18 When it entered the Campus scheme in 2000, the Royal Brompton and Harefield NHS Trust set out, as a pre-condition, that a merger with St Mary's NHS Trust was not an option. It was concerned that a merger between the two Trusts would undermine its capacity to provide the very different patterns of service it delivered to patients. St Mary's set no such condition. Whilst the NHS Capital Investment Manual assumes a single sponsor for capital investment projects, the then London Regional Office of the NHS sanctioned the joint arrangements when approving the OBC. The Department believed a merger was desirable and inevitable once contracts for the Campus scheme had been signed, but did not press for a merger because it recognised that such a request at the start of the scheme would have brought it to a halt.
19 Although there were three Campus partners, the scheme did not have a single sponsor or single Accountable Officer. In 2004 the Department stated that the Chief Executives of St Mary's and Royal Brompton and Harefield NHS Trusts and the Rector of Imperial College were each Accountable Officers for expenditure incurred by their own organisations on the scheme. The Campus partners thought there were two (or three) Senior Responsible Owners and the Chief Executive of St Mary's considered he was the Accountable Officer for the scheme. At the time, there was no resolution on who, if anyone, was the Accountable Officer for the scheme.
20 The Committee of Public Accounts has expressed concern in the past on the risks to capital investment schemes of complex partnership arrangements3, and has recommended that capital projects should have clear accountability arrangements and a single project sponsor. The lack of clear leadership and authority for decision making was one of the factors that undermined the scheme's progress.
21 Ultimately, in addition to the land and affordability issues, it was the differing financial and clinical interests of the two NHS Trusts that led to St Mary's NHS Trust approving the revised business case in 2005 and the Royal Brompton and Harefield NHS Trust declining to recommend it for approval. This reflected, in part, the lack of confidence on the part of the Brompton in St Mary's ability to deliver savings and manage a forecast deficit without compromising the Campus vision.
22 Throughout the development stage, the scheme was handicapped by the Campus partners' failure to provide or secure adequate funding to develop the scheme. Available development funding was based on a proportion of the original estimated OBC cost of £3604 million, not the approximately £894 million it would have cost. The scheme relied on funding from the Strategic Health Authority and Primary Care Trusts. However, between 2002 and 2005 the scheme was unable to secure sufficient project funding from them and the Trusts themselves felt unable to find funding from within their own resources. Instead, the continuation of the scheme was reliant on £4.9 million in funding from co-sponsor Partnerships UK. As a result of the earlier inadequate funding and uncertainty about the future of the scheme, it was severely under-resourced in manpower and capability.
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3 Committee of Public Accounts The English National Stadium Project at Wembley, Eighth Report 2003-04, HC 254; The Millennium Dome, Fourteenth Report 2001-02, HC 516; The Cancellation of the Benefits Payment Card Project, Third Report 2001-02, HC 358; Department of Health: Cost Over-runs, Funding Problems and Delays on Guy's Hospital Phase III Development, Twenty-eighth Report 1998-99, HC 289.
4 The development funding was based on the full £360 million cost of the 2000 OBC, but £27 million related to other hospitals and £33 million to equipment costs so the capital construction cost of the Paddington scheme was only £300 million.