The finances of the proposed move of Liverpool Women’s Hospital; early proposals

Again we are revisiting the work we did in the earlier years of the proposals for the future of the Liverpool Women’s Hospital. This was written in response to Future Generations publications. Since this was written, the disaster of the PFI model for building hospitals is clear. Liverpool still waits for the Carillion Hospital Further details of PFI can be found here


LCCG  ( Liverpool Clinical Commissioning Group) recognises that significant capital is required to re-locate LWH to the site of the new Royal Hospital. Of the various potential funding options, they see a Public-Private Partnership( PPP) as the most viable option.

Following the collapse of Carillion, Philip Hammond, in the 2018 Budget pledged not to sign any new Private Finance Initiative contracts (PFI).

“In financing public infrastructure I remain committed to the use of PPPs. We will establish a centre of excellence to actively manage these contracts in the taxpayers interest starting with the health sector.”

The PFI was a way of creating PPPs where private firms are contracted to complete and manage public projects. It is widely believed to be used by governments simply to place a great deal of debt “off-balance sheet”. In other words another expensive, disastrous financing model.

There has been very little said about what would become of the existing building at the Crown Street site. The PCBC (page 312) states that it is “likely to remain a site for NHS services”.

The Naylor Review( 2017) examines how the NHS in England can raise cash from its premises. Its findings were in line with the requirements set out in the Sustainability and Transformation Plans (STP)s which were introduced in December 2015 to fast forward NHS England’s Five Year Forward View (5YFV). The focus from STPs has evolved from Accountable Care Systems(ACS) to Accountable Care Organisations (ACO)s to Integrated Care Providers (ICP)s. ( Now called ICS) An ICP brings together a number of providers to take responsibility for the cost of care for a defined population within an agreed budget. This will force the NHS into an alliance with social care which is private and means-tested.

Two things underpin the thinking behind the review:

a) the need to free up public land and build much-needed housing to solve the housing crisis

b) the new models of care described in the 5YFV have different infrastructure requirements so surplus land can be disposed of and the profits used as an incentive for Trusts to meet targets imposed by STPs.

It appears that dispersing public assets into private hands is the objective behind these plans and not the long-term benefit to the public service. Private developers own between them enough land to build 600,000 new homes, so there is no critical need to release any public sector land. However, the release of public sector land would increase profitability for the private sector, especially if the sites are in prime locations. Liverpool Women’s Hospital (LWH) is situated adjacent to the Georgian Quarter of Liverpool, one of the most sought-after residential areas in the city. The building is owned outright by the Trust and the freehold is owned by the city Council.

Naylor emphasises the contribution of sales of existing estates and the introduction of private finance to create new builds as key to changing the estate to meet “the new models of care” set out in the 5YFV.

NHS Commissioners and regulators have considerable authority to insist premises be fit for purpose. These powers can be used to force the pace of investment in or exit from inadequate premises reducing payments for properties not meeting future service strategy to encourage moves. Section 7.4 of the review recommends

(Recommendation 10) “STP estates plans and their delivery should be assessed against targets informed by benchmarks set against the review. STPs and their providers which fail to develop sufficiently stretching plans should not be granted access to capital funding, either through grants, loans or private finance until they have agreed plans to improve performance against benchmarks.”

The guidance for STPs says transformation funding which is necessary to deliver key service changes and new models of care will “only be available to systems whose operational plans meet their required control total and performance trajectories.”

Naylor who write this report

Relocation of LWH to the site of the new Royal hospital would force another expense onto taxpayers in the form of a PPP. It would also pave the way for the sale of the present hospital and land to property developers or to private companies eager to get their hands on a modern, functioning hospital. If relocation were to take place and the existing building used for NHS services the likelihood is that those services would be tendered out and fall into the hands of the private sector. This should never be allowed to happen.

Land sales and commercial rents being forced onto Foundation Trusts and Gps are not a way of securing the NHS’ future. The Naylor Review recommended that HM Treasury should provide additional funding to incentivise land disposals through a “2 for 1” offer in which public funds match disposal receipts. A bribe to encourage the sell off of NHS properties and should the bribe not succeed

 there will be a penalty imposed for holding on to assets. The reality of the Naylor Review is another move to privatise public assets. Property developers stand to make a profit from land acquired on the cheap.

By deeming LWH “not fit for purpose” and by presenting a clinical case for change LCCG has put LWH and the land on which it stands in danger of being developed for housing, none of which will be “affordable housing” due to the soaring house prices in the area.

The selling of land just to raise money will not meet the demands of the Naylor Review, only changes of uses of existing services will do. The authority to change the use of an existing building lies with the City Council Planning Office. It would be timely to remind them of the significant investment of the NHS in LWH as a deliberate attempt of the then Dean of Liverpool to invest in the Liverpool 8 area through his Project Rosemary following the Toxteth Riots. The LWH is a much loved hospital, a specialist hospital dedicated to the care of the women and babies of Liverpool and surrounding areas and should remain so.

This article gives background to the Naylor report

This explains how the NHS sells off land

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