Following on our recent Lowdown report on the chaos of the New Hospitals Programme (NHP), there are more signs that the organisation supposedly coordinating plans for “40 new hospitals” is mired in confusion and increasingly aware of how badly the whole project has been under-funded.

The HSJ has revealed that controversial NHP assumptions that the new hospitals would need far fewer beds (proposing a reduction of 14%) have now been dropped:

“it is understood that New Hospital Programme is now asking to maintain existing bed numbers in the latest proposal to the Treasury.”

This change could of course be a result of the concerns raised by a critical National Audit Office report last summer, subsequently echoed by the all-party Commons Public Accounts Committee, which warned that the NHS could wind up eventually building hospitals that prove to be too small from day one (like the first wave of PFI hospital projects signed off from 1997, which averaged between 20-40% fewer beds than the hospitals they replaced).

Indeed the NHP assumptions underpinning their “minimum viable product “model could have further reduced the planned capacity of new hospital schemes … after local project teams have in many cases already made their own unrealistic assumptions on how few hospital beds may be needed as and when any new hospitals are finally opened.

The Lowdown warned back in 2020 that New hospitals won’t end bed shortages, pointing to the example of the plan to replace most of the front line services provided from 1,048 beds by Epsom and St Helier Hospitals Trust in South West London by a new acute hospital with just 496 beds.

In Leicester, project leaders pushed through a deeply flawed Decision Making Business Case back in 2021, only to admit soon afterwards that to preserve the existing minimal provision of 2.4 acute beds per 1,000 population the Trust would need at least 300 – and possibly as many as 800 – additional beds on top of the DMBC proposals.

Other schemes have likewise assumed they would need almost the same or even fewer beds – and have also been seeking ways to further scale down new buildings to match the £400m limit imposed by the NHP in 2021.

The HSJ also reports that the NHP is seeking additional funding from the Treasury, to reduce the extent to which plans have to be cut back to match an inadequate budget.

But the ‘40 new hospitals’ promise was tied to the now discredited Boris Johnson, and has not been publicly embraced by Rishi Sunak. Moreover even a generous increase now in the capital for new hospitals will not deliver any immediate benefit, since none of the new projects even has a completed full business case. From here to any new hospital opening will inevitably be several years.

So whether the NHP will succeed in prising more capital from a tight-fisted Treasury – while the government seems focused on delivering a pre-election tax-cutting spree in the hopes of averting the near-certainty of electoral defeat later this year –is anyone’s guess. Our advice to the NHP: don’t hold your breath waiting.

Despite the certainty of delays, and the government’s own announcement last year that eight hospital projects would certainly be delayed until the 2030s, more schemes are emerging – and triggering a public debate.

More than 15,000 angry people have already signed a petition opposing the plans to b downgrade services at Winchester’s Royal Hampshire Hospital and centre all acute services in a new hospital in Basingstoke or close to Junction 7 of the M3 motorway. Health chiefs have been bigging up the plan, implying that they have been promised up to £900m, despite the fact that Hampshire’s is one of the plans delayed into the next decade.

One scheme that has been waiting in the wings for years despite having theoretically been allocated £312m in funding is the proposal to centralise Shropshire’s emergency services in a new hospital in Shrewsbury, downgrading Telford’s Princess Royal Hospital – leaving Telford, with its 160,000 population as the largest town in England with no local A&E. We reported ten days ago that its Outline Business Case has received a rubber stamp of approval, and that the Independent Reconfiguration Panel has given a qualified go-ahead: now plans for the new hospital have also received planning permission from Shropshire Council. But while the local press trumpets this success the most difficult task lies ahead: trying to develop a full business case that delivers a viable hospital despite huge doubts over the level of funding, after years of inflation have increased the cost way beyond the increased £498m figure included in the Strategic Business Case in 2019. Back in 2022 ministers were still insisting that no extra money would be available, and that the plan had to be cut to fit the budget.

Nottingham University Hospitals is the latest trust to whip up public interest in a new build project that won’t lay the first brick until after 2030. Possibly in an effort to divert public attention from a series of performance failures and continued scandals and revelations of poor maternity care, the Trust chose January 26 to publish a press release headed ‘Once-in-a-generation hospital programme enters new phase’.

It breathlessly announced: “The Tomorrow’s NUH (TNUH) programme, one of the largest funded schemes in the Government’s New Hospitals Programme (NHP), aims to update and improve the main hospital sites run by Nottingham University Hospitals NHS Trust (NUH).” While local punters might be deceived into imagining this might mean new wards, operating theatres and the like, the presser only offers generalities. Anthony May, NUHT Chief Executive, waffles: “Ultimately, we want to create hospitals that will make a difference to the next generation and have as much impact as the QMC did when it opened in the 1970s. This isn’t about just increasing what we currently have, but about creating better hospitals as part of a complete health and care system that is ready for the challenges and opportunities of the future.” But it turns out there is no actual news or decision at the heart of the press release, which lamely tails off with the vague promise that “The scope of this work is now being developed and we will provide an update in due course.” Meanwhile, work is focused on “Enabling works on the planned 1,500 space multi-storey car park and power supply infrastructure.”

Architects are getting excited about the tender for the first new build hospital to replace one of the seven hospitals most severely affected by use of defective RAAC beams. Leighton Hospital in Crewe has published invited bids from to form a design team for the project, which has a construction budget of £341 million. However the actual tender document shows that the project as a whole is set to cost more than double that amount: “The new Leighton Hospital is expected to have an initial capital requirement of circa £740m, with a scope of work over a period of 6 years.” The start date is advertised as May 31 2024, and the end date 30 May 2030. Will this project be delivered on time and within budget?

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