Recommendations & Conclusions
42 items
2
Conclusion
First Report - The New Hospital Program…
Accepted
DHSC has failed in one of its most basic duties by keeping no proper record to justify its final selection of schemes for the programme. DHSC and NHS England officials carried out an assessment exercise which recommended 20 schemes for inclusion in the Health Infrastructure Plan (HIP), a 2019 programme …
Government response. The government accepts the omission in record-keeping for past scheme selections but asserts the process was based on clear criteria agreed with multiple bodies. It outlines its regular, existing selection process which follows HM Treasury's Five Case Model.
HM Treasury
3
Conclusion
First Report - The New Hospital Program…
Accepted
Recent events have shown that DHSC will need to go faster with its efforts to deal with reinforced autoclaved aerated concrete (RAAC) in hospitals. The hospitals named in the government’s October 2020 announcement of NHP included only two entirely constructed from RAAC. Five other RAAC hospitals that DHSC knew 6 …
Government response. The government commits to publishing updated RAAC information on Gov.uk, aiming to begin early works for the seven entirely RAAC hospitals by the end of 2025, and will write to the Committee providing the name of the senior NHSE official …
HM Treasury
4
Conclusion
First Report - The New Hospital Program…
Rejected
DHSC must quickly complete and test its standardised hospital design to avert further delays to hospital construction, and to reduce the current high risk of cost and quality issues in years to come. DHSC has taken too long to get its Hospital 2.0 design off the drawing board. It continues …
Government response. The government rejects the recommendation to start construction of a standardised hospital design scheme in 2024, stating that starting construction without sufficient design maturity risks increased time and cost.
HM Treasury
5
Recommendation
First Report - The New Hospital Program…
Acknowledged
DHSC is at risk of locking in a standard design that will result in future hospitals being too small, which could lead to significantly greater expenditure and disruption in the long run. The version of Hospital 2.0 that DHSC used in its business case for NHP, and the basis on …
Government response. The government notes the recommendation, stating it will engage with any future Health and Social Care Committee inquiries and is continuing to review Hospital 2.0 designs with experts to meet local needs, with the next product release expected in May …
HM Treasury
6
Conclusion
First Report - The New Hospital Program…
Accepted
There appears to be insufficient funding for DHSC to build all the hospitals it plans, and to an adequate size, by 2030. HM Treasury initially allocated £3.7 billion to NHP for the period up to the end of 2024–25 with no indication of what further money it would give up …
Government response. The government agrees to continue engaging with the construction industry, including a market event held in November 2023. It intends for the programme business case, due for approval by May 2024, to explicitly include proposed funding for the pre-2030 costs …
HM Treasury
7
Conclusion
First Report - The New Hospital Program…
Accepted
The Programme is over-reliant on consultancy services. NHP has depended heavily on external consultants since its creation, with 62% of posts filled using consultancy services in February 2023. DHSC estimates it will spend a further £842 million on consultancy services between 2023–24 and 203031. Some use of consultancy is to …
Government response. The government commits to writing to the Committee by March 2024, as requested, to outline its strategy for attracting and retaining civil service skills for the NHP. It states it already has a recruitment strategy, is actively recruiting, and is …
HM Treasury
8
Conclusion
First Report - The New Hospital Program…
Acknowledged
The raiding of capital budgets in the recent past is an underlying cause of the estates crisis the NHS is now in. As this Committee has highlighted several times, DHSC has for some years focused on short-term financial viability in ways that failed to consider the long-term consequences for services …
Government response. The government agrees in principle not to reduce planned capital investment, but states it will continue to follow its usual processes for financial decisions, including switching capital budgets in exceptional circumstances, and will make considerations clear as part of Ministerial …
HM Treasury
1
Conclusion
First Report - The New Hospital Program…
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (DHSC) and NHS England about the New Hospital Programme (NHP).1
Government response. The government provides an update on the New Hospital Programme, stating that four hospitals are open, 18 schemes are underway, and it is building capacity by recruiting staff and procuring a programme delivery partner. It is also examining options for …
HM Treasury
9
Conclusion
First Report - The New Hospital Program…
Deferred
DHSC claims that its plans to standardise approvals processes and that hospital design will reduce the time taken to build a hospital from as much as 11 years to about six. We asked whether there was a case for rebuilding some hospitals using traditional methods so that more work could …
Government response. The government states it is examining the possibility of using existing design and contracting approaches for a small number of schemes to accelerate delivery, with final decisions on this to be made by summer 2024.
HM Treasury
10
Conclusion
First Report - The New Hospital Program…
Not Addressed
After the evidence session, DHSC provided us with its current detailed schedule showing the approval and construction stages for each scheme to be completed by 2030. DHSC told us that this would be subject to detailed re-planning which is underway and asked us not to publish the information on the …
Government response. The government provides a generic statement about its commitment to rational decisions and balancing information protection, but does not address the committee's specific concerns about the feasibility of the construction schedule or contractor capacity.
HM Treasury
11
Conclusion
First Report - The New Hospital Program…
Rejected
DHSC aims to improve the cost-effectiveness and quality of new hospitals by standardising hospital design, including the business case process, and making increased use of modern methods of construction.19 Many traditional hospital construction schemes suffered from cost overruns and delays, which the NHP team believes it can reduce through a …
Government response. The government disagrees with the committee's implicit recommendation, reaffirming its commitment to test Hospital 2.0, its standardised approach, starting with RAAC schemes, while undertaking deep dive reviews and developing prototyping facilities from late 2024.
HM Treasury
12
Conclusion
First Report - The New Hospital Program…
Rejected
In practice, these future time and cost savings also need to be set against the time and cost taken to develop the new approach and additional costs as a result of inflation while schemes wait to proceed. The Infrastructure and Projects Authority recommended that the NHP team should complete its …
Government response. The government disagrees with the committee's implicit recommendation regarding delays, stating it will test Hospital 2.0 with RAAC schemes, acknowledging construction is unlikely to start in 2024 but highlighting ongoing design and prototyping work for late 2024.
HM Treasury
13
Conclusion
First Report - The New Hospital Program…
Deferred
Among DHSC’s other commitments, the need to rebuild the seven RAAC hospitals by 2030 is particularly pressing. RAAC hospitals are costing taxpayers a lot of money as remedial measures are taken to keep them safe and open.24 In this context, insisting on using Hospital 2.0 designs for all seven schemes …
Government response. The government is examining the possibility of progressing a small number of schemes, including RAAC hospitals, using traditional design and contracting methods, with decisions expected by summer 2024, while also intending to test Hospital 2.0 within RAAC schemes.
HM Treasury
14
Conclusion
First Report - The New Hospital Program…
Rejected
More generally, we asked DHSC whether it should commit to first building one hospital according to Hospital 2.0 designs in order to discover its viability in practice, the true scope for cost and time savings, and problems and snags that could be removed, before the design is repeated across multiple …
Government response. The government disagrees with the recommendation for a single pilot hospital, stating it will test Hospital 2.0 within RAAC schemes and further develop designs through established prototyping facilities from late 2024, prior to construction.
HM Treasury
15
Conclusion
First Report - The New Hospital Program…
Rejected
Before the evidence session, we visited a “super hospital” project in Denmark. The Danes had built a prototype of a new operating theatre on the edge of an existing hospital and each surgical team was given access to it so they could test how it worked in practice. Using the …
Government response. The government disagrees with the recommendation for similar live clinical exercises, stating it will test Hospital 2.0 within RAAC schemes and use prototyping facilities from late 2024 to engage clinicians and manufacturers in improving designs and aiding training.
HM Treasury
16
Conclusion
First Report - The New Hospital Program…
Accepted
With the aim of minimising costs while still meeting its programme objectives, the NHP team has been focusing on a basic version of Hospital 2.0, known as the ‘minimum viable product’ (MVP). Under MVP, hospitals will have the minimum viable set of services, in the minimum viable building size, built …
Government response. The government agrees that future hospitals must be the right size, committing to keep assumptions under constant review, working with NHSE to develop long-term infrastructure modelling, and creating a bottom-up assessment model with local stakeholders.
HM Treasury
17
Conclusion
First Report - The New Hospital Program…
Accepted
In written evidence to us, NHS Providers advised that the standardised design had to be sufficiently future-proofed to handle changes in demand, practice and public expectations. It was concerned that future planned bed occupancy levels should be safe, and warned that 95% occupancy “may not be sustainable” and might not …
Government response. The government agrees that future hospitals must be the right size, committing to keep assumptions under constant review and working jointly with NHSE and local bodies to model long-term infrastructure needs and ensure future expansion capability.
HM Treasury
18
Conclusion
First Report - The New Hospital Program…
Accepted
We challenged DHSC about the realism of the MVP assumptions, particularly in the context of a growing and aging population, and asked if it would review them. DHSC told us that these were baseline assumptions, enabling like-for-like comparisons to be made between schemes, and that it was going through a …
Government response. The government accepts the recommendation, stating it will keep hospital size assumptions under constant review. It details work underway with NHS England to develop modelling, put forward program scope options by May 2024, and create a bottom-up model with trusts …
HM Treasury
19
Conclusion
First Report - The New Hospital Program…
Accepted
We asked NHS England whether it was concerned about the assumptions and if switching to wards with single rooms only was safe. It told us that it was working with the NHP team and that Hospital 2.0 must be fit for purpose and thoroughly tested. It also wanted services in …
Government response. The government, despite the item being a conclusion, states it 'agrees with the Committee’s recommendation' and is implementing it. It commits to keeping hospital size assumptions under constant review and details work with NHS England on modelling, business case options …
HM Treasury
20
Conclusion
First Report - The New Hospital Program…
Accepted
Reinforced autoclaved aerated concrete (RAAC) is a lightweight building material that was widely used from the 1960s to the 1980s. From the late 1990s, industry bodies warned that it was unlikely to remain structurally sound for more than 30 years after construction. NHS England became aware of its problem with …
Government response. The government confirms the New Hospital Programme now includes the replacement of all seven RAAC hospitals, with early works to prepare sites beginning by the end of 2025, and existing hospitals remaining safe through ongoing monitoring. The department will assess …
HM Treasury
21
Conclusion
First Report - The New Hospital Program…
Accepted
When the government announced the first 32 new hospitals in October 2020, it included just two hospitals with RAAC throughout (West Suffolk Hospital and James Paget University Hospital).42 Five other hospitals with RAAC throughout that DHSC knew about and wanted to replace were not then included in the Programme. These …
Government response. The government confirms that following a program reset in May 2023, the New Hospital Programme now includes the replacement of all seven RAAC hospitals, detailing ongoing monitoring, mitigation, and plans for early works by the end of 2025, with further …
HM Treasury
22
Conclusion
First Report - The New Hospital Program…
Acknowledged
NHS England told us that it had set up a separate programme in 2019 to deal with RAAC.44 In 2020, government committed to remove RAAC from the NHS estate by 2035, subsequently allocating £685 million for RAAC management and remediation for the period up to 2024–25.45 This has been supplemented …
Government response. The government acknowledges its commitment to eradicate RAAC by 2035, stating this will remain under review. It notes ongoing work to rebuild affected hospitals and assesses financial implications, with future funding needs beyond 2024-25 to be addressed in subsequent Spending …
HM Treasury
23
Conclusion
First Report - The New Hospital Program…
Accepted
After the RAAC crisis in schools escalated in August 2023 and the Institution of Structural Engineers’ guidance was updated, NHS England asked all NHS trusts to confirm they were confident that all RAAC buildings had been identified. At the time of our evidence session, NHS England thought it likely that …
Government response. The government commits to continuing to work with NHS Trusts to expedite RAAC surveys where possible and will continue to publish and update information on confirmed RAAC within the NHS on Gov.uk.
HM Treasury
24
Conclusion
First Report - The New Hospital Program…
Deferred
NHS England also provided us with an update on its progress in dealing with known RAAC buildings. At the time we took evidence in September, it told us that there were projects to remove RAAC from the then 24 sites where it had a full understanding of the issues. It …
Government response. The government, despite stating 'recommendation implemented', confirms that funding needs for RAAC mitigation and eradication beyond 2024-25 will inform bids at subsequent Spending Reviews, thus deferring a definitive commitment. It also commits to writing to the Committee with an assessment …
HM Treasury
25
Conclusion
First Report - The New Hospital Program…
Acknowledged
We asked whether NHS trusts were getting adequate help from national bodies given the risks they had to manage. NHS England told use that it was helping trusts to source the right technical support, but trusts themselves were responsible for managing their estate and the risks within it.55 Trusts were …
Government response. The government, despite stating 'recommendation implemented', broadly outlines ongoing work with NHS Trusts to expedite RAAC surveys and publish information. It doesn't specifically address the committee's observation on the adequacy of help provided to trusts, beyond implying continued support through …
HM Treasury
26
Conclusion
First Report - The New Hospital Program…
Accepted
The seven RAAC hospitals each has a replacement cost estimated at between £500 million and £1.5 billion.57 NHP intends to build all seven RAAC replacement hospitals by 2030 using its standard Hospital 2.0 design. DHSC and NHS England are prioritising NHP schemes above other kinds of capital investment and recognise …
Government response. The government, despite the item being a conclusion, states 'recommendation implemented' and commits to beginning early works to prepare sites for the seven RAAC replacement hospitals by the end of 2025. It also reiterates the commitment to eradicate RAAC by …
HM Treasury
27
Conclusion
First Report - The New Hospital Program…
Acknowledged
DHSC launched a major capital investment programme, the Health Infrastructure Plan (HIP), in 2019. It comprised 27 schemes, all of which joined NHP in 2020. When one of the HIP schemes was split into five separate schemes, the total number grew to 31. An additional scheme (Shotley Bridge Hospital) was …
Government response. The government acknowledges the committee's summary by providing background on the deteriorating NHS estate, the commitment to build 40 new hospitals by 2030, and the establishment and funding of the New Hospital Programme to address these issues.
HM Treasury
28
Conclusion
First Report - The New Hospital Program…
Accepted
Selection of the 27 HIP schemes was carried out by DHSC and NHS England. NHS England produced a long list of 56 possible schemes, and DHSC reduced this to a shortlist of 20 schemes using clear, evidence-based criteria.63 However, to arrive at that 27 schemes that were announced, DHSC included …
Government response. The government accepts the recommendation, acknowledging a past omission in record-keeping for HIP scheme selections. It commits to ensuring its practices result in rational decisions with appropriate documentation and will be able to provide evidence on future decision outcomes, balanced …
HM Treasury
29
Conclusion
First Report - The New Hospital Program…
Accepted
We asked DHSC how this serious failure could have occurred and what it was doing about it. DHSC’s Second Permanent Secretary confirmed that there was no record from that time which was “extremely disappointing” and said she had improved record keeping in DHSC and hoped a similar omission would not …
Government response. The government accepts the implicit recommendation for improved record-keeping and transparency in major capital program selections, acknowledging a past omission. It commits to ensuring future practices allow for providing evidence on decision outcomes, while balancing this with the need to …
HM Treasury
30
Conclusion
First Report - The New Hospital Program…
Accepted
We have previously expressed concern about a lack of evidence and transparency to justify scheme selection in other parts of government.67 In our 2020 report on the Towns Fund, we found that the Ministry of Housing, Communities and Local Government was not open about the process it followed and did …
Government response. The government accepts the overarching concern about transparency in scheme selection processes, acknowledging a past omission in record-keeping. It commits to ensuring future practices allow for providing evidence on decision outcomes, balanced against protecting sensitive information, thereby addressing the underlying …
HM Treasury
31
Conclusion
First Report - The New Hospital Program…
Accepted
We asked witnesses about the implications for the seven schemes that had been removed from the shortlist. For example, it was reported that in August 2023 a ceiling at the hospital in Doncaster collapsed and that there was a risk of the facility closing. NHS England told us that the …
Government response. The government states it is providing record capital funding to the NHS and that decisions to switch capital budgets are only made in exceptional circumstances, following usual processes. It commits to providing more certainty for NHS capital through rolling investment …
HM Treasury
32
Conclusion
First Report - The New Hospital Program…
Accepted
The Government’s announcement of the New Hospital Programme in October 2020 stated that the 40 listed schemes (cohorts 1 to 4) would be “fully funded”. However, in the 2020 Spending Review, HM Treasury only allocated capital funding of £3.7 billion to the NHP for the four years up to 202425; …
Government response. The government agrees that NHP plans and costs should be realistic and deliverable, stating it has provided clarity on funding and is developing a third version of the programme business case for approval by May 2024 to confirm funding for …
HM Treasury
33
Conclusion
First Report - The New Hospital Program…
Accepted
We have previously reported on many of government’s major projects and, time and again, we have seen difficulties with keeping to budgeted costs.72 This might well be repeated with NHP. Forecast costs for the 18 schemes in cohorts 1 and 2 increased by 41% between 2020 and 2023.73
Government response. The government agrees NHP plans and costs should be realistic and deliverable, highlighting actions like providing clearer funding, engaging with the construction industry, and developing a new programme business case for approval by May 2024 to manage costs and secure …
HM Treasury
34
Conclusion
First Report - The New Hospital Program…
Accepted
DHSC faces a number of specific pressures that could make cost overruns more likely. If any of the key assumptions underlying the MVP model of Hospital 2.0 prove overly optimistic or detrimental to future healthcare provision, such as the assumed 95% bed occupancy rate, then NHP may require more funding …
Government response. The government agrees that NHP plans and costs should be realistic, stating it is keeping assumptions under constant review and will include specific funding for pre-2030 costs of schemes completing after 2030 within the new programme business case, due for …
HM Treasury
35
Conclusion
First Report - The New Hospital Program…
Accepted
The NHP team also has to manage a number of commercial risks to the programme which could impact affordability and deliverability. These include a lack of capacity in the UK construction industry, and the significant investment needed in new factory capacity for modular, offsite construction. High inflation in the construction …
Government response. The government agrees that NHP plans and costs should be realistic and commits to continuing engagement with the construction industry through an extensive market engagement strategy to understand and manage capacity constraints and other commercial risks.
HM Treasury
36
Conclusion
First Report - The New Hospital Program…
Accepted
We highlighted to DHSC that there seemed to be a black hole in the funding allocated compared with what would be required to get all the hospitals in the programme built, and asked whether it was discussing the issue with HM Treasury. DHSC told us that it had frequent discussions …
Government response. The government agrees that NHP plans and costs should be realistic, and is developing a third programme business case for approval by May 2024 to secure and confirm funding, including for schemes completing after 2030, thereby addressing the committee's concern …
HM Treasury
37
Conclusion
First Report - The New Hospital Program…
Accepted
NHP is a long-term programme with at least eight of the current schemes now due to complete sometime during the 2030s, as part of what DHSC intends will be a rolling programme.80 One of NHP’s strategic objectives is to build national capability in planning and delivering new hospitals. This is …
Government response. The government acknowledges the NHP requires significant expertise and is actively recruiting into key internal roles while also procuring a programme delivery partner for specific external expertise, with the aim to potentially replace some external resources with directly employed individuals …
HM Treasury
38
Conclusion
First Report - The New Hospital Program…
Accepted
In February 2023, 223 (62%) of the 361 positions in the NHP team were filled by consultants. Consultants outnumbered permanent employees by roughly two to one. Over the period from April 2021 to March 2023, £70 million (79%) of the NHP’s total day- to-day expenditure went on consultancy services.83 DHSC …
Government response. The government acknowledges the high reliance on consultants, stating it is actively recruiting for internal roles and plans to transition to a model where external resources are eventually replaced by directly employed individuals as the programme matures, supported by a …
HM Treasury
39
Conclusion
First Report - The New Hospital Program…
Accepted in Part
However, DHSC’s actual plans seem to contradict this, indicating an ongoing reliance on external delivery partners to provide professional and technical skills and for specific assignments. It estimates that it will spend £842 million on consultancy services between 2023–24 and 2030–31, which represents 75% of its total day-to-day expenditure for …
Government response. The government acknowledges the need for external expertise and the ongoing role of a programme delivery partner, but states it is actively recruiting for internal roles with a view that some external resources may eventually be replaced by directly employed …
HM Treasury
40
Conclusion
First Report - The New Hospital Program…
Accepted
This committee has highlighted many times in the years since 2016 that DHSC has focused on short-term survival of NHS services, while neglecting long-term sustainability, 78 Qq 49–51 79 Q 94 80 Q 91; C&AG’s Report, para 4.2 81 C&AG’s Report, paras 3.17 and 3.19 82 Q 109 83 Q …
Government response. The government states it is providing record capital funding to the NHS and that decisions to switch capital budgets are only made in exceptional circumstances, following usual processes for Ministerial advice and HM Treasury approval. It commits to providing more …
HM Treasury
41
Conclusion
First Report - The New Hospital Program…
Acknowledged
In written evidence, the NHS Confederation also highlighted to us that the NHS was suffering because of the under-investment in capital. It said this was hampering productivity and efficiency at a time when record numbers of adults were unable to work owing to ill health and progress needed to be …
Government response. The government acknowledged the Committee's findings on under-investment in NHS capital, stating it provides record amounts of capital and is committed to providing more certainty through rolling investment programmes.
HM Treasury
42
Conclusion
First Report - The New Hospital Program…
Acknowledged
We asked DHSC whether NHP would affect the maintenance backlog. DHSC told us that the programme would help to address the backlog because around a third of the reported backlog was at sites that would be redeveloped or replaced by an NHP scheme. NHS England accepted that there would be …
Government response. The government acknowledged the Committee's observations regarding the New Hospital Programme and maintenance backlog, reiterating its commitment to capital investment and providing record funding for the NHS.
HM Treasury