A flagship £35 billion plan for 40 new hospitals is based on a “terrifically ambitious” presumption and risks delivering buildings that are too small, senior MPs have warned.
Writing for The Times, two politicians who chair influential Commons committees said they were worried that plans to deliver the government’s key manifesto pledge were unrealistic.
Dame Meg Hillier, the Labour chairwoman of the public accounts committee, and Steve Brine, the Conservative former health and Treasury minister who chairs the health and social care committee, said there was a risk of creating a new generation of inadequate hospitals.
The doubts about another big infrastructure project come as the prime minister considers scaling back the HS2 rail project in “alarm” at its rising cost.
The NHS in England has about 1,500 hospitals, many of which have old buildings in poor states of repair. In 2020 the government announced the New Hospital Programme, with a commitment to building 40 hospitals by 2030. It was criticised for including “major refurbishment” and new buildings in the figure of 40.
So far £3.7 billion has been earmarked, covering up to 2024-25. The eventual cost is, according to reports, forecast to reach £35 billion, although ministers have publicly said only that the programme will “represent more than £20 billion of new investment in hospital infrastructure”.
Forty-hospital target won’t be met
The programme has proven controversial. This year the National Audit Office criticised a lack of records explaining how hospitals had been chosen for inclusion. It said that delays meant the target of 40 new hospitals by 2030 would not be met. Most construction is planned for the project’s final years.
The government has insisted that it will build 40 new hospitals by that date, although this includes three mental health facilities that are not part of the official programme.
Some buildings have also been replaced on the list with hospitals built from unstable reinforced autoclaved aerated concrete (Raac) that require more urgent replacement.
Brine and Hillier said that visits to those hospitals left them “genuinely concerned” for patients and staff, with matrons having to limit the number of patients on upper floors and obesity services being restricted to the ground floor.
Most of the new buildings will be built using a approach known as Hospital 2.0 and championed by Steve Barclay, the health secretary. Using modern construction methods such as modular units and off-the-shelf designs, officials say that the hospitals can be built faster and at a lower cost.
‘Terrifically ambitious presumption’
Hillier and Brine write: “Its viability is based on assumptions which we are concerned are guided less by reality than by the need for the numbers to match the fixed price imposed by government to fund the programme.” They say that government modelling assumes a 66 per cent reduction in demand for hospital care over the next 60 years “based on the expectation that care will increasingly take place outside hospitals, including in social care settings and virtually”.
However, they add: “The mere fact of the UK’s growing and ageing population makes this a terrifically ambitious presumption. It is also dependent on the success of a social care plan to address ongoing pressures there — a plan that does not yet exist and is not yet funded.” The new hospitals and sites will include single-bed rooms rather than open wards, requiring more nurses.
The model “would effectively see our new hospitals designed to run at 95 per cent occupancy”, contrary to an NHS target of reducing bed occupancy to 92 per cent or below.
They conclude: “Both the government and NHS England need to reassure parliament, and crucially the public, that the new generation of hospitals will not turn out to be too small, too crowded, easily overwhelmed and not fit for purpose.”
NHS leaders added their concerns. Rory Deighton, director of the NHS Confederation’s Acute Network, said it was frustrated by delays to the programme that meant it had to dip in to “already overstretched budgets to manage short-term maintenance issues whilst they wait”. He said that NHS services in the community were “in a similar state of disrepair to hospitals and need significant funding to address”, calling for the government to carry out a planned NHS-wide capital review “without delay”.
Saffron Cordery, deputy chief executive of NHS Providers, added: “We need a significant boost to capital investment across the NHS to overhaul ageing buildings and equipment.”
An NHS spokeswoman said that the health service had been working closely with the Department of Health “to ensure future hospitals are designed to meet the needs of patients and staff”.
The department said: “Our innovative Hospital 2.0 model, which has been backed by the National Audit Office, will enable us to build high-quality hospitals more quickly, with better value for money for the taxpayer, featuring single bedrooms which can reduce length of stay, improve infection control and boost use of bed capacity.
“The New Hospital Programme will ensure each hospital is an appropriate size based on the needs of the local population and plans for clinical services.”
Separately, polling from Ipsos and the Health Foundation found that 80 per cent of people backed additional funding for the NHS — support that has remained consistent since November 2022.
People listed boosting staff and improving pay and conditions as among their top priorities for both health and social care, while about half of respondents said they expected services to deteriorate.
It’s a simple pledge — 40 new hospitals for England by 2030, with many built with modern methods of construction (write Meg Hillier and Steve Brine). A whole new future-proofed generation of the so-called, Microsoft-esque “Hospital 2.0”.
The government set up the New Hospital Programme (NHP) in 2020. It is tasked with delivering on this vision with £3.7 billion in funding taking it through to 2025, with more to come in the ensuing years, transforming how healthcare infrastructure is built as it goes along.
We have been scrutinising the NHP’s work through our select committees. The public accounts committee has long been looking at capital investment in hospitals and is examining the delivery of the programme. The evidence we have received so far gives us serious cause for concern.
Our hospitals face many challenges including multibillion-pound maintenance backlogs repeatedly highlighted by the National Audit Office (NAO). The NHP also has in-built risks: back-ending construction of larger schemes to the programme’s final years, and crucially the fact that the NAO found that 32 hospitals, rather than the intended target of 40, will be delivered by 2030. Progress has already been slower than originally forecast.
Seven hospitals are built from crumbling concrete with 41 other buildings across 23 trusts also affected. We visited two of these hospitals in July and were genuinely concerned by the reality for patients and staff.
The impact on day-to-day management was immense: matrons having to monitor how many patients they admit on the first floor so they don’t exceed a safe load; bariatric patients only able to be treated on the ground floor. Millions are being spent just to keep hospitals safe — £685m over the five years to 2025 across all the Raac hospitals.
In a recent meeting of the public accounts committee we joined forces to scrutinise the planning assumptions underpinning Hospital 2.0. Its viability is based on assumptions which we are concerned are guided less by reality than by the need for the numbers to match the fixed price imposed by government to fund the programme.
The government’s modelling assumes a 1.8 per cent reduction each year in demand for hospital capacity over the 60-year life cycle of the new hospitals. This is based on the expectation that care will increasingly take place outside hospitals, including in social care settings and virtually.
This amounts to a 66 per cent reduction in demand over those 60 years, something the NAO cautioned could be unrealistic.
The mere fact of the UK’s growing and ageing population makes this a terrifically ambitious presumption. It is also dependent on the success of a social care plan to address ongoing pressures there — a plan that does not yet exist and is not yet funded.
NHS England, in their evidence to us, appeared to accept that this assumption and therefore the modelled smaller size of the hospitals we can expect under Hospital 2.0 is likely to be wrong.
The NHP also envisions a future of single-bed rooms, rather than open wards, for reasons including privacy, dignity and infection control.
This, of course, can be really positive for patients but there’s no hiding from the fact they can require an increased nursing presence to ensure safe staffing and that has implications for now as well as an impact on the productivity assumptions made in the NHS long-term workforce plan.
This new model would effectively see our new hospitals designed to run at 95 per cent occupancy. The NHS’s objective is to reduce adult general and acute bed occupancy to 92 per cent or below. We heard in evidence from NHS Providers that operating hospitals at 95 per cent occupancy may not be sustainable.
The experience of the pandemic holds glaring lessons that any future-proofed health system must be able to weather unexpected spikes in demand for beds. At 95 per cent full, the loss of the use of an area of a building for any reason could leave these hospitals with bed shortages.
Finally, under the NHP, the average length of patient stay is assumed to reduce by 12 per cent. NHS England argues that single rooms increase the ability to manage demand, and were able to give us an example of 12 per cent reductions in stay they were seeing at a hospital opened in Liverpool.
But the NAO’s report shows us that England already has one of the shortest lengths of stay per patient of any member of the Organisation for Economic Co-operation and Development, and that the NHP’s own evidence on the effect of single beds on length of stay is “highly mixed”.
The public accounts committee will be reporting its findings on the New Hospital Programme shortly, and the health and social care committee is also likely to examine these issues and the assumptions made. We all want new hospitals built — indeed we need to invest in the crumbling NHS estate — so our committees will continue to work together to challenge and scrutinise these plans.
Both the government and NHS England need to reassure parliament, and crucially the public, that the new generation of hospitals will not turn out to be too small, too crowded, easily overwhelmed and not fit for purpose.
Steve Brine is the chairman of the health and social care select committee and the Conservative MP for Winchester. Dame Meg Hillier is the chairwoman of the public accounts committee and the Labour and Co-operative MP for Hackney South & Shoreditch
