Whither the Dulwich Hospital Site?
A Report by Sue Badman
The future of the Dulwich Hospital site on East Dulwich Grove depends on a decision on local GP and community health services under the reformed NHS, and while a new health clinic is likely to be built there, much of the site will probably be turned over to other public sector or community use. If funded public sector use cannot be found for the site, however, other developments will be permitted which could be bad news for those who hoped that health and community services would occupy most of the site.
One of the most frequent topics on local message boards and at the Dulwich Community Council in recent years is “What’s happening to Dulwich Hospital?” Tragically it is more than 10 years since discussions first started on transforming Dulwich Hospital and its site into a community hospital, and a huge amount of time and effort has been spent fruitlessly on developing new plans.
By 2013, the stop/start decision making has left Dulwich Hospital, now Dulwich Community Hospital, in a partially demolished state providing a home of sorts to a local GP practice, the key local GP out of hours service, community services such as a diabetic clinic, blood taking and renal dialysis as well as the Dulwich Helpline and Southwark Churches Care and a community garden amongst other services.
In the intervening period acute services have been gradually run down and decanted to major sites such as King’s College Hospital (KCH), and NHS reforms have been set in train which have meant it is no longer a question of just transforming the hospital but all local Primary Care health services.
The Primary Care Trust’s “Community Hospital”
Southwark Council prepared a planning brief in 2005 which provided a framework for the redevelopment of the hospital site as a Community Hospital. The brief set out the parameters for development of a mixed use scheme comprising health facilities (“The Community Hospital”), ancillary office & community facilities and residential development.
Society members will recall that plans for the (then) local Primary Care Trust to proceed with the community hospital were brought to an advanced stage after a full range of consultations and working parties had taken place, when the NHS dropped the idea completely and it was put into abeyance. Regrettably two blocks of the hospital’s eastern wing were abruptly demolished in 2006 when plans were thought to be at an advanced stage to construct the proposed new hospital on this part of the site. This has resulted in a major blight on the area, leaving a huge derelict site enclosed by hoardings in the middle of an historic and characterful neighbourhood, which the authorities have thus far failed to resolve.
“Can’t do much with the hospital site till we know what health services we need”
It then dawned on the local NHS that their health services were no longer meeting community needs. The result was that before any further consideration could be given to the Hospital’s future, there was a need to define the services required to support the community in the next 20 years or so. NHS reform legislation and financial challenges have given impetus to this.
There are particular challenges in terms of the wider Dulwich demographics and health inequalities - lower life expectancy from cardiovascular disease and cancer; increasing numbers of people with long term conditions; variable access to GP services with some practices requiring updated premises; growing numbers of older people and very young children.
Southwark Primary Care Trust (PCT) thus initiated a programme to review the state of local GP and community health services (GP surgeries and community settings to stand alongside services provided by our major local hospitals) in the wider Dulwich area. This started with an engagement process in 2012 to get some firm direction on what local people wanted from their health services.
Ideas explored with residents resulted in more than 1000 comments generated from survey responses and more than 300 face-to face discussions. Concerns included transport links to health providers; better parking provision and more disabled access; better diagnostic services in community settings; better appointment and out-of-hours systems; and access and concern over the size of Kings were real problems for some people. Local mental health service capacity following the closure of services at the Maudsley Hospital was also highlighted by a local pressure group.
NHS Reforms gather steam
On 1st April 2013 came further changes as a result of the Social Care and Health Act 2012 which created Clinical Commissioning Groups to plan and commission (“buy”) health services in local areas. The new NHS Southwark Clinical Commissioning Group (“CCG”) took on the responsibility for designing health services in Southwark replacing the NHS Southwark Primary Care Trust which closed down. The CCG took over the Dulwich programme started by the PCT.
A new consultation is under way about a firm set of delivery proposals for GP and community services based on the 2012 responses which will lead to a business case and implementation from Autumn 2013. The two main options to deliver local services are (a) primarily at a “hub” health centre at Dulwich Hospital Site (b) at GP Practices. But the consultation concentrates ONLY on the health services not specifically about the hospital site.
NHS Southwark PCT owned the Dulwich Community Hospital site, and used approximately 40% of the building in part for patient services but mainly as office accommodation for clinical staff. The building costs NHS Southwark £2.3m pa.
Also from 1st April, under new arrangements for the management of the NHS the ownership of the Dulwich Hospital assets and estate transferred to a new organisation known as The NHS Property Services Ltd which will provide the full range of property services to the NHS and will still be owned by the NHS. This organisation will look after healthcare buildings and be responsible for strategic management leaving the CCGs to focus on services. NHS Southwark CCG do not expect this to affect their plans and the CCG is already working closely with the new organisation.
What will the new local health service proposals mean for the hospital site?
Some good news and some potentially bad news
The reformed local health services will put services into the community and reduce the need for hospital services on acute hospital sites such as those at KCH.
The Southwark CCG does not recommend continuing with the current service arrangements. While the cost of delivering services will remain the same, many patients can’t get some services at local GP practices and the current Dulwich Hospital does not provide a suitable environment for modern healthcare. The CCG believes it will be able to treat more people in community settings for the same amount of money while improving the quality of care. Projected budget and resources for the CCG suggest a £26m gap by 2017/18 and savings of this amount will be needed to balance the budget. There is bound to be rationalisation of buildings; some existing clinic buildings will close down, and services moved elsewhere. The CCG accepts many people are concerned about the current Dulwich Community Hospital building but cannot recommend continuing to use the existing building as it is.
The good news (with a caveat) is that the new delivery proposals assume the new health hub will most probably be on the Dulwich Hospital site. The size of it will depend on the outcome of the consultation. Once the CCG has decided what sort and scale of hub they want, it will have to ensure formally that this represents the best site from a clinical, patient and cost effective perspective. This includes any capacity to expand the health services in the future. The CCG also has to assess whether the best option would be a refurbishment of the existing building or a new build. This assessment has yet to take place. Any land left over must first be prioritised for use by health and then other local public sector users. Once the CCG has decided what it needs for our local healthcare services, other NHS bodies have to be offered the chance to use any of the site surplus to requirements. As the CCG work closely with other major NHS bodies in the area, CCG think it unlikely these bodies will have any needs outside of what the CCG will be proposing.
Any remaining site must then be offered to other public sector organisations, primarily Southwark Council in this case, with whom CCG are working closely. After that, new owners NHS National Property Co will be required to sell any surplus on the basis of best value. At each stage, the NHS are required to achieve best value for any property and land transferred or sold, though value will be influenced by overall planning controls, which are the responsibility of Southwark Council.
Why can’t we have a brand new hospital on the site?
We believe the site covers about 27,000m2. Local NHS experts tell us that it would be wholly inappropriate for the site to be rebuilt as an acute hospital in accordance with modern clinical & NHS standards for the provision of major acute services and specialisms. It wouldn’t be of an appropriate clinical scale.
It would however be possible to use part of the site for health services and it has been suggested that about 5-7000m2 could be used for extended community medical care of the type now proposed by the CCG in their delivery proposals. This would leave around 20,000m2 for other community uses.
What are the options for the site?
Much of the current building is poorly maintained with some older parts in a precarious state, and would need to undergo major works. The CCG consultation document clearly states that the reformed health services will dictate the priorities for the site and a business case for health services on the site will emerge later in 2013. Decisions about other potential community uses will then follow. Some groups have urged a stronger case should be made for conservation of the buildings as currently they have absolutely no heritage protection and could be demolished tomorrow. There have been two unsuccessful attempts to list the building but it has not hitherto been considered sufficiently unusual or significant to justify this protection.
The recently published draft Dulwich Supplementary Planning Document (2013) did not address the heritage significance of the remaining hospital buildings (including the fine arts and crafts nurses’ home), merely describing them as being ‘of varying age, design and quality’. The surviving buildings are of significant historic and architectural interest worthy of reassessment for statutory listing and could be designated as locally listed heritage assets accompanied by conservation area status. This would enable Southwark to ensure sensitive restoration and adaptation of the historic buildings on the site, though at this stage it is unclear what the impact on refurbishment costs would be of the heritage component.
The Southwark Planning Brief (2005) sets out other planning considerations for the site. The use of part of the site (say a fifth) for a school would help to meet the requirements of the Southwark Planning Brief. A proposal for a free Primary School is under consideration with a major provider which will help to address the projected shortfall in Dulwich primary school places from 2016. Use of the hospital gatehouse as a touchdown base for our ringfenced Safer Neighbourhood police officers is being considered under the new local policing model which comes into effect on 24th June 2013. This would mean officers can stay in Dulwich without having to travel back to Camberwell police station. This would be a cost-neutral option for the Mayor of London’s office, funded from local public resources. Discussions with the Borough Commander continue.
Your views on the range, delivery and location of new CCG health services can be expressed at a series of public meetings and there is an online questionnaire available at: http://www.southwarkpct.nhs.uk/improving_services_consultation
Details of Southwark’s planning process, the Dulwich Hospital Planning Brief and the new Draft Dulwich Supplementary Planning Document can be accessed from
For NHS Property Services Ltd see http://www.property.nhs.uk/
For up to date information on police and school proposals for the site, please speak to your local councillor