New Hospital Programme

Public Accounts Committee Closed Inquiry
Opened: 20 Jul 2023 Closed: 8 Mar 2024 Parliament page
The New Hospital Programme was set up in 2020 to build 40 new hospitals in England by 2030. It has £3.7 billion in capital funding for this for up to March 2025, with more to be provided for the following five years. The Programme is also intended to transform how … Read more
1 Recommendation
41 Conclusions
1 Report
1 Oral session
2 Letters
1 Event
Activity timeline 5 events
8 Mar
2024
Report published
26 Feb
2024
Correspondence
17 Nov
2023
Report published
16 Oct
2023
Correspondence
7 Sep
2023
Oral evidence
Oral evidence sessions 1 session
7 Sep 2023
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New Hospitals Programme
Amanda Pritchard · NHS England Julian Kelly · NHS England Natalie Forrest · Department of Health and Social Care Professor Sir Stephen Powis · NHS England Shona Dunn · Home Office
Title HC No. Published Items Response
First Report - The New Hospital Programme HC 77 17 Nov 2023 42 Response document linked
Recommendations & Conclusions
42 results
2 Conclusion
First Report - The New Hospital Pr…
DHSC lacks proper records to justify Health Infrastructure Plan scheme selections.
DHSC has failed in one of its most basic duties by keeping no proper record to justify its final selection of schemes for the programme. DHSC and NHS England officials carried out an assessment exercise which recommended 20 schemes for … Read more
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3 Conclusion
First Report - The New Hospital Pr…
Revise DHSC's RAAC crisis management plans, expediting surveys and replacement hospital construction.
Recent events have shown that DHSC will need to go faster with its efforts to deal with reinforced autoclaved aerated concrete (RAAC) in hospitals. The hospitals named in the government’s October 2020 announcement of NHP included only two entirely constructed … Read more
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4 Conclusion
First Report - The New Hospital Pr…
Start construction by 2024 on an early scheme piloting standardised hospital design.
DHSC must quickly complete and test its standardised hospital design to avert further delays to hospital construction, and to reduce the current high risk of cost and quality issues in years to come. DHSC has taken too long to get … Read more
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5 Recommendation
First Report - The New Hospital Pr…
Amend Hospital 2.0 design to prevent undersized hospitals and assess national capacity.
DHSC is at risk of locking in a standard design that will result in future hospitals being too small, which could lead to significantly greater expenditure and disruption in the long run. The version of Hospital 2.0 that DHSC used … Read more
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6 Conclusion
First Report - The New Hospital Pr…
Agree explicitly on funding for delayed hospital schemes and realistic programme costs.
There appears to be insufficient funding for DHSC to build all the hospitals it plans, and to an adequate size, by 2030. HM Treasury initially allocated £3.7 billion to NHP for the period up to the end of 2024–25 with … Read more
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7 Conclusion
First Report - The New Hospital Pr…
Develop strategy for attracting and retaining civil service skills for hospital construction.
The Programme is over-reliant on consultancy services. NHP has depended heavily on external consultants since its creation, with 62% of posts filled using consultancy services in February 2023. DHSC estimates it will spend a further £842 million on consultancy services … Read more
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8 Conclusion
First Report - The New Hospital Pr…
Safeguard planned capital investment from diversion to meet day-to-day spending needs.
The raiding of capital budgets in the recent past is an underlying cause of the estates crisis the NHS is now in. As this Committee has highlighted several times, DHSC has for some years focused on short-term financial viability in … Read more
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1 Conclusion
First Report - The New Hospital Pr…
Committee took evidence on the New Hospital Programme from DHSC and NHS England.
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (DHSC) and NHS England about the New Hospital Programme (NHP).1
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9 Conclusion
First Report - The New Hospital Pr…
DHSC delayed in creating standardised hospital design and approval processes.
DHSC claims that its plans to standardise approvals processes and that hospital design will reduce the time taken to build a hospital from as much as 11 years to about six. We asked whether there was a case for rebuilding … Read more
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10 Conclusion
First Report - The New Hospital Pr…
DHSC's confidential hospital construction schedule indicates extensive simultaneous building by 2030.
After the evidence session, DHSC provided us with its current detailed schedule showing the approval and construction stages for each scheme to be completed by 2030. DHSC told us that this would be subject to detailed re-planning which is underway … Read more
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11 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme's cost and time saving estimates for standard design are very ambitious.
DHSC aims to improve the cost-effectiveness and quality of new hospitals by standardising hospital design, including the business case process, and making increased use of modern methods of construction.19 Many traditional hospital construction schemes suffered from cost overruns and delays, … Read more
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12 Conclusion
First Report - The New Hospital Pr…
NHP's Hospital 2.0 standard design development is significantly behind schedule, now expected May 2024.
In practice, these future time and cost savings also need to be set against the time and cost taken to develop the new approach and additional costs as a result of inflation while schemes wait to proceed. The Infrastructure and … Read more
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13 Conclusion
First Report - The New Hospital Pr…
Insisting on unproven Hospital 2.0 designs for urgent RAAC hospital rebuilds by 2030 is questionable.
Among DHSC’s other commitments, the need to rebuild the seven RAAC hospitals by 2030 is particularly pressing. RAAC hospitals are costing taxpayers a lot of money as remedial measures are taken to keep them safe and open.24 In this context, … Read more
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14 Conclusion
First Report - The New Hospital Pr…
DHSC remains reluctant to conduct rigorous real-life testing of the Hospital 2.0 design.
More generally, we asked DHSC whether it should commit to first building one hospital according to Hospital 2.0 designs in order to discover its viability in practice, the true scope for cost and time savings, and problems and snags that … Read more
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15 Conclusion
First Report - The New Hospital Pr…
Require the New Hospital Programme to conduct comprehensive live clinical testing of Hospital 2.0 designs.
Before the evidence session, we visited a “super hospital” project in Denmark. The Danes had built a prototype of a new operating theatre on the edge of an existing hospital and each surgical team was given access to it so … Read more
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16 Conclusion
First Report - The New Hospital Pr…
Hospital 2.0 Minimum Viable Product assumptions are unrealistic, risking undersized hospitals for future needs.
With the aim of minimising costs while still meeting its programme objectives, the NHP team has been focusing on a basic version of Hospital 2.0, known as the ‘minimum viable product’ (MVP). Under MVP, hospitals will have the minimum viable … Read more
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17 Conclusion
First Report - The New Hospital Pr…
NHS Providers warn Hospital 2.0's 95% bed occupancy assumption is unsustainable and unsafe.
In written evidence to us, NHS Providers advised that the standardised design had to be sufficiently future-proofed to handle changes in demand, practice and public expectations. It was concerned that future planned bed occupancy levels should be safe, and warned … Read more
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18 Conclusion
First Report - The New Hospital Pr…
DHSC promises rigorous review of Minimum Viable Product assumptions, despite potential affordability issues.
We challenged DHSC about the realism of the MVP assumptions, particularly in the context of a growing and aging population, and asked if it would review them. DHSC told us that these were baseline assumptions, enabling like-for-like comparisons to be … Read more
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19 Conclusion
First Report - The New Hospital Pr…
NHS England confirms single room wards require significant changes in staff mix and numbers.
We asked NHS England whether it was concerned about the assumptions and if switching to wards with single rooms only was safe. It told us that it was working with the NHP team and that Hospital 2.0 must be fit … Read more
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20 Conclusion
First Report - The New Hospital Pr…
RAAC in hospitals causes severe disruption and clinical risks, impacting patient care.
Reinforced autoclaved aerated concrete (RAAC) is a lightweight building material that was widely used from the 1960s to the 1980s. From the late 1990s, industry bodies warned that it was unlikely to remain structurally sound for more than 30 years … Read more
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21 Conclusion
First Report - The New Hospital Pr…
Initial New Hospital Programme excluded five known RAAC hospitals until 2023 reset.
When the government announced the first 32 new hospitals in October 2020, it included just two hospitals with RAAC throughout (West Suffolk Hospital and James Paget University Hospital).42 Five other hospitals with RAAC throughout that DHSC knew about and wanted … Read more
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22 Conclusion
First Report - The New Hospital Pr…
Government committed to remove RAAC by 2035 with time-limited funding allocation.
NHS England told us that it had set up a separate programme in 2019 to deal with RAAC.44 In 2020, government committed to remove RAAC from the NHS estate by 2035, subsequently allocating £685 million for RAAC management and remediation … Read more
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23 Conclusion
First Report - The New Hospital Pr…
More RAAC buildings likely, straining limited specialist engineering resources across government.
After the RAAC crisis in schools escalated in August 2023 and the Institution of Structural Engineers’ guidance was updated, NHS England asked all NHS trusts to confirm they were confident that all RAAC buildings had been identified. At the time … Read more
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24 Conclusion
First Report - The New Hospital Pr…
Future funding for RAAC remediation beyond 2024-25 remains uncertain despite 2030 eradication goal.
NHS England also provided us with an update on its progress in dealing with known RAAC buildings. At the time we took evidence in September, it told us that there were projects to remove RAAC from the then 24 sites … Read more
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25 Conclusion
First Report - The New Hospital Pr…
Trusts primarily responsible for RAAC risk management, despite some national technical support.
We asked whether NHS trusts were getting adequate help from national bodies given the risks they had to manage. NHS England told use that it was helping trusts to source the right technical support, but trusts themselves were responsible for … Read more
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26 Conclusion
First Report - The New Hospital Pr…
Replacing seven high-cost RAAC hospitals by 2030 poses significant challenge and closure risk.
The seven RAAC hospitals each has a replacement cost estimated at between £500 million and £1.5 billion.57 NHP intends to build all seven RAAC replacement hospitals by 2030 using its standard Hospital 2.0 design. DHSC and NHS England are prioritising … Read more
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27 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme expanded to 48 schemes, incorporating HIP and pre-existing projects.
DHSC launched a major capital investment programme, the Health Infrastructure Plan (HIP), in 2019. It comprised 27 schemes, all of which joined NHP in 2020. When one of the HIP schemes was split into five separate schemes, the total number … Read more
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28 Conclusion
First Report - The New Hospital Pr…
Lack of documentation for HIP scheme selection severely hindered transparency and NAO scrutiny.
Selection of the 27 HIP schemes was carried out by DHSC and NHS England. NHS England produced a long list of 56 possible schemes, and DHSC reduced this to a shortlist of 20 schemes using clear, evidence-based criteria.63 However, to … Read more
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29 Conclusion
First Report - The New Hospital Pr…
DHSC acknowledges "extremely disappointing" lack of records for past HIP scheme selection process.
We asked DHSC how this serious failure could have occurred and what it was doing about it. DHSC’s Second Permanent Secretary confirmed that there was no record from that time which was “extremely disappointing” and said she had improved record … Read more
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30 Conclusion
First Report - The New Hospital Pr…
Government consistently lacks transparency and evidence in justifying scheme selection, fueling political bias concerns.
We have previously expressed concern about a lack of evidence and transparency to justify scheme selection in other parts of government.67 In our 2020 report on the Towns Fund, we found that the Ministry of Housing, Communities and Local Government … Read more
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31 Conclusion
First Report - The New Hospital Pr…
Hospitals removed from the shortlist face critical infrastructure risks due to growing maintenance backlog.
We asked witnesses about the implications for the seven schemes that had been removed from the shortlist. For example, it was reported that in August 2023 a ceiling at the hospital in Doncaster collapsed and that there was a risk … Read more
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32 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme, initially \
The Government’s announcement of the New Hospital Programme in October 2020 stated that the 40 listed schemes (cohorts 1 to 4) would be “fully funded”. However, in the 2020 Spending Review, HM Treasury only allocated capital funding of £3.7 billion … Read more
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33 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme's early scheme forecast costs increased by 41%, risking significant overruns.
We have previously reported on many of government’s major projects and, time and again, we have seen difficulties with keeping to budgeted costs.72 This might well be repeated with NHP. Forecast costs for the 18 schemes in cohorts 1 and … Read more
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34 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme's optimistic assumptions risk further cost overruns and insufficient funding for all schemes.
DHSC faces a number of specific pressures that could make cost overruns more likely. If any of the key assumptions underlying the MVP model of Hospital 2.0 prove overly optimistic or detrimental to future healthcare provision, such as the assumed … Read more
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35 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme faces significant commercial risks from construction capacity shortages and high inflation.
The NHP team also has to manage a number of commercial risks to the programme which could impact affordability and deliverability. These include a lack of capacity in the UK construction industry, and the significant investment needed in new factory … Read more
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36 Conclusion
First Report - The New Hospital Pr…
Significant funding \
We highlighted to DHSC that there seemed to be a black hole in the funding allocated compared with what would be required to get all the hospitals in the programme built, and asked whether it was discussing the issue with … Read more
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37 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme aims to build national capability in hospital delivery, using consultants for specific expertise.
NHP is a long-term programme with at least eight of the current schemes now due to complete sometime during the 2030s, as part of what DHSC intends will be a rolling programme.80 One of NHP’s strategic objectives is to build … Read more
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38 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme heavily relies on consultants, consuming 79% of its day-to-day expenditure.
In February 2023, 223 (62%) of the 361 positions in the NHP team were filled by consultants. Consultants outnumbered permanent employees by roughly two to one. Over the period from April 2021 to March 2023, £70 million (79%) of the … Read more
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39 Conclusion
First Report - The New Hospital Pr…
DHSC's future plans contradict reducing consultant reliance, projecting £842 million spend by 2031.
However, DHSC’s actual plans seem to contradict this, indicating an ongoing reliance on external delivery partners to provide professional and technical skills and for specific assignments. It estimates that it will spend £842 million on consultancy services between 2023–24 and … Read more
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40 Conclusion
First Report - The New Hospital Pr…
DHSC's neglect of long-term NHS sustainability led to a record maintenance backlog.
This committee has highlighted many times in the years since 2016 that DHSC has focused on short-term survival of NHS services, while neglecting long-term sustainability, 78 Qq 49–51 79 Q 94 80 Q 91; C&AG’s Report, para 4.2 81 C&AG’s … Read more
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41 Conclusion
First Report - The New Hospital Pr…
Under-investment in NHS capital impedes productivity and compromises modern healthcare environment standards.
In written evidence, the NHS Confederation also highlighted to us that the NHS was suffering because of the under-investment in capital. It said this was hampering productivity and efficiency at a time when record numbers of adults were unable to … Read more
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42 Conclusion
First Report - The New Hospital Pr…
New Hospital Programme expected to address approximately one-third of existing NHS maintenance backlog.
We asked DHSC whether NHP would affect the maintenance backlog. DHSC told us that the programme would help to address the backlog because around a third of the reported backlog was at sites that would be redeveloped or replaced by … Read more
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Correspondence 2 letters
26 Feb 2024 Correspondence from Shona Dunn, Second Permanent Secretary, Department of Health and Social Care, re Reinforced Autoclave Aerated Concrete, dated 15 February 2024
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16 Oct 2023 Correspondence from Shona Dunn, Second Permanent Secretary, Department for Health and Social Care, re Public Accounts Committee New Hospital Programme Hearing – 7 September 2023, dated 26 September 2023
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