Health centre cost doubles amid funding doubts

The estimated cost of a new health centre in Scotland has more than doubled – with the NHS concerned that the Scottish Government may be unable to stump up the extra cash.

According to papers for an NHS Lothian board meeting this month, the estimated total cost of the proposed National Treatment Centre (NTC) at St John’s Hospital in Livingston is now £184m, compared with £70.9m in the outline business case.

The facility is part of the Scottish Government’s £400m plans to create a network of NTCs to provide extra capacity for planned and diagnostic care. The Livingston NTC was originally due to open in 2023, but the timescale now stretches to 2027.

The Scottish Government has also agreed to fund a new eye hospital at the Royal Infirmary of Edinburgh, after Edinburgh’s Eye Pavilion closed. The forecast cost of this project, also being managed by NHS Lothian, has risen from £123m to £125.6m.

But within NHS Lothian, doubts were recently expressed about the Scottish Government’s ability to fund the NTC and eye services reprovision quickly enough.

At an NHS Lothian finance and resources committee meeting in October, minutes record that “it was noted that [several] major [capital] projects were projected to be running simultaneously and suggested that a decision should be made on priorities in the event that the Scottish Government was not able to fund all [of them]”.

Capital finance manager Nick Bradbury “advised that the Scottish Government had agreed to commit reasonable funds for the NTC and the Eye Pavilion reprovision but the question would be whether they could fund these within the timescales needed”.

In response, NHS Lothian director of finance Craig Marriott said that the case would be presented to the Scottish Government that “these projects were critical to NHS Lothian’s ability to deliver services now and in the future”, given population growth and the need to recover from the impact of Covid.

At the February board meeting, NHS Lothian deputy chief executive Jim Crombie confirmed there had been “very positive engagement with Scottish Government officials and advisors on this [NTC] project”.

The minutes add that “although the situation remained fluid, the progress achieved so far was in line with the project’s expected development trajectory”.

The minutes also refer to “continuing uncertainty” about the role of NHS Scotland Assure – a service for improving the quality and management of healthcare construction projects – and its “emerging requirements”. NHS Assure representatives were invited to speak to the committee at a meeting in December.

The Scottish Government’s NHS recovery plan, published in 2021, said the network of NTCs would be “central” to tackling Covid-19 related backlogs and putting the health service on a sustainable path.

The plan increased investment in the network to more than £400m. It said the programme would “provide the single biggest increase in planned care capacity ever created in the NHS”.

Crombie said: “NHS Lothian is undertaking a significant programme of work involving extensive collaboration with the Scottish Government to create leading, state-of-the-art facilities. We have been given permission to proceed to a full business case which will be submitted in 2024 for the NTC with a projected operational date of 2027.

“However, until conclusion of the full business case, and agreement with the Scottish Government, cost projections and completion dates remain forecast only and dependent on a number of factors. Ongoing design developments, assurance processes and inflation are among those factors and will have an ongoing impact on cost projections in particular.”

A Scottish Government spokesperson said: “Four National Treatment Centres will open this year providing significant additional protected capacity for orthopaedic, ophthalmic and diagnostic capacity.

“The NTC programme is a huge investment in frontline planned care infrastructure and, over the next five years, will provide the single biggest increase in planned care capacity ever created in NHS Scotland.

“We are managing unprecedented levels of inflation in all public sector capital projects as a result of the Covid-19 pandemic, the economic impact of Brexit, and uncertainty in the supply chain due to a range of external factors.

“However, the Scottish Government remain committed to the delivery of the NTC programme, including the NTC planned for Livingston and the new Eye Pavilion.”

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