The Failing ‘Forty New Hospitals’ Programme is a Perfect Illustration of Our Broken Politics

This week, the National Audit Office published a value-for-money report on the Progress of the New Hospital Programme in England. It made for grim reading, if unsurprising to those who have followed this story. 

The Shameful Story So Far

In 2020, Boris Johnson’s Government announced a programme to build “40 new hospitals” by 2030. NHS trusts were invited to “bid for funding” for the construction of a further 8 “new hospitals” as part of a “total package of £3,7bn”

In  Commons statement in May, Health and Social Care Secretary, Steve Barclay admitted that subsequently 7 hospitals (5 not included among the original 40) had been constructed from autoclaved, aerated concrete and had less than a decade left as viable buildings and would also need to replaced – possibly at the expense of some other hospitals initially chosen. 

Meanwhile, 123 trusts had put in considerable staff time or consultancy spend to be one of the additional 8, but were turned down. Barclay was then unashamedly unapologetic. 

In 2020, it was reported that most of the “new hospitals” would in fact just be a consolidation on existing sites.

It was also widely reported in 2021 that NHS England had ordered NHS hospitals to refer to any refurbishments, new wards, or new units on existing hospital sites as “new hospitals,” in a desperate attempt to hit the target of 40.

That same year, the Government’s own Infrastructure and Projects Authority said on the record, as reported in the Health Service Journal, that the Programme had been given a “red” risk rating because of serious concerns about leadership, timescales, and resourcing after two separate reviews.

Meanwhile, existing planned new builds at Liverpool and Sandwell had come to a halt when PFI contractor, Carillion had gone bust. And when the building recommenced, sections of shoddy work had to be re-done by new contractors. 

Meanwhile, reports by the Health Foundation have shown that the UK only spends about half the OECD average on capital expenditure for buildings and equipment. This is reflected in the NHS having for instance fewer scanners per capita than most developed nations and in the parlous condition of much of our ageing hospital estate or the infrastructure designed to support and enable clinical staff.  Capital budgets have often been raided to prop up revenue and keep services afloat. But it is a false economy. 

Examples abound throughout the NHS of leaking or collapsing rooves, flooded corridors, buildings no longer fit for purpose for modern health care delivery or infection control and temporary solutions via prefabs or ceiling jacks. 

The government then compounded all this by announcing urgent and elective care recovery plans with lots more building in the form of community diagnostic hubs or additional urgent care centres on hospital sites. Again, the detail was lacking. 

The Government’s Scandalous ‘40 New Hospitals’ Pledge Exposed

Consultant David Oliver explains how Boris Johnson’s lies continue to have a devastating impact on the infrastructure of healthcare in the UK 

David Oliver

The NAO Report

So what does the NAO report make of all this? 

It was clear that yes indeed the NHS estate and equipment is in dire need of investment, overhaul and upgrade and that it will take far more than a small and arbitrary number of new builds. That we are in no way on schedule to deliver those 40 new hospitals. And that 7 new hospitals originally chosen but then dropped from the programme have been given no clear justification and that the reasoning has not been made public or transparent. There was, it concluded “a failure in record keeping” that made it impossible to know how hospitals were chosen. The NAO said that;

“Until 2023, DHSC was unable to secure agreement from the Major Projects Review Group about NHP’s approach to building future hospitals and the scale of capital funding it would need for the programme’s crucial last six years, when most new hospitals are to be delivered. It is unsurprising that when government finally took decisions, it required major changes to NHP’s scope”

The next government will inherit this unholy mess and several more years of neglect and depreciation. 

What is Wrong with This Government’s Approach

This whole sorry saga is a perfect example of all that is wrong with the Conservative government’s stewardship of the NHS and it’s complete failure to adhere to the Nolan Principles for holder of public Office. NHS England, notionally an executive, non-departmental body with a clear separation from the Department of Health and Social Care, has been sadly complicit and unchallenging. 

Boris Johnson et al were only interested in soundbites, grandstanding rhetoric and big but arbitrary numbers (just as they had been with pledges on more nurses or police officers or Covid-19 testing or PPE). 

There seemed to be no attempt to look at the real scale of the capital underinvestment and the amount of money needed to transform the NHS estate and equipment across acute, community and mental health care (and not just secondary care hospitals – which were pretty much the only sites chosen). There was no credible risk assessment or logistical plan or realism in the times scale. 

Worse than this utter incompetence in charge of a major public asset, they then blatantly misled the public about upgrades or add-ons to existing hospitals being “new builds” and mounting a comms operation to ensure that NHS leaders colluded in the big lie. 

They failed to deliver what they promised. And showed zero remorse for this or for the amount of futile work they had imposed on already overstretched NHS managers. 

Most of all, the situation we now find ourselves in is because of years of neglect of the NHS estate by the Government until things came to such a head that doing nothing was no longer an option. 

If you want an example of why they are unfit to be in charge of the NHS, then look no further than the New Hospitals Programme