Why Royston will lose its hospital. I attended a very professionally run 'Consultation Cafe' on Tuesday.

I took up the public invitation to attend partly because I believe in consultation when decisions are being made, and partly because on a working afternoon they might have difficulty finding people to consult. A very positive 'Vision and Strategy' paper for Hertfordshire was available before the meeting, which is just as well, because the efficient afternoon programme went straight to the discussion of alternatives for Royston. The vision and strategy paper reflected agreements made 18 months ago. I care about Royston and I really care about health provision, so it is with some shame that I have to admit I was unaware of these agreements made for us here in Royston and North Herts. But summarising the relevant substance of the paper: Its scope covers intermediate care services - broadly short term care outside of a main hospital, i.e. in care homes, community hospitals or a patient's own home. These services are provided mainly for older people, by health care professionals and care assistants. The number of older people in Hertfordshire is expected to rise by 50% over the next 20 years and there is increasing public demand for for new treatments. The vision and strategy includes more care-needing people staying in their own homes, or in beds in nearby nursing homes bought when needed at the best price. The paper presented figures showing the weekly bed cost for Royston Hospital was 1710 per week for 18 beds in 2010-11, 2138 per week in 2011-12 for 12 beds, compared with a market cost of 950 per week. The PCT uses 12 beds in Royston Hospital - which is run by Hertfordshire Community Trust (one of the largest employers in the county). There have been several initiatives to replace services at Royston Hospital (a euphemism for their attempts to close it and sell the site). The delays have been frustrating. Local care homes have already been invited to tender for the intermediate care package HCC and the PCT wish to commission. Beds commissioned from care homes will replace NHS beds. An independent care provider will redevelop the Royston Hospital site to provide 5-6 Intermediate care beds and around 40 nursing/residential beds, a number of which would be bought by the NHS and HCC. Other services provided by Royston hospital, including clinics, will be provided either in the new facility on the hospital site, in an extension to the Health Centre, or elsewhere once the hospital site has been redeveloped. The interim arrangements for these services during the redevelopment were the only subject of the consultation cafe, nothing else. So all of this was a given for the consultation. We were told quite emphatically that the existing building was quite unsuitable. For example the first floor is uninhabitable because it gets too hot. I confess I was left wondering why HCT (one of the largest employers in the county) has not been able to lag the pipes or maintain the radiator valves so that office occupants can turn down the heating. But I digress ... We were merely being invited to choose which of four alternative strategies for non-bed based services should be adopted for the interim period while the site was being developed. The obvious option - to use part of the hospital site - had a hastily inflated price tag of about a million pounds. I

say hastily inflated because there obviously hadn't been time to add the various extra technical items onto the powerpoint slide. Only the total had been changed, from its original value of what I think should have been somewhere in the 500Ks. The option of an extension to the Health Centre (which would be a permanent extension and an enduring asset - though without any commitment as to how it might be used later) came in at something like 800k. The other two options were interim or long term leasing of some other property (exemplified by one on an old commercial estate deep in a residential area). The essential features of such a site, we were told, are disconnection from both the central Health Centre and the hospital site, and the fact that typically for such buildings, it could not be satisfactorily convert for the special requirements of clinics, patients with disabilities, privacy and toilet facilities. So basically the choices were to fragment the services to an unsuitable commercial property for a few hundred K, pay 800k for an enduring health care related asset in the civic centre, or spend a million on temporary portacabins. This is what they wanted to consult interested parties on. Don't question that million pounds - it has been arrived at by a professional consultant who knows about development costs and portacabins and sloping sites, and he knows his business - he works for a development firm. And don't ask why management in the private sector can provide beds at approximately half the cost of Royston Hospital. They just can. I am reminded of the old but true joke, about committees spending more time discussing whether to paint the bicycle sheds than they do on closing a factory. It was as if we were being asked which colour we would like the bike shed to be painted - to blend in with green. And don't ask why it has to be Dulux. With the ruthless professionalism of Derren Brown, but without any of his subtlety, they will get the right answer. They probably don't even need to apply weightings to the categories such as accessibility, clinical suitability, long term value and so on that each group was invited to assess them for. It was indeed an exceptionally well managed consultation. The pre-prepared press release should need very little tweaking. That is why top executives are paid so much more than it would cost to fix the heating. Meanwhile Royston must decide whether that really is the last consultation we want to be involved in. Along with all the other low cost private health care issues we now hear about almost daily, remember that when a private health care provider wants to restructure or close an establishment it is a simple commercial decision. If the site is sold there will be no more public consultations. The charitable funds donated in the last century by men with real vision to establish a local hospital in Royston, on a site large enough to meet the needs of the twenty first century and possibly beyond even that, will have prematurely disappeared under the short sighted stewardship of a passing quango. There will be nothing of substance left. If that is not what we want there are some sticky questions to be answered by HCT and the PCT including the ones we were told not to ask. But be quick - these people won't be around for long, and they may be planning some last minute deals before their current jobs disappear. If they are, there won't be time for any consultation on the deals they make.