In the last issue of The Lowdown (January 19) we reported another instalment of the saga of the collapse of Boris Johnson’s promise to build 40 new hospitals by 2030, warning that only one of the six ‘pathfinder’ projects initially allocated funding now stands any chance of being built by 2025.
All of them are likely to see their initial plans hacked back to fit a new a maximum target cost of £400m, having been asked by the New Hospitals Programme last summer to resubmit their full plans and the cheaper option. This questions the clinical viability of some of the projects, but corresponds with the limited capital available: as yet only £2.7bn has been allocated to building new hospitals – equivalent to just £450m each for the first six.
The delays and confusion surrounding the initial “fake 40” new hospital projects and the promised upgrade of another 70 hospitals has brought a decline in the construction sector, with a 47% drop in the number of healthcare projects beginning on site in the last quarter of 2021 compared with 2020. Building Better Healthcare reports that “no major projects reached the contract awarded stage” in the final quarter, and “Hospitals, in particular, experienced their weakest period, with the value of work starting onsite in the last quarter of the year falling 62% against the previous year.”
But the confusion and certainty of widespread disappointment will have now grown even further with the revelation in the HSJ that a staggering 128 trusts – almost two thirds of all trusts in England – have submitted bids to be one of just eight additional promised projects, to bring the total of new hospitals to 48.
Unless ministers are forced to see sense and review Rishi Sunak’s inadequate Spending Review, well over nine out of ten of these trusts will inevitably see their hopes dashed and bids rejected – with dozens of projects ahead of them in the queue for a slice of as yet non-existent funding, and no foreseeable prospect of another funding round this decade.
Interestingly Michael Gove’s “Levelling Up White Paper,” which announces no new money and appears entirely designed to prop up Boris Johnson among his dimmer “red wall” back benchers, retreats from the promise of 48 new builds and offers only a “commitment” to build 40 new hospitals by 2030, with an even more wishy washy “ambition” to deliver 50,000 more nurses.
The Lowdown has consistently highlighted the urgent need for new hospitals to replace those built in the 1970s with defective structural planks, most of which have not been prioritised, and none allocated any capital as yet by the New Hospitals Programme.
Several of these are now either included in larger schemes or submitted separately among the bids that have flooded in as trusts recognise the danger of missing the boat on funding.
Last month one of these, Frimley Health Foundation Trust in Surrey has thrown its hat into the ring, setting out plans for a complete £1.26bn rebuild to transform it into a state-of-the-art net-zero hospital, with more operating theatres and more specialist services, in what a trust spokesperson – clearly unaware of the limited cash likely to be on offer – optimistically described as a “once-in-a-lifetime opportunity.”
Another, the collapsing Airedale Hospital in Steeton, is included in the literally fantastic plan from the ‘Act as One’ health and care partnership that covers Bradford District and Craven – for THREE new hospitals, costing £1.7 bn.
Queen Elizabeth Hospital in Kings Lynn has mounted a campaign for the £679m it needs to rebuild the hospital that is being held up by over 200 metal props, warning that it would cost over £550m just to keep adding props.
And Leighton Hospital in Crewe, run by Mid Cheshire Hospitals Foundation Trust – and also in danger of falling down as another victim of defective concrete planks – has also submitted a £663m plan to replace it.
Grandiose plans not linked to collapsing buildings include the trusts in Lincolnshire integrated care system, which the HSJ reports have together submitted bids with a total value of £1.2bn.
In London, Imperial College Healthcare has optimistically submitted its Strategic Outline Case for rebuilding St Mary’s Hospital in Paddington, including 840 and “new, user-centred clinical facilities across three main hospital buildings,” and a clinical life sciences cluster on the land freed up, at an estimated “£1.2-1.7 billion net, once receipts from the sale of surplus land are taken into account.”
Some smaller plans are still coming in above £400m, including the £500m plan to replace Stockport’s Stepping Hill Hospital, which has a £95m backlog maintenance bill;
Kettering hospital chiefs have boldly submitted the case for investment of “up to £765m” – to fund “the first three phases” of a £1bn-plus 5-phase scheme.
Bolton Foundation Trust seems to be a rare bargain bucket exception, having submitted a modest plan for a £252m first phase rebuild of Bolton General Hospital, citing high and significant risk backlog maintenance bills of £165m.
With backlog maintenance bills soaring above £9bn and rising, causing increased numbers of incidents that disrupt patient care, the 128 desperate trust bosses all have a valid case for investment to upgrade, modernise and make buildings safe – but without a sea-change in government policy, at least 120 of them stand no chance of getting the capital they need.
They, along with NHS Providers and the NHS Confederation would be well advised to lend tacit or more open support to the SOSNHS campaign, now backed by over 40 trade unions and campaigning bodies and centred on the need for an emergency down-payment of £20bn to kick-start the refurbishment and expansion of the NHS to meet the needs of patients in this decade rather than later.
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