Recommendations & Conclusions
5 items
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 …
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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 to be optimistic that the design and a related new commercial model will reduce future construction costs by 25% and could even reduce the total time taken to develop new hospitals from 11 years to six. Yet, until the design is complete and has been tested, these claims are at risk of being just pipe dreams. Unlike Denmark’s programme for building ‘super hospitals’, DHSC has not allowed time for proper piloting of its new standard hospital. Failure to pilot thoroughly could store up problems for future generations because of defective or poorly thought through standardisation. The New Hospital Programme 7 Recommendation 4: For the twin purposes of piloting and making progress, DHSC should aim to be ready to start construction during 2024 of at least one early scheme that uses its standardised hospital design, with a particular focus on trialling new clinical infrastructure such as standardised operating theatres.
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Government response AI summary
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.
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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 …
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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 more centralised, modern approach. But NHP’s estimates of the level of savings that can be made are very ambitious. It has previously said that schemes that fully adopt its new approach would cost 25% less and take 20% less time to build than under traditional design and construction approaches. Then, at our evidence session in September, DHSC was more optimistic regarding time savings, telling us the model would reduce the total time taken to develop new hospitals from an average of 11 years to about six. This would amount to a time saving of some 40%, twice as much as was estimated earlier in 2023.20
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Government response AI summary
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.
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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 …
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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 standardised design by the end of 2022, for use in early proof of concept testing. Instead, the NHP team plans to release the template design, known as Hospital 2.0, in stages during 2023, with the final release by December 2023. However, by July 2023 the NHP team was running around five months behind schedule.21 DHSC told us that some elements of the design had been finished and that the complete package would be ready by May 2024.22 The C&AG’s report of July 2023 highlighted that there were delays in recruiting a temporary design team of up to 300 specialist designers. Remarkably, in September, DHSC told us that it had now recruited the team it needed to complete Hospital 2.0.23 16 C&AG’s Report, paras 3.24 and 3.25 17 Letter from Shona Dunn, DHSC dated 26 September 2023 18 C&AG’s Report, para 17 and Figure 12 19 Q 29; C&AG’s Report, para 3.6 20 Q 29; C&AG’s Report, para 3.6 21 C&AG’s Report, paras 3.8 and 3.9 22 Q 84 23 Q 31; C&AG’s Report, para 3.9 12 The New Hospital Programme
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Government response AI summary
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.
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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 …
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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 schemes. DHSC seemed reluctant to accept the desirability of rigorous real-life testing, replying generically that it was always looking for opportunities to accelerate the programme.26
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Government response AI summary
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.
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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 …
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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 lessons from these clinicians, the new hospital was being built with theatres that were already known to work for all types of surgery. We asked whether the NHP team was planning to use similar live clinical exercises. DHSC told us it was consulting with clinicians but was not currently planning live testing. The NHP team will look at organisations that already have new facilities.27 However it decides to proceed, NHP needs to get the Hospital 2.0 design and build right, otherwise all new hospitals will have problems in years to come.28 Assumptions underlying new standard hospital design
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Government response AI summary
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.
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HM Treasury