Q21 Mr Mitchell: I just wonder what the reaction was in the Department and in the London regional office as the problems seemed to multiply and the costs went up. There must have been several brown-trouser moments in this kind of situation. Was there a situation in which you considered cancelling it before 2005?
Mr Taylor: There were, as the Report indicates, at least two occasions when not the Department specifically but the partners and the SHA considered cancellation and on both occasions something turned up. In other words, new proposals came forward, first from Westminster City Council, which colleagues, including colleagues in the Department felt genuinely had to be looked at. In other words, they could have turned the economics of the situation, although in retrospect that process looked as though it went on for too long-and it is difficult to feel that it did not go on too long-it probably would have felt as though it was unreasonable not to have those options explored at the time. There was a growing feeling, which is reflected in the correspondence in the Department, that the scheme was looking unaffordable and that is clearly documented in January 2005.
Q22 Mr Mitchell: Until right to the end.
Mr Taylor: Yes.
Q23 Mr Mitchell: One final question. I am a bit puzzled as to Westminster City Council's role in this. What assessment was made of Westminster's own interest? Was it pursuing its own interest in flogging this land to the trust? Was this a self-interested move or a genuinely altruistic concern that the project should go ahead?
Mr Taylor: Its primary interest was that they were genuinely keen to see development of the St Mary's site in particular.
Mr Nettel: Those of you who know Paddington will know that it is an area that it undergoing significant regeneration and is a priority area, Praed Street in particular, and St Mary's is in the middle of that. The Council have been extremely keen to see St Mary's prosper as we are the only NHS hospital in the City of Westminster and they care about us to that extent. However, they also knew that if they could get the scheme as it was designed at the end of this process off the ground, then this would release most of the St Mary's site as it currently stands next to Paddington station for complete redevelopment, which was one of their key urban development priorities and has been for a very long time.
Q24 Chairman: Dr Goodier may I just ask you about that, because you have not had a chance to say anything yet? We have had this point about Westminster City Council. They advised that the scheme could not fit on the land available, so why did you not cancel it at that stage in 2002-03? Costs had doubled, Westminster Council was obviously dubious about it, why did you not just step in and cancel it then?
Dr Goodier: The SHA was formed in April 2002 and took a few months to settle in.
Q25 Chairman: I am talking about late 2002/early 2003.
Dr Goodier: Yes, an opportunity was missed there and with hindsight we would agree-
Q26 Chairman: You should have cancelled it then.
Dr Goodier:-it should have been withdrawn or there should have been a new outline business case. There is no question about that.
Q27 Helen Goodman: Mr Goodier, I should also like to ask you about this beds forecast which Mr Mitchell has raised. We are constantly being told that throughput is being increased and people only need to stay in hospital for two or three days and occupy a bed for two or three days. Would that be the average occupancy that you would have expected in this hospital for these beds?
Dr Goodier: The modelling that we have been doing is based upon a specific diagnosis and the length of stay for that and particularly taking some account of peer group hospitals.
Q28 Helen Goodman: What is the average occupancy then that you were projecting in this forecast?
Dr Goodier: The point to establish is that to have a length of stay for a hospital is of not much value to anybody because you need to have a length of stay for a particular medical condition. If you took the whole hospital and they treated very simple district general hospital conditions, the length of stay could be very low, but if it were a complex hospital such as Hammersmith which is dealing with very complex cases, you would expect it to be higher. What we try to do is to compare the length of stay for a condition against another condition. For example, for a fractured neck of femur there is an NHS median length of stay of 25 days and some of the hospitals in north-west London were reporting 38 days. This was not an issue about one or two days.
Q29 Helen Goodman: If it was 20 days, and we can see here that the estimates changed in a five-year period by 1,500 beds, we would be talking about more than 15,000 patients a year. How could you forecast change for the number of patients needed to such a large extent in that time?
Dr Goodier: May I just ask you where the figure for 1,500 beds came from?
Q30 Helen Goodman: You have just told me 20 days, there are 365 days in a year, there are 1,500 bed changes set out in paragraphs 2.18 through to 2.24, just do the arithmetic.
Dr Goodier: What I suggested was for one particular condition.