Government set to fail target of 40 new promised hospitals by 2030, watchdog says

Just 32 of the projects intended to fix NHS buildings are expected to be completed by the end of the decade

A hospital ward (Peter Byrne/PA) (PA Archive)

The government is on track to break a key promise to build 40 new hospitals by 2030, a report by the public spending watchdog has found.

Delays to projects mean the target is unlikely to be met, with work on buildings in the second cohort of the scheme yet to have started as of May, the National Audit Office said.

Critics branded the findings “utterly damning” and accused the government of “woeful progress” despite having tried to “move the goalposts” to meet the deadline.

In May, health secretary Steve Barclay told MPs there had been a change to the hospitals included in the programme owing to the need to urgently deal with some that were in danger of collapse.

Some needed urgent repairs as they had been built with reinforced autoclaved aerated concrete (RAAC), a lightweight material used up to the mid-1980s, he said.

He acknowledged that work may not be completed by 2030 for up to eight of the original group.

The NAO said that the Department of Health and Social Care (DHSC) had adopted a “broad” definition of “new”, including refurbishment of existing buildings as well as completely new hospitals.

By the watchdog’s analysis, 32 hospitals in England classed as new by the definition the government first used are set to be completed in 2030.

In October 2020, the government stated that 32 of the schemes under its New Hospitals Programme (NHP) would count towards the 40 new hospitals commitment, while the other eight projects were already either “in build” or “pending final approval”.

The government explicitly stated it would announce a further new eight schemes also to complete by 2030 in due course, the NAO said.

Using the original definition, the NAO found that changes to the programme announced by DHSC in earlier this year mean that by 2030 the government expects to complete the following:

– Eight pre-existing schemes within NHP, which do not count under the original definition and date back as far as 2010

– 24 new hospitals already within NHP

– Five new hospitals that will replace hospitals that were built using RAAC, and which were announced in May 2023

– Three new mental health hospitals, which were approved, and will be managed, outside of NHP.

In May this year, construction was yet to begin on any in the second wave of building in the programme, including Royal Bournemouth Hospital, Shotley Bridge Hospital in County Durham and Derriford Emergency Care Centre in Plymouth, for which work was expected to start between 2022 and 2024.

Staff shortages mean the design for a standardised hospital has also been delayed and will not be completed until May next year, the NAO said.

There are some important lessons to be drawn... These include strengthening the business case process to improve confidence on affordability and delivery dates, and improving transparency for key decisions

Gareth Davies

The approach to achieving key objectives at the lowest possible cost could also result in hospitals that are too small, according to the watchdog, as modelling assumptions may be unrealistic about the extent to which care in future will be provided outside hospitals.

The government failed to achieve good value for money, with the scheme having cost £1.1 bn by March this year and progress being slower than expected, the report said.

The NAO made several key recommendations, including for announcements about major capital programmes extending over more than one spending review period to “fully reflect known uncertainties”.

It also called for a reconsideration of assumptions that could result in future hospitals being too small.

Gareth Davies, 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.

“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. There are some important lessons to be drawn for major programmes from the experience of the New Hospital Programme (NHP) so far.”

The public deserve answers about how many more delays there will be to the local hospital upgrades and repairs they were promised

Daisy Cooper

Health chiefs said trusts were “deeply disappointed” in the delays while opposition critics demanded Mr Barclay appear in Parliament “immediately” to respond to the findings.

Siva Anandaciva, chief analyst at The King’s Fund think tank, said the report showed the government had missed “several opportunities to give its flagship hospital building programme the resources and momentum it deserved.”

“New hospitals that should have been built under the national programme have been delayed and this has only increased the overall cost to taxpayers,” he said.

Sir Julian Hartley, chief executive of NHS Providers, urged the government to “shift gears” and increase capital investment to overhaul ageing NHS estates.

“Many trusts in the NHP (New Hospital Programme) 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,” he said.

“The government could have better-managed expectations about the funding available, given the uncertainty involved and the impact of inflation.”

Today's NAO report shows government’s woeful lack of progress against its commitment to build 40 new hospitals by 2030. It has failed to even begin construction on any of the new hospitals in its second cohort which it thought were quick wins

Dame Meg Hillier, Public Accounts Committee

MP Dame Meg Hillier, chairwoman of Parliament’s Public Accounts Committee, accused the DHSC of “trying to move the goalposts” so it could claim it had met the target.

“Today’s NAO report shows government’s woeful lack of progress against its commitment to build 40 new hospitals by 2030. It has failed to even begin construction on any of the new hospitals in its second cohort which it thought were quick wins,” she said.

Shadow health secretary Wes Streeting said: “This shocking report could not be more damning of the failing new hospitals programme.

“The Conservatives have overpromised, under-delivered, and they’ve been found out. Meanwhile, patients are being treated in outdated, crumbling hospitals.”

Liberal Democrat deputy leader Daisy Cooper said: “This utterly damning report demolishes the government’s claims to be building 40 ‘new hospitals’.

“People are fed up with the Conservatives repeating empty promises and slogans, while patients are treated in crumbling hospital buildings in urgent need of repair. Steve Barclay must come to Parliament immediately and respond to the findings of this report.”

Despite the report’s findings, a DHSC spokesperson said: “The NAO’s report acknowledges that despite changes to the original programme, 40 new hospitals are still expected to be delivered by 2030 and praises the programme’s innovative plans to standardise hospital construction, deliver efficiencies and improve quality.

“We remain firmly committed to delivering these hospitals, which are now expected to be backed by over £20bn of investment, helping to cut waiting lists so people can get the treatment they need quicker.

“Three new hospitals have already opened and more will open this year so patients and staff can benefit from major new hospital buildings, equipped with the latest technology.”