A review of Jersey's new hospital has concluded the current Overdale plans shouldn't go ahead.
A report, commissioned by the new government, says it 'would no longer seem prudent to spend such a large sum on one project in such uncertain times'.
It says the current scheme is unachievable within existing estimates - and could cost up to £115 million more by today's calculations alone..
"Further, in the current arrangement, there is little flexibility in the timing of the commitment to commence main works and so this could be required when costs are at their most volatile and least affordable. The project could be delayed until more stable times, but the risk could return mid-project with the same consequence."
The 'Our Hospital Review' was instigated by Chief Minister Deputy Kristina Moore when she took office in July as part of her first 100 days Action Plan.
It has been led by Infrastructure Minister Deputy Tom Binet, with Health Minister Deputy Karen Wilson and Assistant Health Minister Deputy Rose Binet. Alan Moore was appointed Principal Expert Advisor.
The final report puts forward four alternative options - a smaller new hospital at Overdale, phased redevelop of the existing hospital on Gloucester Street - with or without land on Kensington Place - and a hybrid model delivering healthcare services on all three sites.
The report says that last option would provide the 'best opportunity to make the scheme more affordable and appropriate'.
"Part of the consideration of taking this approach is because there is currently significant cost uncertainty – the larger the scheme, the more uncertainty there is – not for the known elements of the work, but for inflation and risk contingencies."
It also suggests the former Les Quennevais school continues to be used for healthcare services in the long term, and that mental health services could be established at a separate standalone location, which could be on the Overdale site
It estimates that could save £50 million at today's prices, with other benefits being less risk, and that more of the work could potentially be done by local contractors.
The review team considered evidence from more than 60 stakeholders and visited various healthcare facilities in Northern Ireland as part of its work.
It did not consider other potential sites in the island, because reopening the site selection process would lead to long delays to any new hospital being built.
"...there is an overriding need to deliver modern healthcare facilities for Jersey and that a hybrid or multi-site option is workable and a considerably more favourable solution than a potential further prolonged delay to identify an alternative affordable single site option."
The review gives an outline for a possible timeline for the phasing of work on a hybrid site:
"Although subject to availability and profiling of capital funding, relevant approvals and favourable tendering conditions, the Review would suggest the following phased development programme as a target to be followed:
• Phase 1 – Development of services at Overdale to be commenced on site within 24 months with a 36month construction programme to completion.
• Phase 2A – Development of phase 2 services at Kensington Place to be commenced on site within 36 months with a 36-month construction programme to completion
• Phase 2B - Development of remaining services in part of the current Hospital Site at Gloucester Street adjacent to Kensington Place, following completion of Phase 1 and 2A. This final phase to be commenced on-site within 72 months, with a 24 month construction programme to completion
• A review of the requirements for Mental Health facilities to be commenced immediately and proposals on site within 36 months with a 24-month construction programme to completion."
It suggests the next steps should be to consult with healthcare staff and others on the services that should be provided on a hybrid or phased solution and to make sure there is enough funding to maintain clinical operations at the General Hospital in the meantime.