Government urged to invest in hospital infrastructure to prevent backlog from worsening

It is “extremely unlikely” that the government will meet its target of completing the New Hospital Programme by 2030, according to a new report by the National Audit Office.

The report reveals that the government is expected to deliver just 32 out of 40 intended new hospitals, and the maintenance backlog currently sits at £10.2 billion.

The NHS Confederation says delays to building or refurbishing hospitals means trusts are having to find additional money for ongoing maintenance issues, adding more pressure on finance departments which are already “stretched to the limit”.

“Our members tell us that the maintenance backlog continues to be a significant challenge, impacting productivity and their ability to deliver the transformation required, hindering their progress in reducing the elective backlog and rendering some areas as unusable,” said Matthew Taylor, chief executive of the NHS Confederation.

Why are new hospitals needed?

Around 43% of NHS estate was built before 1985, and now, many of the buildings are at risk of collapse.

Seven hospitals are known to be structurally unsound, and 41 buildings at 23 hospitals trusts contain Reinforced Autoclaved Aerated Concrete (RAAC) – an aerated lightweight material with no coarse aggregate.

This material was used widely after the war, but it is now thought to be “life-expired and liable to collapse”, particularly if it has not been maintained.

To tackle this issue, in 2019, the Department of Health and Social Care created a Health Infrastructure Plan (HIP) which aimed to modernise the NHS estate.

Under the plans, the government said it would build 27 new hospitals by 2030. Then, in 2020, the government expanded the scheme to build 40 new hospitals during the same time frame.

The government had previously agreed to reconstruct a further eight hospitals outside of these plans, which meant a total portfolio of 48 ‘new’ hospitals (i.e. completely new, rebuilds of existing major new buildings and major refurbishments) by 2030.

However, the government is only expected to deliver 32 of these hospitals. Excluding the eight pre-existing schemes, the NAO’s analysis reveals that just 11 (34%) represent whole new hospitals, with another 20 meeting other elements of DHSC’s definition, while one scheme does not meet the definition.

The NAO are now calling on the Department of Health and Social Care, NHS England and the government more widely to:

• Ensure announcements about major capital programmes extending over more than one spending review period fully reflect known uncertainties
• Ensure DHSC chooses future hospital construction projects transparently and keeps full records
• Avoid further bunching of construction schemes
• Ensure NHP reconsiders assumptions that may result in ‘minimum viable product’ future hospitals being too small.

Greg Davies, the head of NAO said: “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 so far. These include strengthening the business case process to improve confidence on affordability and delivery dates, and improving transparency for key decisions.”

NHS would be in a better position if government had invested in infrastructure earlier

Nuffield Trust Chief Executive Nigel Edwards said the government’s “big” and “vague” plan to build 40 new hospitals was destined to fail as there was never enough money to be able to deliver the scale of construction that they wanted to.

“From the start, the definitions have been confusing, and while there has been a substantial amount of rebuilding and development, many of the projects are not entirely new hospitals on new sites.

“It is extremely unlikely that ministers will meet their target of completing the programme by 2030, and the NAO report adds even more doubt, especially given how slowly this ailing programme has been progressing so far,” he added.

Mr Edwards says that NHS would be in a far better position now if the government had decided to invest more in hospital infrastructure a decade ago.

“Letting hospital buildings languish for this long has meant that the high priority critical list for repairs has ballooned. And instead of being able to make informed choices about where to invest taxpayers’ money in the best care for the future, we’re in a position of needing to spend money on whichever hospital is most dangerous or most likely to fall apart,” he said.