A letter to West Herts Hospital Trust from the Department of Health and Social Care – encouraging them to strongly consider the timescale and deliverability when deciding between a new hospital or a refurbishment of existing ones – has been made public.

The New Hospital Campaign, which strongly opposes the redevelopment of the ‘dilapidated’ Watford General Hospital, obtained the letter last week.

It reiterates the department’s “appetite for deliverability and timeliness”.

A NHC spokesman said: “The letter is quite explosive. It seems to instruct the trust to put only three options on the shortlist, all involving the Watford General site as the main A&E hospital for the area.”

The shortlist is set to be drawn up in the autumn as part of the trust’s Outline Business Case.

He continued: “There is no mention in the letter of any option involving building on a new, clear, more accessible site which many thousands of local residents have asked for in two petitions on the parliamentary website.”

The letter, signed by second permanent secretary for the DoHSC David Williams, says the DoHSC – joint with NHS England and NHS Improvement (NHSEI) – supports three options set out by the trust, which will be part of the Outline Business Case.

Option one is £300m investment in a new clinical block at Watford General Hospital, plus £50m investment at Hemel Hempstead Hospital and St Albans City Hospital.

Option two, would see a £370 million investment in a new clinical block at WGH, including emergency department reprovision, plus £50m investment at HHH and SACH.

Option three is a £540 million investment to replace the Prince Michael of Kent building in Watford, re-providing the majority of clinical services at WGH into a new build facility, plus £50 million investment at HHH and SACH.

That said, Mr Williams states: “Our appetite for deliverability and timeliness, particularly in the current climate, remains high. With this in mind, we would not expect you to undertake options appraisal on any proposal that significantly increases the timescales for delivery of the scheme beyond 2025.”

“Our expectation at this stage is that the trust’s preferred options will take full account of major affordability risks such as scope and size, cost inflation and optimism bias.

“The Outline Business Case process should identify both the best solution clinically for the trust as well as ensuring delivery of the most cost-effective solution.

“The expectation is that the trust will work to identify ways to reduce the overall capital cost.”

Deputy chief executive of WHHT Helen Brown said in response: “The option of an all new hospital on a new site will be part of our longlist and will be subject to the same rigorous process and financial constraints as the other possibilities we are looking at.

“The process of reducing the longlist to a shortlist is due to take place this autumn so we cannot say at this stage if a new hospital option will be on the shortlist.

“The DoHSC has been clear that we should not consider any options that significantly increase the timescale of the scheme beyond 2025.

“The key elements of the letter were shared with our stakeholder group in June, shortly after the letter was received. The full version of the letter is now also on our website. As it is a letter sent from another body, we needed to seek their agreement to share it.

“The letter from our regulators does not state that only three options will be on the shortlist.

“The letter set outs three options that they expect to see on the shortlist, which will have at least four options.

Edie Glatter of the NHC added: “If the trust keeps a new A&E hospital on a clear, central site off the shortlist it would make a mockery of any meaningful involvement of patients.

“The engagement programme would be a farce and a waste of everybody’s time and money. It would also create a lack of trust in our decision-making processes.”

Helen Brown said: “We are sorry to learn that some people are claiming that the engagement is not genuine. We have enjoyed meeting stakeholders and have found their feedback tremendously valuable.We have already made changes to our appraisal criteria in light of their comments and we are expending considerable effort in answering their questions on all aspects of our outline business case.”