Apr 01st 2012
Public Inquiry and Planning Inspector’s conclusions
The Acquiring Authority (Sandwell and West Birmingham Hospitals NHS Trust) is an NHS trust created pursuant to section 25 of the National Health Service Act 2006 (NHS Act). Paragraph 27 of Schedule 4 enables an NHS trust to purchase land compulsorily for the purposes of its functions by means of an order confirmed by the Secretary of State.
The Secretary of State asked for a Public Inquiry into the Compulsory Purchase Order to establish whether there was a “compelling need in the public interest” and whether CPO was the best option. This took place in June 2010. The Inquiry sat for two days. The inspector, David Prentis, made unaccompanied visits to the Order lands and surrounding area on 14 and 16 June 2010 and accompanied visits to City Hospital, Birmingham, Sandwell General Hospital and parts of the Order lands on 15 June 2010.
The Order was made on 25 September 2009 to facilitate the construction of a new hospital and associated facilities. By the time of the Inquiry there were no remaining statutory objections and no objectors or interested parties appeared at the Inquiry. In terms of statutory consultation processes the Order was therefore considered uncontroversial.
The existing hospital buildings are aged and require substantial amounts of maintenance. City Hospital was built in 1887, as an infirmary for the Birmingham Workhouse, and the main inpatient wards date from this period. Sandwell General was also originally a workhouse infirmary although the main clinical areas date from the 1970s. Around 45% of the wards are of the “Nightingale” type.
The Inquiry concluded that “Whilst this estate is operational, if it were to be retained in the longer term it would require in excess of £100 millions of investment to bring it up to modern standards.
“Such investment would not, however, resolve the problems of fragmented services which have resulted from the adaptation of the two sites over many years.
“For example, at City Hospital patients admitted to A&E who need surgery are transferred to the operating theatre via a long public corridor. Patients on the rehabilitation ward whose condition deteriorates are transferred to the main hospital by ambulance. There are multiple locations for operating theatres resulting in duplication of infrastructure and inefficient use of staff. Only 6% of the beds at City Hospital are in single rooms, which are widely dispersed, thus creating difficulties for the treatment of infectious diseases. The Nightingale wards are difficult and expensive to adapt to modern standards of privacy and decency. Whilst the Trust has a good record on infection control, this is achieved by disproportionate effort and expense
“The single site solution would enable the Trust to extend the hours at which junior doctors can be under the direct supervision of the most experienced doctors. It would provide better clinical adjacencies, allowing a higher standard of care and more effective use of staff time, and would remove the need for staff and patients to transfer between the two hospitals in response to urgent medical needs. The concentration of activity on one site would allow surgeons to become more experienced in particular procedures which would result in better clinical outcomes.”
Sandwell and West Birmingham Hospitals NHS Trust is a teaching trust and has links with the University of Birmingham, Birmingham City University and the University of Wolverhampton. It contributes to the training of doctors, nurses, midwives, physiotherapists and other health professionals. The inspection report concludes that the proposed facilities would provide a much improved training environment.
In addition the scheme would be a catalyst for wider regeneration. In his report David Prentis writes; “It would result in the removal of existing buildings which, in general, are unsuited to modern business use and would create high quality new buildings in a landscaped setting which would enhance an important gateway site. The new hospital would retain a significant number of jobs in the local economy. The canal, which is now largely hidden from public view, would become part of the pedestrian public realm. The environment of the canal would be improved, enhancing its value as a local amenity and a wildlife corridor.”
The scheme also has the benefit of freeing up some of the land at City Hospital and Sandwell Hospital for housing developments in line with Birmingham City Council and Sandwell MBC’s plans for new housing. There would however still be a large community hospital providing a wide range of outpatient, diagnostic, intermediate and urgent care on each of those sites, as well as a major day surgery centre at the Birmingham Treatment Centre on the City Hospital site.
NHS Compulsory Purchase Order powers have been used only once before, on a much smaller development in London which required the acquisition of a corner shop. In his report Mr Prentis said; “Whilst some land interests have been secured, there remain substantial areas where owners have not engaged with the process and there is still a need for the Order to allow the site to be assembled.
“Compared with the previous example of the use of these powers, the case here is much stronger because the proposal is a pre-requisite for a wider restructuring of healthcare provision in response to significant health inequalities in the locality. Moreover, there are also wider social and environmental benefits which support the case for confirmation of the Order.
“There are no objections to the Order and those involved in the provision of health and social care locally are strongly in support. There is clearly a compelling case in the public interest for confirming the Order and, without it, the new hospital and its associated facilities will not be provided.
Mr Prentis concluded; “I consider that the starting point for considering the need for the proposed hospital should be the broader strategy set out by the RCRH Partnership. That strategy is a response to the particular health needs of the population served by the Trust. The strategy would result in a reduced need for acute care beds with more care provided in a community setting.
“However, it also requires more efficient and effective acute services delivered from a modern hospital on a single site. In my view the proposed hospital is an important part of the RCRH Partnership’s overall strategy. In the absence of a single site solution, it seems likely that the Trust’s ability to implement other aspects of the strategy would be constrained by the need to continue to devote resources to the operation of two acute hospital sites.
“I consider that the Trust has demonstrated that there is a clear need for the proposed hospital as part of its broader strategy for the delivery of improved healthcare. Moreover, it has been shown that the Order lands would provide a site of the required size in the most appropriate available location.
“In the main, the case for confirmation of the Order rests on the health needs I have described. Nevertheless, some account should be taken of the wider regeneration benefits of the scheme. I saw that the Order lands lie within an area of poor environmental quality characterised by a significant proportion of vacant properties. Whilst detailed design is a reserved matter, it appears to me that the redevelopment of the site would have the potential to create a landmark building adjacent to Grove Lane, which has been identified by SMBC as a key gateway location. The opening up of the Cape Arm to public pedestrian access would create a new public open space adding to the amenities of the area. Subject to detailed design, it would also have the potential to benefit the environment and wildlife. The siting of the hospital in the central part of the Grove Lane area leaves areas remaining which would be suitable for future regeneration projects. In my view the proposal would support the wider regeneration of Smethwick in accordance with the objectives of the Area Action Plan and the emerging Black Country Core Strategy.
“A CPO should only be made where there is a compelling case in the public interest which justifies interfering with the human rights of those with an interest in the affected land. In particular, consideration should be given to Article 1 of the First Protocol to the European Convention on Human Rights (peaceful enjoyment of possessions). Circular 06/2004 states that it is necessary to take a balanced view between the intentions of the acquiring authority and the concerns of those whose interests are to be acquired.
“I have concluded that there is a clear need for the proposed hospital as part of the Trust’s broader strategy for the delivery of improved healthcare. Moreover, it has been demonstrated that the Order lands would provide a site of the required size in the most appropriate available location. Whilst these are the most important factors weighing in favour of confirmation of the Order, I consider that the proposal would also support the wider regeneration of Smethwick in accordance with the objectives of the AAP and the emerging CS. In my view this factor contributes to the case for confirmation.
“I have also concluded that, if the Order were to be confirmed, there is a reasonable prospect that the financial resources required to implement the scheme would be available and that the need for further planning approvals is unlikely to represent a significant impediment. However, without the use of compulsory powers I consider that there is very little prospect that all the land needed to build the hospital could be assembled.
“On the other hand, the Order would result in the displacement of those businesses currently operating from premises within the Order lands. The impact on those businesses would, however, be mitigated by the statutory provisions relating to compensation. Moreover, there are no remaining objections to the Order.
“I conclude that there is a compelling case, in the public interest, for the confirmation of the Order to facilitate the construction of a new hospital and associated facilities. Compulsory acquisition would be a significant interference with the rights of those having interests in the Order lands. However, I consider that the benefit of the improvements to healthcare I have described above, together with the wider regeneration benefits of the scheme, would outweigh any private loss. The use of compulsory powers would be proportionate because the purpose for acquisition is of sufficient importance, in the public interest, to justify such interference.
“I recommend that the Sandwell and West Birmingham Hospitals NHS Trust (Grove Lane, Smethwick) Compulsory Purchase Order 2009 be confirmed without modification.”
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