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Promise of 40 New Hospitals Not on Track, Watchdog Says

The Government is set to miss its own deadline for building 40 new hospitals in England by the end of the decade, according to a report by the spending watchdog released today.

The National Audit Office (NAO) said building delays mean that only 32 of the projects are likely to be delivered by 2030.

However, the Department of Health and Social Care (DHSC) insists it's on track to deliver all 40 projects within the original timescale.

The DHSC launched a health infrastructure plan in 2019 to modernise the NHS estate and replace seven hospitals that were structurally unsound because of decaying reinforced autoclaved aerated concrete. It planned 27 new hospital schemes for completion by 2030, and in October 2020 expanded this ambition to 40 new hospitals. It named 32 of these hospitals alongside details of the work to be done, and said a further eight would be selected later.

Boris Johnson, prime minister at the time, hailed the commitment as "the biggest hospital building programme in a generation".

What is a "New" Hospital?

The NAO report found that the Government's definition of what constitutes a "new hospital" was so broad that it encompassed completely new hospitals, major new buildings at existing sites, as well as refurbishments of existing buildings. Once eight previously announced projects were excluded, the analysis suggested that only 11 of the 32 hospitals named in 2020 were whole new hospitals.

In 2020, the DHSC estimated capital funding requirements for all 48 projects at between £19.8 billion and £29.7 billion. The watchdog said that although the Government stated that the initial 40 schemes would be "fully funded", an allocation of between £3.7 billion £16 billion applied only to projects in the first 4 years, risking larger schemes being left to the end of the decade. This would "likely result in many schemes being simultaneously under construction, making it harder to find builders and potentially increasing costs". 

By June 2023, three of the eight schemes in phase one had opened — or part opened — against an expectation that five would be ready. Between 2020 and 2023, forecast costs for schemes in the first two phases of development had increased by 41%, according to the NAO's analysis.

Meanwhile, an initiative to cut building costs in the latter part of the decade by a quarter through using standardised designs "remains unproven" and has been hampered by shortages of skilled staff, according to the report.

Overall, the Government had "not achieved good value for money" with its health infrastructure plan, whilst progress has been "slower than expected".

Gareth Davies, the head of the NAO, said: "The programme has innovative plans to standardise hospital construction, delivering efficiencies and quality improvements. However, by the definition the Government used in 2020, it will now deliver 32 rather than 40 new hospitals by 2030."

Important lessons should be learnt from progress so far, including "strengthening the business case process to improve confidence on affordability and delivery dates, and improving transparency for key decisions", Mr Davies added.

Government Committed to Meeting the Deadline

In a statement sent to Medscape News UK, the DHSC said some changes were made in the construction timetable to prioritise hospitals affected by deteriorating reinforced autoclaved aerated concrete, but that "40 new hospitals will still be delivered by 2030".

A DHSC spokesperson emphasised: "We remain firmly committed to delivering these hospitals, which are now expected to be backed by over £20 billion of investment."

NHS Providers said it was "concerned" that the NAO considers the hospital building programme to not be good value for money so far, as well as the slowness of delivery. 

Many hospital trusts are "deeply disappointed that their building plans won't be delivered before 2030, and many more trusts were disappointed not to be offered funding at all", commented NHS Providers chief executive Sir Julian Hartley in a press release.

Progress with the New Hospital Programme. Published 17 July 2023.

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