The prevailing aura of chronic, shambolic failure hangs over the government’s much-vaunted “New Hospitals Programme,” a brainchild of Boris Johnson, whose 2019 manifesto seeking to convince the electorate promised 40 new hospitals plus 20 ‘hospital upgrades’.
Ministers even claimed in 2019 that six new “large hospital builds” had received funding to “go ahead at once,” but that soon changed. In the autumn of 2020 two additional major projects (rebuilding Hillingdon Hospital and North Manchester General) were added into a new list of eight “pathfinder” projects (now Cohort 3), but without increasing the allocation of just £3.7 billion capital.
At no point has the government ever explained the criteria on which they have selected some schemes, de-prioritised others, and subsequently shuffled them around, leaving Labour committed to starting over again with a complete reappraisal of projects. (It seems unlikely this will delay progress much more than it has been delayed already.)
Every delay has meant that initial projections of costs have been outdated while the initial allocation of capital for upgrades and new buildings has remained unchanged, and increasingly inadequate.
By July 2021 Natalie Forrest, leader of the New Hospitals Programme (NHP), admitted to a conference that the ‘brakes had come on’ for some of the pathfinder projects, most notably Princess Alexandra (Harlow in Essex), while some were having to change designs due to new requirements. There were also concerns over the capacity of the construction industry to complete so many projects by 2030.
Later that same month the NHP team effectively tore up initial proposals, writing to all eight of the initial “pathfinder” schemes calling for their plans to be resubmitted, each also including a proposal with costs cut back to £400m. The cash squeeze threatened the viability of the schemes, all of which were already projected to above this new limit.
Nonetheless ministers kept insisting that not only was the government ‘on track’ to build 40 hospitals, and NHS England even invited trusts to submit bids to become one of eight additional projects to make 48 “new hospitals”. A massive 128 bids were received – many of them way above the suggested £400m limit.
But in the event the need to prioritise rebuilding hospitals built with defective RAAC concrete beams and ceilings (at a cost of £500m – £1,550m per hospital) has meant that the chances of any of the new additional schemes being carried through was vanishingly small.
Last May then health and social care secretary Steve Barclay admitted that eight major projects initially on the list of 40 would be pushed back into the 2030s (St Mary’s/Charing Cross/Hammersmith Hospitals (Imperial); Queen’s Medical Centre/Nottingham City Hospital; Royal Preston Hospital; Royal Lancaster Infirmary/Furness General; East Sussex Hospitals; Hampshire Hospitals; Royal Berkshire; and North Devon District Hospital).
Barclay announced that five more hospitals completely constructed from RAAC (in addition to the two already on the list of 40) were to be prioritised instead, along with three mental health projects not initially included. The five RAAC hospitals set for rebuilding are Airedale in West Yorkshire, Queen Elizabeth King’s Lynn in Norfolk, Hinchingbrooke in Cambridgeshire, Leighton in Cheshire and Frimley Park in Surrey.
In August the National Audit Office, in a surprisingly limited and out of date report on the NHP that had taken a year to produce concluded that there was no chance of fulfilling the pledge to build 40 new hospitals, and that at best 32 might be built by 2030, with a further eight completed later.
In November, the all-party Commons Public Accounts Committee (PAC) published an even more stinging report, stating that it had no confidence that Government will deliver the new hospitals it promised, and expressing extreme concern at the New Hospital Programme’s (NHP) lack of progress.
The PAC report, echoing some of the points raised by the NAO, also warns of the potential problems created by the Department of Health and Social Care’s “aspiration to develop new cheaper and faster approaches to hospital construction,” which includes a new standardised hospital design called ‘Hospital 2.0’:
“Resourcing and design capacity issues have hampered the progress of Hospital 2.0 and development of the design and process is now running at least five months behind schedule.”
But most worrying of all for the PAC is the fact that the new standardised designs, following the poor example of the first wave of PFI hospitals, are being based on unrealistic assumptions on increased levels of occupancy and reduced length of stay (just as lengths of stay in acute hospitals are beginning to increase). These assumptions “appear very likely to produce hospitals that are too small.”
Worse still, again following the design failures of PFI, the focus has been on cheap and cheerless stripped-down hospitals built as the ‘Minimum Viable Product’ to cope only with the assumed levels of need, leaving no scope to handle peak demand as the population grows.
Moreover, the committee warns, “there appears to be insufficient funding for DHSC to build all the hospitals it plans, and to an adequate size, by 2030. HM Treasury initially allocated £3.7 billion to NHP for the period up to the end of 2024–25 with no indication of what further money it would give up to 2030. In early 2023, it finally set an indicative maximum for capital funding of £18.5 billion for the following six years, making a total of £22.2 billion…”
However some of the early schemes have already seen forecast costs increase by 41%.
Four years on, not a single new project even has a completed business case, and with inflation still running hot and no inkling of what level of funding might be available, none even has any idea of what budget their business case would need to conform to.
The PAC is report is critical of the way in which the NHP was run, and in particular its dependence upon (costly) management consultants.
“The Programme is over-reliant on consultancy services. … with 62% of posts filled using consultancy services in February 2023. DHSC estimates it will spend a further £842 million on consultancy services between 2023–24 and 2030-31.”
The HSJ reported last summer that the NHP had already spent £60m on consultancy, with much of the work going to Mott MacDonald and KPMG.
However just weeks after the PAC report was published NHS England began inviting bids for a massive new £600 million consultancy contract for a “Programme Delivery Partner” to support the NHP over the next six and a half years, with the option to extend for a further four until 2035. The first two years were valued at £307m.
And in January NHS England advertised for a new civil servant to lead the project as ‘Senior Responsible Owner’ on a salary between £97,000-£162,500, raising questions about whether Natalie Forrest, who has been seconded from the NHS to act as director of NHP since 2021, might be an applicant for the job – or sidelined by a new appointment.
The commitment to building 40 new hospitals is conspicuous by its absence from Rishi Sunak’s ‘Five pledges,’ but there must be questions raised over the way so much senior management time and effort throughout the NHS have been wasted by the delays, inaction and false starts of the NHP as it has fallen victim to government indecision, rising costs and tightening finances in the aftermath of the Covid pandemic.
So far the NHP has delivered nothing tangible at all, matching the government’s failure to make sufficient funding available to give any of the potential projects a viable budget.
But if one thing is guaranteed, it is that the longer the NHP continues to follow the bad precedents and wild assumptions of the PFI hospital projects in the 2000s, the greater the danger of wasting billions on hospitals that are built too small.
And the longer the delay in replacing the seven hospitals most plagued with RAAC, the greater the danger that one or more may collapse or need to be closed for public safety creating a massive crisis in health care and another major scandal.
* Meanwhile the decay of neglected NHS buildings is creating an additional crisis: last month’s new official figures showed that England’s NHS backlog of maintenance had rocketed by 13.6% in the last 12 months to a massive £11.6 billion, having almost doubled from £6.5m in 2018/19. Two thirds of the latest backlog is rated “high” or “significant” risk. High risk is defined as “where repairs/replacement must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution.”
Twenty nine trusts face backlogs above the £100m mark, and it’s likely these numbers will continue to increase given the grossly inadequate level of capital funding. An ITV News report last year revealed that nearly half of NHS hospitals in England have been forced to close wards and vital services due to flooding, power cuts and structural problems.
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