Set up by the Johnson Government in 2019, to much fanfare, the New Hospitals Programme (NHP) was to fulfil the then Government’s manifesto commitment. It combined eight hospital building projects that were already under construction or pending final approval with the pledge for 40 more, which were to be completed between 2021 and 2030. Since then, the programme has been beset by delay and uncertainty.
The then Department of Health and Social Care said the total cost of delivering the schemes had been estimated at significantly over £20 billion, but only £3.7 billion had been allocated up to 2024/2025. This commitment arose amid a £11 billion maintenance backlog within the wider NHS estate not addressed by the Programme.
Review
After the July 2024 election, the new Government appointed Ara Darzi (Baron Darzi of Denam) to undertake an independent review into the performance of the NHS in England, with the aim of putting the NHP onto what is seen as a realistic, deliverable and affordable footing. The scope included hospitals in the NHP without full business case approvals for their main build phase.
Nearly six months have passed by since the election where the new Labour Government committed to undertake a review of the previous administration’s flagship NHP for England and provide a through and realistic and costed timetable for delivery.
This is against the backdrop of the Infrastructure and Projects Authority annual report upon the NHP which The Secretary of State for Health and Social Care Wes Streeting summarises as: ‘There are major issues with project definition, schedule, budget, quality and or benefit delivery which at this stage do not appear to be manageable or resolvable. The project may need rescoping and or its overall viability reassessed.’
Government plans
The Government has now announced its plans for the progression of the NHP which will see the staged funding of hospital development, with the most urgent and advanced taking place firstly with the remainder being undertaken in ‘waves’ between 2025 and 2039.
The Secretary of State highlights that the Government’s review of the previous administration’s approach through the National Audit Office shows that no funding has been set aside for future years with ‘the programme built on the shaky foundation of false hope’.
In line with its previous commitment, the Government provides continued support for the urgent remediation of 7 hospitals (Airedale in West Yorkshire, Queen Elizabeth King’s Lynn in Norfolk, Hinchingbrooke in Cambridgeshire, Mid Cheshire Leighton in Cheshire and Frimley Park in Surrey and West Suffolk Hospital in Bury St Edmunds and James Paget Hospital in Norfolk), where reinforced autoclaved aerated concrete (RAAC) had been used in their used in construction. The chancellor, in her October budget committed £1 billion in funding to cover also the backlog of critical maintenance, repairs and upgrade across the National Health Service estate, with a further £1.5 billion investing in new surgical hubs, scanners and beds. Thereafter, the Government commits to 5 yearly waves of investment backed by £15 billion of funding, with each consecutive waves averaging £3 billion per year.
Staged approach
The staged approach will see projects in ‘Wave zero’ which are already in the advanced stages of development and to be completed in the next 3 years. Projects in ‘Wave 1’ will be in construction between 2025 and 2030. This includes the 7 RAAC hospitals.
Projects in ‘Wave 2’ will see construction taking between 2030 and 2035. These include:
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Leicester Royal Infirmary and Glenfield Hospital
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Watford General Hospital
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Specialist Emergency Care Hospital, Sutton
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Kettering General Hospital
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Leeds General Infirmary
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Musgrove Park Hospital, Taunton
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Princess Alexandra Hospital, Harlow
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Torbay Hospital
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Whipps Cross University Hospital, north-east London.
Wave 3 includes 9 schemes which will start construction between 2035 and 2039.
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St Mary’s Hospital, north-west London
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Charing Cross Hospital and Hammersmith Hospital, north-west London
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North Devon District Hospital, Barnstaple
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Eastbourne District General, Conquest Hospital and Bexhill Community Hospital
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Hampshire Hospitals
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Royal Berkshire Hospital, Reading
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Royal Lancaster Infirmary
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Royal Preston Hospital
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Queen’s Medical Centre (QMC) and Nottingham City Hospital.
Framework for construction
The Secretary of State in his announcement confirmed that the Government will shortly announce a new framework for the construction of the new schemes. This will bring forwards a different way of contracting, working partnership with industry, with the aim of mitigating costs scheduling and delivery risks and saving money through a standardised design approach (Hospitals 2.0), with the intention of speeding up the opening of new hospitals.
This reprioritisation, together with rising costs of building materials, the programme for delivery of some hospital projects has slipped by some way, has resulted in consternation amongst NHS Trusts, particularly those which now find themselves within Waves 2 and 3 where planning permission has been obtained for new development and significant range enabling works have been undertaken. In some cases, significant areas of cleared land await development and could remain so for some considerable time.
Not only are aspects of the NHP delayed but also there are significant knock- on implications for schemes where wider organisation and regeneration of the hospital estate and wider locality were envisaged, including the investment decisions associated with these. The delay is likely to raise particular questions for grants of planning permission and the prolonged timescale for implementation and detailing of schemes with Hospitals 2.0 in mind and the good planning of the public realm within which those hospitals sit.
The Government’s announcement is likely to have far reaching implications for healthcare development for Trusts located around England. The planning sector looks to respond effectively to meet the challenge.
Jonathan Standen is a Planning Director with Lichfields and planning advisor to leading healthcare projects in England.
