Wes Streeting may have sneaked out his announcement during Donald Trump’s inauguration ceremony on January 20, hoping attention would be focused elsewhere, but it’s clear that the new timetable for building new hospitals is bad news for almost all areas of the NHS.
Of course, the underlying problem was the 14 years of austerity policies that starved the NHS of capital for renewal, rebuilding, and revenue for daily running costs. Now that Labour, though, is also firmly set on its own funding squeeze (albeit this time presented as seeking “growth”), there seems little point in simply blaming the Tories.
Starmer’s government is, by consensus, committed to providing sufficient funding for the NHS to keep the lights on. This announcement further demonstrates a reluctance to go beyond that, plunging the new hospital programme into chaos, and it follows the stalling of action to tackle inadequate staff and equipment. These are all crucial elements of the NHS’s capacity crisis, which worsens as we await a plan to resolve it.
Impact of delays
Worrying as the postponement of the start of several larger new hospital schemes to the late 2030s clearly is, the government’s continued refusal to address the huge and growing £13.8 billion bill for backlog maintenance has even wider ramifications.
Almost half (21) of the 43 trusts facing maintenance backlogs of £100m-plus (with combined backlogs totalling £3.8 billion) are outside the new hospitals programme, and facing a desperate plight as ministers again make clear they are not a priority concern.
Unless there is a miraculous change of tack in the 10 year plan promised for later this year, dozens of trusts that didn’t even make it onto the list for new buildings will have tens of thousands of staff and their patients stuck with crumbling buildings and clapped out equipment for the indefinite future.
U-turn on new hospitals
The Lowdown pointed out last summer that Labour had surprisingly amended its Mission statement on the NHS and its manifesto shortly before last year’s general election, appearing for the first time to promise to deliver the “New Hospitals Programme” (NHP) that was set up following Boris Johnson’s cynical 2019 promise to build 40 new hospitals by 2030.
This was despite the fact that Labour had consistently argued in opposition, as Keir Starmer has since pointed out in PMQs, “The promise of 40 new hospitals didn’t involve 40, didn’t involve hospitals, they weren’t new, and they weren’t funded.”
Nonetheless, Labour’s Manifesto, for some reason, committed to delivering on the Tory promise, stating: “It is also clear that NHS estates are in a state of disrepair after years of neglect. Labour is therefore committed to delivering the New Hospitals Programme.”
It was immediately obvious that this would be a broken promise. The vehicle for that breach of promise was Wes Streeting’s statement, coupled with the DHSC document “New Hospital Programme – plan for implementation.”
It reveals that the government has now limited its commitment to continuing with a number of schemes already under construction, while also promising that 16 projects costing anything up to £17.5 billion, (7 of them prioritised schemes to replace hospitals built using defective RAAC concrete) will commence before the next election needs to be held in 2029.
Nonetheless Streeting not only announced nine more hospital schemes would commence after 2030, but he also relegated another eight of the largest (and most pressing) schemes to start between 2035 and 2040.
Disappointment and dismay
These most heavily delayed projects are: Charing Cross and Hammersmith Hospitals; North Devon Hospital Barnstaple; Royal Lancaster Infirmary; Royal Preston Hospital; Queen’s Medical Centre and Nottingham City Hospital; Royal Berkshire Hospital, Reading; Hampshire Hospitals; and Eastbourne District General, Conquest Hospital (Hastings) and Bexhill Community Hospital.
While some of the trusts dumped into the post 2035 ‘Wave 3’ have issued pointless press statements welcoming “certainty”, or (like Hampshire Hospitals and East Sussex Healthcare) have said nothing at all, others have expressed their frustration.
Sam Higginson, the chief executive of Royal Devon Healthcare NHS Trust, says he is “deeply disappointed” that the redevelopment of his North Devon District Hospital may have to wait until 2038: “For us that’s too far in the future,” he says.
“There is a limit how long we can run that infrastructure for and we are right at that limit.”
Anthony May, Chief Executive of Nottingham University Hospitals NHS Trust, said: “Whilst we welcome the government’s ongoing commitment to Tomorrow’s NUH (TNUH), we are very disappointed that the review of the New Hospital Programme (NHP) announced today means significant delays to the TNUH scheme.
“With one of the largest reported maintenance backlogs in the country (amounting to £439m), the NHP investment is desperately needed, and sooner rather than later, as the current condition of our estate limits our ability to provide the environment that our patients and staff deserve.”
But the toughest response to the biggest delays has come from Professor Tim Orchard, chief executive of Imperial College Healthcare NHS Trust in North West London, which has seen both of its major projects (Charing Cross and Hammersmith, and St Mary’s) kicked into the long grass. He summed up the new plan:
“This is devastating news for our communities, our staff and patients, and for the whole of the capital’s healthcare system. We understand that the Government’s New Hospital Programme must be affordable but the simple truth is that St Mary’s Hospital, in particular, will not last until the 2040s.”
Indeed as local campaigners Hammersmith and Fulham Save Our NHS (HAFSON) point out, some of the oldest parts of St Mary’s will be 200 years old in 2040 – and still not replaced.
The Imperial Trust press release noted:
“Successive governments have kicked the can down the road for far too long, leaving us with the task of running a group of major hospitals that have not been maintained.
“We are fortunate to have excellent clinicians and wider workforce who have been prepared to go the extra mile to compensate for our failing buildings. Our estates teams have frankly been working miracles to keep things going.
“But the ask – to continue in this way until the 2040s – is just too much. It is simply impossible.”
Prof Orchard argued that the plan to replace St Mary’s promised not only to improve the quality and safety of health care but would also be a net contributor to Chancellor Rachel Reeves’ attempt to stimulate economic growth:
“Our existing partnership with Imperial College, Westminster City Council and 15 co-located life science, tech and data companies, under the banner of Paddington Life Sciences, will contribute £1.5 billion per annum to the UK economy if we are able to redevelop our site to allow its further expansion.”
And he has raised the obvious question of what possible alternatives might be considered:
“We will explore all possible means of funding our redevelopments, working with our Paddington Life Science and other partners, as well as with Government. We will also continue to work with local councils and MPs, who we know share our deep disappointment, to pursue our wider case.”
But the frustration is not limited to trusts with the latest starting date.
Given the go ahead, but now stalled to 2030
All six of the supposedly ‘shovel ready’ projects apparently given the go-ahead back in 2019 (despite none of them having even completed a business case) have now been shunted back again – to Wave 2, starting after 2030.
These are: replacing Princess Alexandra Hospital, Harlow; Watford General Hospital; Whipps Cross Hospital, part of Bart’s trust in North East London; a new Specialist Emergency Centre for Epsom & St Helier trust in South West London; reconfiguration of University Hospitals of Leicester; and a new wing for Leeds General Infirmary.
The Specialist Emergency Care Hospital planned for Sutton has time and again been presented as imminent by local health bosses, with claims that the funding had been agreed – even as the costs of the new building grew with each delay. In 2021, with the new hospital costed at £511m, the Trust was told by the New Hospitals Programme to develop an alternative scheme costing no more than £400m.
Now the DHSC has estimated it will cost between £1.5 billion and £2 billion when (and if) it begins building some time after 2032. The response from the St George’s, Epsom and St Helier University Hospitals and Health Group’s Deputy Chief Executive, Dr James Marsh, was openly angry:
“After decades of false promises, the people of southwest London and Surrey have been let down once again. Every year we delay adds up to £150m to the cost of a new hospital and keeping the current buildings safe to provide care.
“We have already had to condemn and demolish one of our wards. It’s only a matter of time before other parts of our hospital become unsafe for treating patients. We now need to plan and prepare for the catastrophic failure of our buildings which could mean moving patient care into temporary buildings.”
Dr Marsh ends with a challenge: “If the health secretary thinks we can continue to care for patients for 10 years in this building, we invite Wes Streeting to come and see the state of the estate himself.”
Leeds Teaching Hospitals Trust Professor Chief Executive Phil Wood also emphasised the extent to which their local health services had been let down by successive governments:,
“We are extremely disappointed to hear that we will be unable to start construction on the new hospital at Leeds General Infirmary until at least 2030.
“We have been waiting since 2019 to build this new hospital for our patients, staff and communities in Leeds, Yorkshire and beyond. … We also need to understand the impact this delay will have on our hospital services and our ageing estate, which has one of the highest backlog maintenance requirements in the NHS.”
Like the Imperial Trust response, Prof Wood also emphasises the extent to which investment in a Leeds new build would contribute to potential economic growth in the surrounding area:
“The Trust plans … would transform healthcare for our patients, staff and communities across Leeds, Yorkshire and beyond and will have far-reaching benefits by creating an Innovation Village, which will deliver the latest technology to patients’ bedside and bring a huge economic boost to the region.”
The delay to the Whipps Cross rebuild has also provoked a critical response from Group Chief Executive of Barts Health NHS Trust Shane DeGaris, who said:
“Today’s announcement of a significant delay to the redevelopment is deeply disappointing for Whipps Cross Hospital, our staff, and the local people we serve.”
But the other three trusts that have been pushed back into Wave 2 have been more cagey. University Hospitals Leicester, which had been forcing through highly controversial and flawed plans as if they could proceed immediately, has said absolutely nothing at all about the latest announcement.
West Hertfordshire Hospitals offered a “Statement on government’s approval of Watford General Hospital redevelopment,” which cringingly admitted in a final paragraph that “We would have hoped for an earlier slot but understand the constraints on the public finances.”
And Princess Alexandra trust bosses also presented the decision as a positive: “The government has confirmed the funding and timetable for a new, state-of-the-art hospital for Harlow.”
The Trust admits that the announcement meant “a significant delay to the original plans for a new Princess Alexandra Hospital,” but emphasised the good news: “it does provide certainty that there will be a new hospital during the next decade.”
Hattie Llewelyn-Davies, chair of PAHT, and chief executive Thom Lafferty minimised the immediate problems that will continue for at least 10 more years until a new building is complete:
“In the meantime, our ageing hospital estate continues to face significant and ongoing problems.”
If there is one lesson all of these repeatedly delayed schemes should draw from the latest announcement it is that it’s a waste of time and money developing more detailed plans until there is a clear commitment from government to fund a project within its 5-year term, and evidence that capital will be made available.
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