What a disappointing response from the minister to the Hospital Review Panel’s report.1 He accuses the Panel (that I chair) of assessing the government’s business case for the new hospital facilities as if it were an NHS hospital, ignoring the Jersey context. This might be a more valid criticism if the government hadn’t gone out of its way to make clear that it was using UK Treasury guidance – known as the Green Book – in formulating its own business case.
For example:
The government’s Outline Business Case (OBC) for the new hospital facilities says “In line with the UK Treasury Green Book ‘5 case’ model, the OBC examines the strategic, business financial, commercial and management aspects of the programme”.
The 2025-28 budget said: “The HMT/Green Book 5 ‘case model’ is being used”.
In the Assembly on January 21st the Treasury Minister said: “The outline business case… follows the principle of the Green Book”.
At a Scrutiny hearing on March 7th, the government’s Chief Executive said: “Phase one of the acute hospital (Overdale) has been ‘green booked’.”
So the government said it was following UK guidance. Our Scrutiny report – based on a report by a highly respected independent advisors with considerable knowledge of the Jersey context – identified numerous examples where the guidance had not been followed. Now the government’s response seems to be, that stuff wasn’t relevant to Jersey after all.
It’s a bit like a kid who promises they’ve done their homework, but then when you find out they haven’t done it, turns around and says “well it was rubbish homework anyway”. Not good enough.
This isn’t just an abstract argument about whether or not the right guidance was followed. It’s about the basic principles of large project management. The government’s OBC is supposed to provide the evidence base – the proof – that the new hospital facilities (not just Overdale – remember, the OBC also includes Kensington Place and a new mental health hospital at St Saviour) are right for the island and can be afforded.
Effectively, the minister is saying, we’ll do all that stuff – the health strategy, the mental health strategy, the workforce strategy, the ongoing funding – later. In the meantime, just trust me. This means that we are effectively going to build 3 new hospitals (plus the Enid Quenault facility) and then make the health strategy, the workforce strategy and the funding fit the estate that’s been built.
It is the exact opposite of the way that a business case should be constructed.
You should start with a health strategy that defines what kind of hospital you need and the facilities it provides, you model the workforce to deliver that health strategy and then you set out the funding to deliver it. All BEFORE you build the hospital, so that you know you are building a hospital that meets the island’s healthcare needs, that you will be able to staff it and you can afford it. Neither is it the case that this would significantly slow the project down – it is the stuff that any project team would be expected to do.
To give just one example. The new hospital at Overdale will have approximately 60 more beds than Gloucester St – an increase of about a third. Yet it appears from the OBC that staff costs barely increase at all. Are 60 extra beds going to be kept empty? Is the idea to add a bed or two each year, as demand increases? If it is, does the government not realise that it costs money to maintain beds and wards even if they are not in use?
The minister’s response also says that the report was inaccurate, citing for example that a lot of the information that the Scrutiny Report says was missing was available, if only we’d asked for it. This is simply untrue. The relevant information was requested via email on November 6th and in a meeting with the hospital programme team on the 19th. It was not provided.
Let us remember, the whole point of a business case is to provide all the information to justify the investment. It’s to provide the proof that you’re building the right hospital – or in our case hospitals – that they will meet the health needs of the island, that there is a workforce strategy in place to staff them and that the capital and revenue costs can be afforded in the long term.
The government seems to be gambling that the public have given up caring about the details of a new hospital (or hospitals). They just want something built. Whether that is or is not the case, States members have a responsibility to scrutinise the government and to ensure good governance and value for money. That is what we have tried to do as a Scrutiny Panel.
The failures that our Scrutiny report identified in the government’s business case mean that we are flying blind. We simply do not know whether the new hospital facilities will meet the island’s healthcare needs, or whether we can afford to build and run them.
- To recap: the government produced an Outline Business Case to explain the basis for the hospital at Overdale, the Kensington Place ambulatory facility and the proposed St Saviour health village. The Scrutiny Panel reviewed the OBC, using outside experts to assess its compliance with best practice. Our advisers were highly critical of the OBC, and the adviser critique formed the basis of our Scrutiny report into the new hospital facilities. It is our report to which the minister is now responding. ↩︎
Jonathan Renouf 