Q181 Greg Clark: Would you say that it is reasonable to expect in a scheme like this that for it to go ahead there would be community support rather than community opposition?
Mr Bell: One of the challenges with a scheme like this is that in the case of the Royal Brompton and Harefield we really are hospitals which serve the nation and our community is spread all over the country. We do have a local market which we serve, but the vast majority of our patients really come from outside London. St Mary's can speak for themselves with respect to the definition of their community, but our community, by definition, is people in need of very, very specialised services coming to us largely on a referral basis from all parts of the country.
Q182 Chairman: Mr Nettel, could you look at paragraph 2.17? It says there that you did not embed risk management controls in 2004 because you could not afford to fund such processes. We are talking about a £900 million scheme. How could you afford not to have such processes?
Mr Nettel: The Report sets out quite clearly what we did about risk management. There were three separate stages. When we introduced specific risk registers into the process as part of the OBC work after 2000 we had a very comprehensive risk register, in fact that was then updated for the scheme in 2003 which involved The Point in a very detailed way. The 2004 OBC included an updated risk register and a risk management strategy. The issue which the Committee needs to focus on is not whether we had a risk register and whether we followed the letter of the law in the way in which these things are managed, but whether in fact we assessed the risk which had to be assessed. In the Report there are four specific areas which the NAO point to which required specific attention. One was having two NHS trusts and three responsible officers. That had an issue relating to governance. I can tell you that the joint project board, because we have checked this, we have gone through the notes of every joint project board which took place throughout the period of the project, considered this on 22 separate occasions explicitly. The second issue was commissioners' reluctance to support the scheme's development costs. That was considered by the joint project board 25 times. The absence of strategic support from the Department itself was also considered by the joint project board on 19 occasions. I can supply the dates.
Q183 Chairman: Okay. You have covered your backside. Finally, how many more Paddingtons are there limping along in search of a deal which is beyond them?
Mr Taylor: I hope there are none. Certainly part of the point of the review to which I have referred is to ensure that there are none.
Q184 Chairman: There are none.
Mr Taylor: That is the ambition.
Q185 Mr Mitchell: Can you round it off by telling us what happens now? At what stage are the costs of whatever needs to be done, because these are presumably older buildings and St Mary's was going to be sold off for commercial and residential development, which may or may not be over-bedded or under-bedded, I do not know, taken into consideration, when does the cost of any alternatives begin to enter into it and what decisions have been taken on that?
Mr Taylor: I know that proposals are under consideration locally.
Dr Goodier: Each trust is planning its own independent view of the future. The strategic health authority has had an independent external review of tertiary specialist paediatrics in the area. We have formed an opinion about heart and vascular services within the SHA. We have been looking at the issues to do with capacity and efficiency and what is an appropriate capacity for north-west London. We have been modelling role delineation to try to work out how that capacity is spread across the various different hospitals and organisations in north-west London and of course we have taken on board the issues raised in the White Paper to do with the move towards ambulatory care centres and so on. However, as you will understand, we are in the process of being disbanded as an SHA and since February we have started to look on the wider London SHA perspective of trying to look at one-London planning. That is an issue here as well because a lot of London hospitals are very close to one another. St Mary's is really quite close to University College Hospital, only three miles or something away. So those cross-boundary issues of the SHA boundaries which were raised in these reviews and the need to plan across the whole of London are being embraced now. We have had quite a bit of work going on in the background to compare how each of the different SHAs in London has been looking at its approach to planning, modelling and the capacity issues therein.
Q186 Mr Mitchell: This looks like a postponement to the Ides of Forever, does it not, with new requirements and new plans, new situations coming in? Can you give us any idea when we shall have some costings and plans for the existing hospitals?
Dr Goodier: Each hospital is doing its own plans at the moment.
Mr Bell: We are following a staged process at this stage. Rather than going for a big bang solution as this vision would have, we have now had to retrench to a very methodical staged process, much more modest in terms of the need to address some of the immediate inadequacies which do exist in some of our buildings and to plan on a longer basis for the things which extend beyond the five to ten-year horizon. In our case we have completed to this stage a five-year planning process.
Mr Nettel: More or less the same position as St Mary's. We are looking at a phased development and will hopefully have firmer plans about what that might look like towards the end of this calendar year.
Chairman: Thank you very much gentlemen. The Department has a capital investment programme of nearly £8 billion, reduced from £12 billion. If this sorry saga is anything to go by, that does not fill us with great confidence. This is unfortunate for the taxpayer who has lost £15 million and five years of wasted effort, but it is a tragedy for the people of west and central London. We visited some of these facilities and you would not expect to find them anywhere in the middle of central London, one of the great capitals. This is very unfortunate. Clearly we had a scheme which was too ambitious for the abilities of those involved in the scheme. Thank you very much.