fallen over the past 20 years because of a massive transfer of long-stay beds for mental illness and long-stay geriatric care to residential homes in the private sector, in an act of covert privatisation. Health Secretary Frank Dobson is concerned enough to have launched a national bed inquiry.
NHS acute bed numbers in England have been stable over the past four years at about 108,000, and it is these beds that are being dramatically reduced under PFI schemes. When the department claims acute beds are little changed under the PFI, it is not comparing the bed numbers of existing hospitals with PFI bed numbers, but estimates of planned new beds under new schemes with the outcomes under the PFI. But, as planners calculate beds knowing they will be PFI financed, there is in effect no difference between planned new beds and PFI beds.
As for cost overrruns, again the department is dissimulating. There have been only seven large hospital projects over the past 20 years on which to base such claims, and Guy's Hospital, which Dobson likes to cite and where costs have more than doubled, was an example of a private-public partnership where the change to trust status provoked a £14 million liability to VAT - the biggest reason for the overrun.
In the past seven years the average cost overrun for NHS investment programmes has been about 8 per cent. Justifying the PFI because the NHS loses control of its costs while the private sector does not is not supported by the figures.

"Hospital on Nightmare Road"
Eastern Daily Press 29th December 1998 David Macauly reporting. A two page spread.
Much trouble about access to the new hospital which is in an advanced state of construction. Extensive quotes from Martin Shaw, Norfolk's director of planning and transportation, and from Graham Martin, chairman of Colney Parish Meeting. Fair to say that chaos reigns.
Dr Murray Gray, Chairman, Planning Committee, South Norfolk Council has his say.
Editorial in the EDP of the same date
"The bones of the new Norfolk and Norwich Hospital are being assembled at Colney, and this flagship PFI scheme is on course for opening in 2002.
It also looks, however, like taking into the next millennium one of the most common planning problems of the second half of this century - that of a major development being constructed without an adequate, let alone efficient, infrastructure.
The hospital site is only a short distance from the A47 and the A11. But there is no planning permission for a scheme giving it direct access on to the trunk road network. Instead, there are fears of Colney being plunged into an "environmental nightmare" as extra cars taking people to and from the hospital, the growing Norwich Research Park and the new sports park at the University of East Anglia add to congestion in the area.
Opponents of the Colney hospital site have long used transport problems as one of their main arguments, and now have just cause to say: "I told you so." We trust they will accept, however, that the hospital scheme is unstoppable and that nothing positive can be achieved by resurrecting the old divisions over the matter.
Supporters and opponents of the site should be able to see a common interest in pushing the county council, the Highways Agency and other authorities to secure the provision of a road access to the hospital, that is both efficient and relatively environmentally friendly, in time for its opening."

New hospital beds fear
A huge shortfall of beds at the new hospital being built at Colney could spark an unparalleled crisis as hundreds of patients are turned away, doctors warned today.
The fears emerged after a winter bed crisis hit medical services in the city. The Norfolk & Norwich Hospital, to be replaced by the privately financed hospital, had to refuse non-prority patients as it went on alert over Christmas.
Staff have been struggling to cope with demand despite extra beds for emergency admissions - up 50% for the time of year.
But the new £214 million hospital, due to replace the N&N and the West Norwich hospitals in 2002, is set to have almost 400 fewer beds.
A review is in place and doctors and the city's MPs are pleading with health chiefs to reconsider.
Dr Simon Lockett, local medical committee chairman, said; "It's very scary. GPs are very worried about the size of the new hospital. There clearly isn't spare capacity in times of need and winters aren't going to stop happenong."
Current projections say the new hospital will have 809 beds, considerably less than the current 1,200 at the two hospitals.
Concern was raised in a report to the British Medical Association last year, which predicted bed shortages and a crisis in patient care.
Malcolm Stamp, chief executive of the Norfolk & Norwich NHS Healthcare Trust, could not say whether the current crisis would lead to more beds.
"When we first started out on the new hospital we put into place a regular review procedure.
"We need to start making some decisions about what the number of beds at the new hospital will be. We need to be clear." (response)
Norwich North MP Dr Ian Gibson said: "Malcolm Stamp really ought to see this as a major priority. The problems this Christmas show how easy it is to be caught out."
A decision was previoussly made by a review committee, made up of various health bodies, to increase the number of beds from 701 to 809.
Norwich South MP Charles Clarke said: "Bed numbers need to be kept under constant review in the light of experience and projected need."
Dr John Noble-Nesbitt, chairman of Norwich Community Health Council, said: "There are more community based beds but the added pressures at winter need to be taken on board as well."
Eastern Evening News 4th January 1999

We're doing our best...
Mr Stamp said: "The hospital has already experienced an exceptionally busy winter period which has resulted in some operations being postponed and patients having to wait longer for treatment than we would wish.
"It is regrettable that any patient is inconvenienced in any way but every effort has been made by our staff to address the heavy work load."
Eastern Evening News 6th January 1999

"We want answers"
City MP Dr Ian Gibson is insisting that the scenes of Christmas chaos at Norfolk & Norwich Hospital's casualty department must never happen again.
He is backing the Evening News call for a quick reply from health chiefs on whether they plan to increase the number of beds at the new hospital being built at Colney.
But hospital bosses refused to say whether there would be extra beds - even though it was revealed that the new site will have to deal with thousands more patients than originally forecast.
The Norfolk & Norwich, due to be replaced by Colney in three years, had to refuse non-priority patients as demand soared over Christmas - up 50% for the time of year.
Dr Ian Gibson, MP for Norwich North, visited the Colney site yesterday and said another ward should be developed to cope with increasing demand.
"They have underestimated once and had to put the number of beds up.
"It was clear the figures were going to have to be revised again.
"They should be trying to convince the people of Norwich the facilities will be adequate and the scenes we've had this Christmas will never happen again".
The £214 million development due to replace the Norfolk & Norwich and the West Norwich hospitals in 2002, is set to have 809 beds compared to the 955 currently available.
Doctors have warned the shortfall could spark an unprecedented winter bed crisis.
The Norfolk & Norwich Healthcare NHS Trust said it could not make a decision on the number of beds until East Norfolk Health Authority told it how many patients the new hospital would deal with.
The current bed capacity was worked out from a projected 81,703 cases each year but an ongoing review is expected to agree to a new, and much bigger, workload for the hospital in the spring.
The same process in 1996 saw the trust increase bed numbers by 108.
And it has emerged the number of cases dealt with by the trust in the current year is likely to be about 92,000, says the health authority.
Dr Chris Price, health authority director of primary care, said: "Even in October 1996 there was already more work than the 87,703 cases being done - we left ourselves a margin then.
"The work has grown again since then and we are definitely going to be asking the trust how it will work with a higher number of cases."
Malcolm Stamp, trust chief executive, said: "For the case load of 87,703 we have been asked to deal with we are confident 809 beds are fine."
Mr Stamp said, once the results of the review were known, the trust would work out how to cope with the extra patients and work.
It might include providing extra day care places, shifting work to other hospitals or providing extra beds.
Eastern Evening News 16th January 1999


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"It is the people's national health service and we should never forget that."

(Alan Milburn MP, Minister of State for Health, Hansard 15th May 1997)

"City centres are the places for hospitals."

(John Gummer, recently Minister for the Environment, Bristol 22nd March 1996)