No one can be surprised that that the Secretary of State for Health and Social Care has eventually had to recognise a bit of reality in delaying and reprioritising the New Hospitals Building Programme. Schemes that Boris the Builder gleefully announced as ‘ready to go’ in 2019 are to be put back until after 2030.

Steve Barclay has ‘reprioritised’ his programme to direct funding to the most urgent hospitals facing the risk of falling down. However Barclay apparently took some persuading, if the account in the Guardian is to be believed.  Perhaps he noticed that all the constituencies in which the hospitals requiring “urgent” attention were in Conservative held seats. Liz Truss and Michael Gove obviously need all the help they can get. 

But many of those now effectively bumped off the priority list are also in Tory areas: and there is still no word on the outcome of the 120-plus bids that were submitted in hopes of being chosen as one of an additional eight schemes to make 48 “new hospitals”.

There are several ways of looking at this fiasco:

From the perspective of the ‘winners’ in the original struggle to push their scheme to the top of the greasy pole of political favour: they might be feeling dismayed that they have lost their “once in a lifetime” chance of a shiny new hospital. But the fine print of the announcement suggests they may be one of 20 schemes technically “in Build” or underway by next year.

Steve Barclay’s decision may be motivated by a fear of the electoral damage that might be done if only a handful of the initial 40 projects have started any work: and by fear that an incoming Labour government might well prioritise projects in areas less beneficial for the Tories. So it seems he intends to sign up to 20 long term contracts before the next election that may be impossible to rescind afterwards – the statement pledges that, “by next year, more than 20 will be underway,” even though the Chancellor has yet to commit any of the additional capital needed to fund what “is now expected to represent over £20bn of investment in new hospital infrastructure.” The legal strength of this strategy may well be tested further down the track.

From the Treasury point of view: they have reasserted their control over the capital programme, whatever is being said about ministers agreeing business cases. It contradicts their policies to allow ministers to promote favoured schemes when other hospitals are falling down. But this raises the question of what happens in the run up to the next election if the Treasury say no to a “promised” new hospital. Will Jeremy Hunt step in?

From NHS England’s perspective it represents a recognition that problems which properly lie at ministerial level/ Treasury level are finally being addressed. But something is obviously going wrong if no one has noticed hospitals are falling down before now and no one thinks it is their job to do something about it.

From the point of view of those looking to invest in new capital projects over the next ten years, including in new technology, new equipment , new productivity boosting measures ; for example in pathology services, scanners etc,. it surely means further delays – and more pressure on NHS managers to privatise and subcontract services. Already health chiefs in North West London looking to replace St Mary’s hospital are crying foul as they find it postponed beyond 2030.

From the Labour Party point of view: it should be time to present their own coherent plans for a capital renewal programme. We need plans which aren’t based around self-imposed fiscal limits but instead are based on meeting long term needs most economically (by for example reducing the long-term test discount rate applied to future benefits in business cases, and directly financing large scale capital projects) and automatically funding self–financing business cases from an Infrastructure Bank. For those who think its unaffordable read Marc Robinson “Bigger Government,” which concluded extra spending on health and social care was inevitable, affordable and desirable in the future to meet a more elderly population’s need.

Plainly councillors, trade unionists and campaigners involved in scrutiny will want to make sure that legal duties are being fulfilled. 

This is the relevant piece of legislation. –

Questions about strategic plans, business cases, procurement processes and contracts will need detailed scrutiny.


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