Concerns over the New Hospitals Programme (NHP) have been growing in recent months, since NHS Providers warned that it was on “shaky ground” last July, since half of the trusts in the programme were not confident that they had been allocated sufficient funding to deliver their project.

In October the fears were reinforced by a report to the NHS England Board that again warned that “The Programme has not, to date, had a budget for the full Programme agreed by HMG, a Programme scope or timeline.”

NHS England has also been keen to emphasise that they are not responsible for the delays and the problems: “It is also currently a DHSC Programme, although it is supported by NHSE staff,” a point echoed again at the December Board meeting.

The report went on to reiterate that not only are many of the schemes much less than a new hospital, but the 40 projects incorporate seven schemes that were already in progress before the promised building programme was announced (as discussed above):

“The New Hospital Programme has now met some major milestones; the first of the full 40 hospitals – the Northern Centre for Cancer Care – has been completed, and six further hospitals are under construction.” 

A table at the end of the report showed a shambolic mixed state of play, with the one project completed, six ‘under construction’, one (a new eye hospital for Moorfields) awaiting approval of a Full Business Case, 18 yet to agree an Outline Business Case, 10 still to complete even a Strategic Outline Case, 3 still further behind, developing a Pre Consultation Business Case, and one (“Full refurbishment of Charing Cross Hospital and a mix of refurbishment and new rebuild at Hammersmith Hospital”) noted as “TBD” – presumably To Be Decided. 

Nor did it give any indication on when decisions will be made over the additional eight projects that would make up the total to 48. The report states:

“Linked to the upcoming review of the programme business case, decisions are under review with HMT and No.10 to take forward the inclusion of the next eight schemes in the programme. Additionally, we continue to work with DHSC and HMG to secure a solution for the hospitals impacted by reinforced autoclaved aerated concrete (RAAC), which will need new builds to properly mitigate their risk of closure over the next 10 years.”

A few weeks later, following Jeremy Hunt’s Autumn Statement, the LibDems revealed that the combination of allocations and projected rates of inflation amounted to a £700m cut to NHS capital funding, and warned this would make it even less likely any new hospitals would be built.

In mid December NHP told an industry event hosted by the DHSC that all new hospitals are to be built with single rooms only. They did not admit that is likely to require amendments to many trusts’ current proposals, creating further delays and increasing costs. Providers expressed anxiety about costs and funding, while Nuffield Trust chief executive Nigel Edwards told Medscape News UK

“There is some evidence that single rooms can reduce infection rates, although they can also cause issues with patients feeling isolated. They may also increase the need for nurse staffing and observation to prevent falls.”

By January 1 even the ardently pro-Tory Daily Telegraph was warning that only seven of the promised 40 hospitals even begun construction – while remaining tactfully silent on the fact that all seven had been in progress before the promise was made.

Two weeks ago one of the first hospitals promised funding for a rebuild, the 414-bed Princess Alexandra Hospital in Harlow, revealed the project, a new £850m hospital on a greenfield site, was held up awaiting the green light on funding. Initial hopes on having the new hospital running by 2025 have given way to fears that unless a decision is made soon it may well not be opening until 2028-2030.

When asked to comment the Department of Health once more repeated the initial promise of £3.7bn for the “biggest hospital-building programme in a generation”: but if replacing a 414-bed hospital is to cost £850m, it’s obvious that the funding is nowhere near enough to build even five new hospitals.

Now, as this Lowdown article is completed, the Observer has homed in on more evidence that the NHP is in disarray, warning that only ten of the promised 40 new hospital projects have the full planning permissions they need to go ahead.

Combining the Observer’s own analysis with official data obtained by the Lib Dem deputy leader, Daisy Cooper, the article finds some projects “only have outline planning permission, which is insufficient to allow building work to commence,” while many of them have no planning permission at all.

One obvious reason for this is that without a business case for a new hospital or any idea of how much money is on the table to build it, NHS trusts can’t put any clear proposals to planning committees.

The same article also tacitly raises another issue of concern: whether the new hospitals will contain sufficient capacity to meet the growing needs of their local population. It quotes Health Foundation estimates last year that the NHS would need 23,000-39,000 new beds in England by 2030, “equivalent to around 38–64 average sized hospitals.” 

But of course most of the new hospitals would not be offering extra beds, but replacing existing clapped-out buildings. Concerns have been raised over the reduced bed numbers in the proposed new Whipps Cross Hospital, and the belated opening of the Royal Liverpool Hospital last year brought immediate complaints that bed numbers had been reduced from the previous hospital.

Couple this with the ongoing questions about the level of capital available, pressures on trusts to reduce the size and costs of their schemes, and the continued high rate of inflation, and we can see real grounds to fear that even the hospitals that are built could be far too small and bogged down in immediate crisis.


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