How to make the New Hospital Programme a success

In July, the newly elected Chancellor of the Exchequer announced a full review of the last government’s pledge to build 40 new hospitals by 2030.

Rachel Reeves said a “thorough, realistic and costed timetable for delivery” is needed. Jane Ansell, Pace’s Head of Healthcare, believes that a focus on total standardisation could also be hindering the programme’s progress. 

Jane Ansell says: “The Hospital 2.0 programme has been pursuing standardisation across both building and future operational elements of the new build and while this may drive down costs, the resulting slow-down of direction and rework continues to increase the fiscal costs on the build, given the current inflation and cost of capital.”  

Unnecessary checkpoints have only increased over the past few years as it became apparent the original £3.7bn budget had been sorely underestimated. According to the National Audit Office, only 32 of the proposed 40 hospitals plus eight RAAC-affected (reinforced autoclaved aerated concrete) hospitals will be completed as originally planned. 

Ansell says: “We’re spending so long trying to standardise the process, it’s slowing everything down. We need to expedite the business cases so they can be assessed more rapidly and building can commence.”  

In addition, with the pursuit of standardisation and the perceived efficiency that may bring, there’s a danger of removing the autonomy and flexibility needed for a successful process. 

Ansell says: “The hospital estate teams really know their hospitals and fully understand the jeopardy associated with the delay to the national programme. Trusts know their patients, understand their changing demographics, the weakness in their estate, and they know what they need to get critical risk resolved.” 

Managing the untenable position they are in – trying to maintain buildings that are not fit for purpose now, let alone for the next 50 years – means they are constantly juggling small-scale capital investment. Regional teams are much closer to the reality trusts are facing and are well placed to better understand population needs to push business cases through at pace, reducing risk and reducing the current need for high-cost, short-term fixes to maintain compliant buildings.    

Further delays, combined with a drive towards complete standardisation, could heighten risks and create a bigger backlog maintenance bill.  

Ansell adds: “We need to ensure that when we build these hospitals, we can actually afford to run them and, as needed as the capital investment is, it doesn’t come with any additional revenue commitment. Creating spaces that can be affordable is a challenge for trusts that have no option but to address their estate’s crisis.”  

To illustrate this, she cites: “There is a Hospital 2.0 requirement to build only single rooms in any new structure. Of course, we expect technology to play its part, helping to monitor patients and feeding alerts and flags to ‘Control Centres’, but the challenge of staffing wards consisting of only single rooms cannot be underestimated in terms of skills availability and the cost to the hospital.” 

If we do not understand and overcome the range of challenges swiftly and get on with the New Hospital Programme at speed, there will be a tsunami of current and approaching issues, leading to greater risk around patient treatment standards being met and safety issues continuing to rise.