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40 new hospitals – what’s the real story?

In this blog, we delve deeper into the government’s controversial 40 new hospitals pledge and attempt to get to the bottom of the numbers as well as seeking to understand whether the targets the scheme has set will actually be reached.
Published on
August 25, 2023

Confused about the government’s 40 new hospitals programme? You’re not alone.

Ever since it was announced as a manifesto pledge by the Conservatives in December 2019, it’s been a clear lesson in semantics, misunderstanding and (some would say) smoke and mirrors.

How many of the 40 new hospitals are actually new? How many will be completed by 2030? How much will it actually cost? What about the further eight projects the government said would be funded nationally in 2021?

It’s all quite a lot to get your head around, with the only guarantee being more confusion.

Here, with the help of stats compiled and collated by the HSJ, we attempt to get to the bottom of it.

How do the numbers break down?

  • Of the 40 new hospitals, 7 are RAAC hospitals prioritised to be replaced by 2030. These are hospitals that can’t operate safely beyond 2030.
  • 10 smaller projects, mostly based in the South West, are still aiming to complete by 2030.
  • 12 large projects still aim to complete by 2030, but 8 large projects will be delayed beyond 2030.
  • 8 projects were already being built when the programme started, while 3 mental health facilities that were planned outside the programme are now being counted, apparently to help the government keep their 2030 pledge of 40 new hospitals.

What about the 8 extra hospitals?

In 2021, the New Hospitals Programme (NHP) was expanded when the government invited bids for another eight new hospitals to be funded nationally. Despite this, in May 2023, the government revealed that just five new schemes – all of them acute hospitals with unsafe roof plank structures, according to the HSJ – had been accepted onto the programme.

This came after 128 bids were submitted, meaning 123 were unsuccessful. Many trusts openly voiced their disappointment.

The five new schemes – Airedale General, Queen Elizabeth Hospital King’s Lynn, North West Anglia FT’s Hinchingbrooke Hospital, Mid Cheshire Hospitals FT’s Leighton Hospital, and Frimley Park – are all now being prioritised because they are RAAC hospitals that are deemed unsafe to operate beyond 2030.

How many are already complete?

According to a recently released government media fact sheet on the NHP, 2 schemes are already completed and 5 are under construction. By 2024, it says more than 20 will be underway.

The government says it remains committed to delivering all schemes announced as part of the NHP, which is expected to represent more than £20 billion of investment in new hospital infrastructure.

It also insists it is on track to deliver its manifesto commitment to build 40 new hospitals in England by 2030.

It says all three mental health schemes now being counted as part of the programme – Surrey and Borders NHS Foundation Trust, Derbyshire Healthcare NHS Foundation Trust and Mersey Care Foundation Trust – meet its definition of a new hospital, even though they were already underway before the pledge was made.

Will the target be met?

A report released last month by the National Audit Office (NAO) found that the government is likely to miss its target to build 40 new hospitals by 2030.

According to the spending watchdog, only 32 will be built in time. It said the project had been beset by delays while warning that ‘cost-cutting and inaccurate modelling of future demand could mean new hospitals are too small’.

The NAO claimed the government had used the definition of ‘new’ broadly, including refurbishment of existing buildings as well as completely new hospitals.

Of the 32 that will be built in time, 24 will be from the original new hospitals programme, the body said, along with the five that were added in May 2023, and three new mental health hospitals.

The further eight do not count towards the original definition of ‘new’ because they were already in motion when the commitment was made, the report added.

Are they really new?

The government currently describes its definition of a new hospital as: a major new clinical building on an existing site or a new wing of an existing hospital, or a major refurbishment and alteration of all but the building frame or main structure.

Some would certainly argue this stretches the definition of new. Back in August 2021, the Department of Health and Social Care (DHSC) distributed guidance to NHS trusts on ‘key media lines’ to use when responding to questions about the 40 new hospitals pledge, which defined a ‘new’ hospital in three ways: a whole new hospital on a new site or current NHS land, a major new clinical building on an existing site or a new wing of an existing hospital, or a major refurbishment and alteration of all but the building frame or main structure.

It’s interesting that, in its latest briefing note, ‘a whole new hospital or new site on current NHS land’ has disappeared from the definition.

In November 2021, the BBC emailed every NHS Trust involved in the programme, asking which of the three categories their project fitted into. Of the 34 trusts who responded, just 5 said they were building a whole new hospital. A further 12 said they were building new wings, 9 said they were rebuilding existing hospitals, and others couldn’t say which category they fell into.

Some would argue the wording doesn’t matter as long as hospitals are being improved and rebuilt, but others will bemoan the lack of transparency and clarity.

Others are concerned that the numbers simply don’t add up; they say £20 billion won’t be enough. And with only two hospitals currently constructed, others will question whether the 40 number can realistically be reached by 2030, and whether some of the facilities can even be counted as hospitals in the traditional sense.

There is also frustration from those in the mental health community, who argue mental health is badly under-represented when it comes to the programme. In total, there are only four new mental health schemes within the NHP, and three of these were underway before the manifesto pledge had even been made.

It’s certainly disappointing to see such a small number of mental health schemes being included, especially when the government says it is committed to putting mental health on an equal footing with physical health. What’s more, of the 128 bids for the eight new projects announced in 2021, a significant number were focused on mental health. But none were successful, calling into question the idea of parity between acute and mental health.

The government has said the programme will now become an ongoing, rolling one, allowing further funding bids in the future, but no set timelines have yet been provided for this.

A lot of confusion and uncertainty abounds when it comes to the 40 new hospitals pledge, and it takes a fair bit of brain power to try and work out exactly what is going on. That, if nothing else, is certainly not a great way of creating confidence in a programme.

Still confused by all this? You’re not alone!

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