Fabricated BuildingsThe Conservative NHS Investment Myth
As the latest Conservative regime takes office, Rachel Morris considers one of the starkest failures of its predecessor
We’ve heard the word “deliver” an awful lot lately. Boris Johnson delivered his farewell speech on the steps of 10 Downing Street on 6 September. In keeping with his record, Johnson’s adieu was riddled with half-truths, untruths, evasions and misleading boasts.
Johnson claimed his Government got “this economy moving again… in spite of all opposition, all the naysayers,” egregious given the actual state of the economy, the number of desperate people and closing businesses, and the plummeting value of sterling.
The naysayers now seem to include Johnson’s replacements. New Chancellor Kwasi Kwarteng on Friday slammed the low growth rate incubated by the last 12 years of Conservative rule and the highest tax burden since the 1940s.
This contrasts distinctly with the former occupant of 10 Downing Street, who had claimed just a fortnight earlier that the Government was “delivering on those huge manifesto commitments.”
One of those manifesto commitments was to deliver 40 new hospitals – a fact entirely and conspicuously omitted from the Chancellor’s non-budget. The NHS is a 21st Century service being run out of 19th Century buildings. Will 40 hospitals do the trick? Are they even real, or likely?
The NHS has been a site of political debate since its founding in July 1948. As a child in 1974, I went on a Manchester march with my nurse mum, holding a placard saying, “Underpaid, Understaffed, Under stress, Understand?”
Past disputes seem trivial, however, compared to the current NHS crisis. Sticking plasters will no longer do, and you can’t put a cast on tectonic plates.
The Government knows the national affection for our health service, which is why they make huge promises about its future funding. Notoriously, many were enticed into voting for Brexit by guarantees on a campaign bus that hundreds of millions more would be invested.
Moreover, the Department of Health and Social Care (DHSC) has even upped the number of ‘new hospitals’ pledged – to 48 – by adding eight existing ‘schemes’, all to be delivered by 2030. Johnson tweeted on 8 February that: “Whether it’s recruiting 50,000 extra nurses, building 48 new hospitals or delivering a record-breaking increase in funding, this Government has never been shy about its support for the NHS.”
The DHSC issued a communications guidance document in August 2021, sent to all NHS trusts, stating: “The schemes named in the announcement are not all identical and vary across a number of factors. However, they do all satisfy the criteria we set of what a new hospital is and so must always be referred to as a new hospital.”
These criteria, according to the document, can include: “a major new clinical building on an existing site or a new wing of an existing hospital, provided it contains a whole clinical service, such as maternity or children’s services; or a major refurbishment and alteration of all but building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure.”
Do those definitions fit within your understanding of ‘new hospital’? No, me neither. Lest you think I’m splitting hairs, healthcare think tank the Nuffield Trust agrees, defining a new hospital as “a new building on an entirely new site”.
By their definition, of the Government’s 40 ‘new’ ones, 22 can be classed as rebuilding projects; 12 as new wings of existing hospitals; three rebuilds of non-urgent care hospitals; and three can truly be termed ‘new’ as people who speak the English language understand that word. Oh, but two of the three actually-new hospitals will open as old ones close, as replacements. Both were planned anyway, before 2019.
NHS Providers is the membership organisation for NHS acute, ambulance, community and mental health services treating patients and service users. With respect to the “initial” £3.7 billion investment pledged by the Government for the above schemes, it says an actually-new mid-sized hospital costs circa £500 million. So 40 actually-new hospitals would require £20 billion.
In July, NHS managers warned that the programme was “moving at a glacial pace”, with some schemes as much as four years behind schedule due to lack of funding, construction delays and huge cost increases, in part due to inflation. The chief executive of the NHS Confederation expressed the same concerns.
An NHS Providers survey found that half the trusts involved don’t believe the money needed will ever materialise. Leeds General Infirmary alone estimated the cost for two new buildings to be £75 million more than budgeted, thanks to delays in construction and the rising costs of works and materials.
The National Audit Office (NAO) also announced in July that it would carry out a “value for money review” into the programme, due to report in 2023.
The programme was given a ‘Code Red’ by the Infrastructure and Projects Authority (IPA), which carried out two reviews last year and found it “appears to be unachievable”. A red rating means “major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable”.
You have to wonder if the Government is playing a shell game, assuming the general public is thick and regulators unserious, or if they really are numerically illiterate and project planning-incontinent. The eternal leadership question: evil or stupid?
Yet, as Johnson shambled off into a sunset of after-dinner speeches, he reaffirmed the Government’s commitment to this shambles. “Yes we will have… 40 more hospitals by the end of the decade… [laid on] great solid masonry on which we will continue to build together”.
At the time he uttered this statement, there were 6.8 million people waiting for NHS England appointments, a severe shortage of ambulances and beds, 132,000 NHS vacancies, and real-terms wage cuts.
It would be lovely to think this wasn’t all just gaslighting, and that the new Government feels the need to actually deliver on promises. However, all that Health and Social Care Secretary Thérèse Coffey has delivered so far is instructing NHS staff to “be positive” and avoid Oxford commas. Yet more gas and air, nurse!
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