From the time he took over as Prime Minister, Boris Johnson has been banging on about building new hospitals. He promised it in the summer of 2019, and again at party conference, and again in the manifesto for the 2019 general election, which stated:

“On top of more money for the NHS every year, we’re investing in hospitals so that our brilliant doctors and nurses have the facilities they need to give patients the best possible care.

We’re providing £850 million for 20 hospital upgrades, £2.7 billion for the first six new hospitals, and seed funding so that work on 34 more can make progress.”

In November 2019 The Lowdown questioned how realistic the promise might be:

“It’s hard to understand from this over-egged hyperbole that all the Johnson government has done is provide £2.7 billion to fund just SIX new or refurbished hospital projects.

“£100 million is also provided as “seed funding” for 21 trusts to draw up plans for another 34 hospital projects – which will potentially cost another £10 billion or more – after 2025.

“This is a long way from being the biggest hospital programme in a generation: from 1997 onwards Tony Blair’s government built well over 100 – albeit funded through PFI.

“It’s also questionable whether the 34 future projects will ever get beyond the planning stage, since they would need to be agreed and funded by a future government after at least one further election, during or after 2025.”

The Lowdown broke down the listed projects: six “new hospitals” were to be a new £400 million “major acute” hospital for Epsom & St Helier trust; a new hospital to replace the ageing Whipps Cross Hospital in north east London; new hospitals to replace Watford General and Harlow’s Princess Alexandra Hospital; a reconfiguration in Leicester to reduce from three sites to two, and new wings and  ‘sympathetic redevelopment’ of the Grade I listed Gilbert Scott Building for Leeds Teaching Hospitals.

In addition 21 hospital trusts receiving seed funding accounted for up to 38 “new hospitals” although many of these would clearly not be much more than refurbishment or additional new wings.

These were listed as: Cambridge (Addenbrookes); East Sussex (Conquest Eastbourne District Hospitals);  Hampshire (Royal HampshireN. Hants Hospital); Hillingdon Hospital; Imperial College (Charing CrossSt Mary’s and Hammersmith); Lowestoft (James Paget) Kettering General; Lancashire (Royal Preston); Milton Keynes Hospital; North Devon District Hospital;  Nottingham (Queens Medical CentreNottingham City Hospital); North Manchester General Hospital;  Plymouth’s Derriford Hospital; Reading’s Royal Berkshire Hospital; Royal Cornwall Hospital, Royal United Bath Hospital; Musgrove Park Hospital, Somerset; Torbay District Hospital, Devon;  Morecambe Bay (Royal Lancaster InfirmaryFurness General Hospital);  West Suffolk Hospital; and ‘up to 12 community hospitals’ for Dorset Healthcare.

Notably this list did not include any projects already ongoing. But a year later the whole story had changed. A major press release in October 2020 stated:

“The Prime Minister today confirmed for the first time that 40 hospitals will be built by 2030 as part of a package worth £3.7 billion, with 8 further new schemes invited to bid, delivering on the government’s manifesto commitment.”

This was followed by a completely different list, including eight schemes that had not been anywhere to be seen in the initial ‘fake forty’:

Four were described as “In build”: Midland Metropolitan Hospital, Sandwell and West Birmingham; Cumberland Cancer Hospital; Royal Liverpool Hospital; 3Ts Hospital, Brighton;

Four more were “Pending Final Approval”: Moorfields Eye Hospital, central London; Northgate Hospital, Morpeth; Major Trauma Hospital Salford; and a new “Defence and National Rehabilitation Centre,” in Loughborough.

The six funded schemes were included, and then 25 jumbled  schemes (5 of which were Dorset community hospitals), plus a newly announced rebuild of Shotley Bridge hospital in Durham, making 40.

The same press release then announced for the first time that there would be a “Competition for 8 further hospitals including new Mental Health Hospitals”. That competition eventually opened up on July 15 and closes this month, with the winning schemes not revealed until next spring.

However the newly revised version of events in the recently leaked New Hospital Programme comms ‘Playbook’ (which tells Trust bosses what they must say, and how they must clear any press releases or publicity with the 7-strong national Comms team before going public) contradicts the October 2020 Press release, and states:

“Currently, the national programme comprises eight pre-existing schemes and 40 new hospitals, totalling 48 hospitals.” It quietly drops in the fact that only 32 of the 40 have been decided, with the other 8 yet to emerge from “expressions of interest”.

Of the list of 32 projects which the Playbook insists must all be described as “new hospitals” at least 11 are clearly additional or refurbished wings or units alongside the main hospital, and five more are small-scale community hospitals with limited services.

The Playbook has been criticised by leaders of two professional bodies seeking to uphold standards in public relations. Chartered Institute of Public Relations president Mandy Pearse said: “Accuracy and honesty in public sector communications are important in maintaining public trust. This comment within the Playbook is ill-judged.”

Public Relations and Communications Association chief Francis Ingham told PR Week: “It is important that public communications are factual and neither misleading nor exaggerated. To any normal person, a new wing does not equate to a new hospital. In the interests of public confidence in such announcements, we would urge honest, straight-forward accuracy.”

Neither honesty nor accuracy are to the fore in the spin doctors’ Playbook, which also insists that despite the very obvious delays, fresh questions about the affordability of even the “pathfinder” schemes, and lack of any visible progress, NHS CEOs have to always state that the ‘new hospital’ plans “remain on track.

It divides the various schemes into five “phases”:

Phase 1 – “In-flight” schemes – that are in construction or shortly to start construction and are currently anticipated to complete construction between 2021 and 2025.

Phase 2 – “Agile” schemes – are smaller projects that are flexible in delivery and have the potential to complete construction earlier in the decade – currently expected to complete 2024-26.

Phase 3 – Pathfinder schemes  – larger and more complex schemes whose plans are “relatively advanced” and “currently anticipated to start construction between 2023-24 and complete in the period 2026-28.”

Phase 4 – Full Adopter schemes – will be delivered “in the latter half of the decade”

Phase 5 – “Next eight” schemes – “to be identified under the current open process and delivered in the latter half of the decade”.

But whichever way the story is now spun, chopped or changed, two factors have remained as constant:

NOT ONE new hospital plan has yet been finalised,

And the bill for backlog maintenance for hospitals not scheduled for any new building has soared to £9 billion, with a worsening plight for the dozen or so hospitals built in the 1970s using reinforced autoclaved aerated concrete planks.

Among the hospitals affected by the crumbling concrete are Crewe’s Leighton Hospital (Mid Cheshire); Hinchingbrooke (North West Anglia FT); Wexham Park (Frimley Health FT); James Paget Hospital, Lowestoft; Queen Elizabeth Hospital, Kings Lynn, and West Suffolk Hospital (Bury St Edmunds)

Several of these hospitals are in such a dire state that it could be cheaper to knock them down and rebuild. In the most recent backlog maintenance statistics, for example Mid Cheshire Hospitals abruptly announced a massive £373.9m backlog, with estimates that it would take 15 years and cost £555m to replace all of the crumbling planks, while West Suffolk Hospital (the only hospital of this type on the list of 32 new hospital projects) reported a monster backlog of £634.9m, and the estimated cost of repairing the roof of Queen Elizabeth Hospital in Kings Lynn is £500m.

Rishi Sunak appears committed to an austerity agenda. But unless he makes a massive U-turn to allocate billions more in capital as well as revenue to the NHS there is no way that all the many Comms staff working for the NHS at local and national levels can spin their way out of this growing crisis which affects so many areas.

Nor will spin hide the seemingly inevitable failure of the Johnson government to deliver its keynote manifesto pledge.

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