The promise made by former Prime Minister Boris Johnson in 2020 to build 40 “new hospitals” by 2030 was unlikely to have been taken seriously by many at the time.
The construction industry, with a better idea than the Prime Minister about how long it takes to plan and build a new hospital, certainly didn’t swallow it. Few of the projects in what became the New Hospital Programme (NHP) were on inspection found to be ‘new hospitals’ anyway; the 40 was made up mostly of extensions and refurbishments.
A report from the National Audit Office (NAO) has revealed that only 32 of the projects can now be delivered by the target date. It would have been a terrific boon for UK healthcare if the 32 were in fact new hospitals, but of course they aren’t. And what has been done so far, says the NAO, has not been good value for money.
The NAO advises that the NHP should avoid bunching too many projects together as this would drive up costs. This advice is hardly needed though as the NHP has only found four contractors that would be willing and able to take on new hospital buildings, which are complex projects costing around £600 million, on which much can go wrong. There is an estimated £10 billion backlog of repairs needed for existing hospitals, thanks to about ten years of underfunding since the David Cameron/ George Osborne austerity programme started, and it is unclear how much money will be available for ‘new hospitals’ while the backlog is tackled.
Still, the Department of Health and Social Care insists that 40 new hospitals will be delivered by 2030 with over £20 billion of investment expected to be made available. Three have already opened this year, DHSC says.
NAO head Gareth Davies concedes that the NHP has innovative plans to standardise hospital construction, that will deliver efficiencies and quality improvements. He said: “However, by the definition the government used in 2020, it will now deliver 32 rather than 40 new hospitals by 2030. Delivery so far has been slower than expected, both on individual schemes and in developing the Hospital 2.0 template, which has delayed programme funding decisions.”
The NAO report says that the standardised modular approach planned for use in the NHP called Hospital 2.0, has been assessed as providing £4.80 of benefit for every £1 of cost. It has also been assessed as being cheaper on 15 out of 23 assessed schemes than individual hospital trusts’ own plans. But it warns that this hospital design might be too small and the design should be reconsidered.
The NAO says that the NHP assumes that there will be a reduction in treatment inside hospitals in future years, thanks to patients increasingly being treated through social care. NAO says that while this is an aim of NHS England and the Department of Health and Social Care, this is so far unfunded and is not guaranteed to happen.
The NHP also assumes that hospitals will need fewer beds in future with patients experiencing shorter stays under its plans, which the NAO says is “poorly supported by the evidence”. NAO says there are important lessons for the delivery of major programmes to be learned from the experience of the NHP; somehow one doubts that they will be.
Nick Barrett
Editor