8 The escalation of projected costs since OBC approval, from £360 million to over £800 million by 2003, led to an expression of concern from the Treasury. A Member of Parliament also requested an investigation from the National Audit Office. This led to the creation of a Steering Group. The Group, which consisted of representatives from the Department of Health, Treasury and the National Audit Office, was tasked with:
■ reviewing the change in the scheme's costs since OBC approval; and
■ reviewing the process which led to this situation.
9 The Group's findings, published in September 2004, highlighted concerns in two main areas: project governance and management and affordability. It concluded that unless the identified weaknesses were addressed, it was unlikely that the required investment in the NHS in west London would achieve its objectives. The review recommended:
a The Strategic Health Authority should lead a process identifying options for investment in the NHS in west London for heart and lung, paediatrics, tertiary services and St Mary's infrastructure;
b Primary Care Trusts should lead the development of appropriate models of care;
c Responsibilities for projects should be clearly set out and there should be a single client who takes full responsibility for the cost and funding implications of design changes;
d Recent Gateway recommendations for the Paddington Health Campus should be implemented for the management of any new investment scheme and appropriate project resources should be provided for any project team by Primary Care Trusts in line with national guidance and the revised scale of investment.