Recommendations & Conclusions
28 items
2
Recommendation
76th Report - New Hospital Programme up…
Accepted
With little contingency up to 2029–30, there is a risk that delays and cost overruns in the early years will have knock on effects on subsequent hospital schemes. Although some of the early hospital schemes in the programme (known as ‘wave 0’) are open or due to complete soon, enabling …
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With little contingency up to 2029–30, there is a risk that delays and cost overruns in the early years will have knock on effects on subsequent hospital schemes. Although some of the early hospital schemes in the programme (known as ‘wave 0’) are open or due to complete soon, enabling works for many hospital schemes in the next wave (‘wave 1’) are yet to start. Wave 1 contains the first schemes to be built to the Hospital 2.0 design which will be more complex. The Hospital 2.0 design is novel and it is taking time to finalise. Wave 1 will include 16 more hospital schemes than anything delivered so far, with a planned spend of £8.9 billion from 2025–26 to 2029–30, compared to £720 million for schemes in wave 0. Despite these challenges, the Department has set aside very little contingency funding for 2025–26 to 2029–30, just 3% of total funding for the period. If the programme faces unexpected cost increases in the next few years, there is very little buffer to absorb them, and knock-on delays to subsequent hospital schemes are likely. recommendation The Department must closely monitor progress to ensure knock-on effects are managed effectively by: a. using an assessment of progress on the early schemes to re-estimate the hospital opening dates and costs for later schemes; and b. improving transparency by reporting publicly on progress and spending every year for each scheme, and explaining any significant variances and the consequences for the programme.
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Government response AI summary
The government agrees to closely monitor progress, explaining it uses benchmark data and forecasting to re-estimate schedules and costs, and regularly updates its integrated plan. It will improve transparency by providing regular updates in the NHP annual report, noting that annual spending is already published …
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HM Treasury
3
Recommendation
76th Report - New Hospital Programme up…
Accepted
There is a risk that the new Hospital 2.0 design might not benefit some patients or may add cost. The Hospital 2.0 design was originally due to be ready in December 2023 but, following multiple delays, the Department will not finalise the design until summer 2026 at the earliest. A …
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There is a risk that the new Hospital 2.0 design might not benefit some patients or may add cost. The Hospital 2.0 design was originally due to be ready in December 2023 but, following multiple delays, the Department will not finalise the design until summer 2026 at the earliest. A key aspect of the design is that wards will consist of solely single bedrooms. The Department expects single bedrooms to lead to efficiencies such as fewer hospital acquired infections and shorter hospital stays for patients. However, some research has indicated that the clinical and economic impact of single bedrooms may be modest. The Department has not clearly explained what metrics it will use to assess whether it is realising benefits, nor has it sufficiently focused on unexpected downsides of 100% single bedroom wards. For example, some patients, particularly those that are frailer or more vulnerable, may feel alienated being alone and monitored remotely. The Department acknowledges that the new hospitals may incur more staff costs until new ways of working are embedded. 4 recommendation The Department must ensure the new hospital design delivers benefits. It should: a. alongside its Treasury Minute response to this report, the Department should write to the Committee with details of how it expects the new design to lead to measurable benefits for patient experience, patient outcomes and operational efficiencies; b. identify tangible risks to achieving these benefits and seek to manage these; and c. commission and report the results of an independent assessment of whether the benefits are being realised following the opening of the first hospitals built to the new Hospital 2.0 design.
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Government response AI summary
The government agrees and confirms it has already written to the Committee with details on expected benefits and evaluation plans for Hospital 2.0. It also outlined its approach to managing risks and committed to reporting independent impact evaluation findings from 2034-35, with earlier learning from …
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HM Treasury
4
Recommendation
76th Report - New Hospital Programme up…
Accepted
The Department has not yet developed a convincing rationale for the proposed size of new hospitals or how larger hospitals complement aspirations for new models of care and reducing demand in hospitals. Shifting care out of hospitals and into the community is one of the key features of the NHS …
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The Department has not yet developed a convincing rationale for the proposed size of new hospitals or how larger hospitals complement aspirations for new models of care and reducing demand in hospitals. Shifting care out of hospitals and into the community is one of the key features of the NHS 10-year plan, but the Department has assumed that larger hospitals will be needed. The Department has not clearly explained why bed capacity for hospitals in the New Hospital Programme needs to increase by 6% when it has also committed to spending more on care outside hospitals relative to what it spends in hospitals. The Department has engaged with NHS trusts to ensure that plans to provide care within and outside hospital settings are joined up, but local community care projects will be difficult to align with the New Hospital Programme as funding is separate. Some hospitals may require additional capacity to improve flow of patients in and out of the hospital, but we see a risk that hospitals will fill to the number of beds available with a knock-on impact on running costs. Bed numbers for wave 1 hospitals are not yet completely finalised, even though some of these hospitals are due to start construction in 2027–28. On its visit to Denmark in the last Parliament, the Committee learned that the Danish hospital rebuilding programme aimed to reduce significantly the total numbers of beds. recommendation Once the new design for hospitals is finalised, the Department should write to the Committee to: • provide further assurance on the bed capacity needed in new hospitals given its wider focus on shifting care out of hospitals and into the community; 5 • explain the new model of care that will be employed in these hospitals and how each individual scheme has taken expected changes to community care into account when deciding bed numbers; and • in cases where increases are necessary, explain how this is needed to optimise the flow of patients through hospital and quality of care.
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Government response AI summary
The government agrees with the recommendation and commits to writing to the Committee in Spring 2027. This letter will provide details on planned bed capacity for Wave 1 schemes, explaining how numbers reflect their Model of Care, expected demand, and the planned shift to community …
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HM Treasury
5
Recommendation
76th Report - New Hospital Programme up…
Accepted
The Department has been slow to develop the capacity and capability it needs to deliver such a complex programme. The Department’s central programme team for the New Hospital Programme will require significant technical expertise to deliver successfully. Prior to the 2025 reset, the programme had struggled to recruit staff and …
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The Department has been slow to develop the capacity and capability it needs to deliver such a complex programme. The Department’s central programme team for the New Hospital Programme will require significant technical expertise to deliver successfully. Prior to the 2025 reset, the programme had struggled to recruit staff and had become reliant on external contractors. By November 2025, the programme team was still struggling with a vacancy rate of 39% due to an ongoing recruitment freeze in the wake of plans to dissolve NHS England. Following the end of the freeze, the Department is now confident that it has filled all key roles. However, we remain sceptical that the programme has the expertise it needs given that the risk that vacancies will delay the programme had been rated red, the scale of recruitment required to close the gap from November, and the time new staff will need to get up to speed. recommendation The Department must provide greater assurance that it has the skills and capability it needs for the programme. It should: a. be clear on the programme’s critical path and what this means for its staffing requirements; and b. develop a clear plan to address skills shortages, which could include working with other departments who are taking forward initiatives to develop key skills. Once completed, it should write to the Committee with the details.
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Government response AI summary
The government agrees and will publish an operational workforce plan in summer 2026 and complete scheme-level capability assessments by Autumn 2026. This work will inform a longer-term plan to address skills shortages, to be sent to the Committee by Winter 2026.
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HM Treasury
6
Recommendation
76th Report - New Hospital Programme up…
Accepted
The 46 hospital schemes must deliver quality hospitals on time and on budget over 25 years and for £60 billion. Given its cost and importance, and that the design concept of Hospital 2.0 remains unproven, we are concerned that the New Hospital Programme is not being treated in government as …
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The 46 hospital schemes must deliver quality hospitals on time and on budget over 25 years and for £60 billion. Given its cost and importance, and that the design concept of Hospital 2.0 remains unproven, we are concerned that the New Hospital Programme is not being treated in government as a ‘mega project’. The programme has been high-risk since its inception and beset with delays. It is currently in the Government Major Projects Portfolio and subject to scrutiny by the National Infrastructure and Service Transformation Authority (NISTA). However, in September 2025 we reported our concerns that significant programmes, including the New Hospital Programme, had not been afforded ‘mega project’ status. 6 The Government has made changes to how particularly risky, costly and complex projects—mega projects—would be managed including greater parliamentary scrutiny and more streamlined decision making. Mega projects also benefit from fixed capital funding, flexibility to move funding between years and freedom to determine pay for specialist roles. The governance and performance failures to date add to the already very strong case for the New Hospital Programme is sufficiently risky to need mega project status. The programme has many hallmarks of a mega project, such as strategic importance, level of spend, unified procurement, a singular design and a centralised programme team. Delays or cost increases to one scheme are likely to have knock-on effects on other hospital schemes. recommendation This programme requires an appropriate level of oversight and scrutiny commensurate with its risk, size and complexity. As the programme develops, HM Treasury and the Mega Project Decision Panel should assess whether this should be overseen as a mega project—at least up until the point that Hospital 2.0 is a proven concept—and advise ministers accordingly, who should regularly update Parliament. 7 1 Current progress of the updated New Hospital Programme Introduction
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Government response AI summary
The government agrees with the recommendation that the programme requires appropriate oversight and scrutiny. HM Treasury and the Mega Projects Decision Panel have assessed the New Hospital Programme for 'mega project' status but concluded it does not meet the criteria, with NHP remaining under Major …
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HM Treasury
1
Conclusion
76th Report - New Hospital Programme up…
Not Addressed
On the basis of a Report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and from NHS England on the New Hospital Programme (NHP).1
Government response AI summary
The government's response discusses RAAC replacement schemes and the development of a long-term plan for health capital spending, which does not address the Committee's statement about taking evidence for its report.
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HM Treasury
7
Conclusion
76th Report - New Hospital Programme up…
Wave 1 hospitals are significantly larger and more complex to build than the wave 0 schemes. The seven hospitals in wave 0, of which six will have fewer than 100 beds, are expected to cost £720 million in total. In contrast, the 16 wave 1 hospitals are forecast to cost …
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Wave 1 hospitals are significantly larger and more complex to build than the wave 0 schemes. The seven hospitals in wave 0, of which six will have fewer than 100 beds, are expected to cost £720 million in total. In contrast, the 16 wave 1 hospitals are forecast to cost £16.6 billion in total, including £8.1 billion from 2025–26 to 2030–31.9 Furthermore, ten of the wave 1 hospitals are the first schemes the Department is building to the novel Hospital 2.0 design, which is not expected to be finalised until summer 2026.10 The programme has included a contingency of only 3% of total funding from 2025–26 to 2029–30, compared to a total contingency of 21% across the programme, and so there is little headroom for any delays or cost overruns that occur in the early years.11
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HM Treasury
8
Conclusion
76th Report - New Hospital Programme up…
We asked the Department how it was ensuring that the smaller earlier projects would not overrun and create a knock-on problem for the larger, more complex hospital projects in later years. NHS England told us that the reset had allowed it to revise the NHP’s governance arrangements, allowing for clearer …
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We asked the Department how it was ensuring that the smaller earlier projects would not overrun and create a knock-on problem for the larger, more complex hospital projects in later years. NHS England told us that the reset had allowed it to revise the NHP’s governance arrangements, allowing for clearer and more agile oversight as well as more regular reports. This information could then be used to nudge other hospitals backwards or forwards to accommodate any movements in the timetable.12
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HM Treasury
9
Conclusion
76th Report - New Hospital Programme up…
The Department told us that it hoped that lessons learnt from its delivery of earlier waves would allow the later, more complex waves to be delivered more effectively.13 However, the Department also acknowledged that the wave 1 hospitals would be a lot more complex than those currently being delivered through …
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The Department told us that it hoped that lessons learnt from its delivery of earlier waves would allow the later, more complex waves to be delivered more effectively.13 However, the Department also acknowledged that the wave 1 hospitals would be a lot more complex than those currently being delivered through wave 0. Wave 1 contains the complicated RAAC replacement schemes where typically almost all the buildings, rather than part of the estate, need to be replaced.14 One of the ways to prevent delays is to ensure that all precontract issues such as planning, surveys, site preparation are completed before contract are let.15 Replacing hospitals built from reinforced autoclaved aerated concrete (RAAC)
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HM Treasury
10
Conclusion
76th Report - New Hospital Programme up…
Hospitals built from RAAC face significant safety risks, and schemes to replace them need to proceed at pace.16 In 2022 an independent report recommended that hospitals built from RAAC should be replaced by 9 C&AG’s Report: para 1.10 10 Q 8 11 C&AG’s Report: para 3.24 12 Qq 4-6 13 …
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Hospitals built from RAAC face significant safety risks, and schemes to replace them need to proceed at pace.16 In 2022 an independent report recommended that hospitals built from RAAC should be replaced by 9 C&AG’s Report: para 1.10 10 Q 8 11 C&AG’s Report: para 3.24 12 Qq 4-6 13 Q 7 14 Q 6 15 Q 19 16 C&AG’s report, paras 1.14 and 2.8 10 2030 at the latest.17 A subsequent report, published in December 2025, concluded that with mitigations and maintenance, the RAAC hospitals can stay operational past 2030 but with significant risk and cost.18 Under the Department’s new timetable for the NHP, the final RAAC replacement hospitals are due to be finished in 2033.19
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HM Treasury
11
Conclusion
76th Report - New Hospital Programme up…
By 2025, the Department had already spent £500 million on maintenance and mitigations for RAAC hospitals to ensure patient and staff safety.20 The Department told us it now planned to give NHS trusts with RAAC hospitals a further £440 million to pay for maintenance until the replacement hospitals are finished.21 …
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By 2025, the Department had already spent £500 million on maintenance and mitigations for RAAC hospitals to ensure patient and staff safety.20 The Department told us it now planned to give NHS trusts with RAAC hospitals a further £440 million to pay for maintenance until the replacement hospitals are finished.21 Written evidence we received highlighted that maintenance work on RAAC hospitals reduces risk but cannot remove it where RAAC planks are inaccessible.22 Between 1% and 6% of RAAC planks are inaccessible at each hospital built from RAAC.23
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HM Treasury
12
Conclusion
76th Report - New Hospital Programme up…
We asked the Department if it expected to replace all seven RAAC hospitals on time, or if some of the RAAC hospitals were facing timetable pressures, as reported by the National Audit Office. The Department told us that it did not take lightly the risk RAAC hospitals present, and understood …
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We asked the Department if it expected to replace all seven RAAC hospitals on time, or if some of the RAAC hospitals were facing timetable pressures, as reported by the National Audit Office. The Department told us that it did not take lightly the risk RAAC hospitals present, and understood the need to replace the RAAC hospitals as soon as it possibly could. It currently felt that these hospital schemes were on track – the trusts were currently working through key stages of their respective business cases and were still due to start construction on the dates in the implementation plan.24
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HM Treasury
13
Conclusion
76th Report - New Hospital Programme up…
The Department also said it would have preferred to complete the replacement hospitals sooner, but delivery speed had been constrained by market capacity. The Department said that it was confident, however, that it would be able to deliver the RAAC hospitals despite constraints in construction skills and capabilities. The Department …
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The Department also said it would have preferred to complete the replacement hospitals sooner, but delivery speed had been constrained by market capacity. The Department said that it was confident, however, that it would be able to deliver the RAAC hospitals despite constraints in construction skills and capabilities. The Department was working to build market capacity through its contractor framework, with contracts to be awarded over the next couple of months. The Department also said that large contractors from Europe would be involved to further increase capacity.25 17 Mott MacDonald, RAAC 5 Deep Dive Report, April 2022 18 C&AG’s Report, para 2.8; Mott MacDonald, RAAC strategic planning: assessment of the RAAC 7 hospitals, December 2025 19 C&AG’s report, Figure 9 20 C&AG’s Report, para 2.8 21 Q 12 22 Hleb Buziuk (NHP0001) 23 Mott MacDonald, RAAC strategic planning: assessment of the RAAC 7 hospitals, December 2025 24 Qq 3 and 9 25 Q 13 11
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HM Treasury
14
Conclusion
76th Report - New Hospital Programme up…
More broadly, there are other hospitals outside the programme with problems which the Department must address through wider spending on repairs and maintenance. The total backlog of work required to improve the NHS estate was estimated to cost £15.9 billion in 2024–25.26 We received written evidence from NHS providers highlighting …
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More broadly, there are other hospitals outside the programme with problems which the Department must address through wider spending on repairs and maintenance. The total backlog of work required to improve the NHS estate was estimated to cost £15.9 billion in 2024–25.26 We received written evidence from NHS providers highlighting that, from 2023–24 to 2024–25, the total increase the size of the maintenance backlog (£2.1bn) was higher than the total investment trying to reduce the backlog (£1.02bn).27 The previous Committee raised concerns in 2020 that the Department had not published a capital funding strategy to support the NHS long- term plan.28 The Government committed to finalising a capital strategy in 2020 but has not yet published it.29 26 C&AG’s report, para 1.9 27 NHS Providers (NHP0003) 28 Committee of Public Accounts, NHS Capital Expenditure and Financial Management, Eighth Report of Session 2019–21, HC 344, 8 July 2020 29 HMT, Government response to the Committee of Public Accounts on the Seventh to the Thirteenth reports from session 2019–21, CP 291, 28 September 2020 12 2 Designing Hospital 2.0 and programme integration with wider NHS strategic goals Designing Hospital 2.0
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HM Treasury
15
Conclusion
76th Report - New Hospital Programme up…
The Department aims to build hospitals in the programme to a new, standardised hospital design called Hospital 2.0. It expects the new hospitals to be more efficient to operate, digitally-enabled and to provide each patient with their own single bedroom. The Hospital 2.0 design was originally due to be completed …
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The Department aims to build hospitals in the programme to a new, standardised hospital design called Hospital 2.0. It expects the new hospitals to be more efficient to operate, digitally-enabled and to provide each patient with their own single bedroom. The Hospital 2.0 design was originally due to be completed in December 2023 which proved unachievable.30 We asked the Department whether it was still on track to complete the Hospital 2.0 design by spring 2026 as reported by the NAO. It said that Hospital 2.0 would be fully assured and complete by summer 2026 and that the design had been available for trusts to use for some time to allow them to develop their business cases.31
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HM Treasury
16
Conclusion
76th Report - New Hospital Programme up…
The Department assumes that these single bedrooms will be more efficient, reducing the average patient length of stay by 0.5% annually, plus an additional one-off reduction of 8% to 10% when the new hospital schemes open. However, some research has indicated that the clinical and economic impact of changing to …
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The Department assumes that these single bedrooms will be more efficient, reducing the average patient length of stay by 0.5% annually, plus an additional one-off reduction of 8% to 10% when the new hospital schemes open. However, some research has indicated that the clinical and economic impact of changing to single-room wards is likely to be modest.32 We asked the Department if single bedrooms are suitable for the majority of patients, who tend to be frail older people. It told us that the designs have been subject to feedback from a wide variety of clinical and patient groups, and that while initially sceptical, staff working in other hospitals with single bedroom wards have been broadly positive about the benefits of operating differently.33 30 C&AG’s report, paras 2.10 and 2.12 31 Q 8 32 C&AG’s report, para 3.14 33 Qq 15 and 43-44 13
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HM Treasury
17
Conclusion
76th Report - New Hospital Programme up…
We asked the Department whether it had mechanisms in place to capture any unexpected downsides of the design. The Department responded that it would identify adverse consequences through its oversight regime. NHS England added that it will be easier to identify downsides where it has hard metrics, and that it …
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We asked the Department whether it had mechanisms in place to capture any unexpected downsides of the design. The Department responded that it would identify adverse consequences through its oversight regime. NHS England added that it will be easier to identify downsides where it has hard metrics, and that it is keen to improve their data and real-time analysis.34 The Department subsequently wrote to us with additional information on how it plans to assess and monitor the benefits of the Hospital 2.0. design. It is developing a standard operating model to help trusts identify benefits and the associated impact on revenue and workforce requirements. It is also developing benefits management plans to monitor realised benefits and potential downsides.35
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HM Treasury
18
Conclusion
76th Report - New Hospital Programme up…
Written evidence we received from NHS providers noted that trusts were concerned about future financial pressures as a result of operating the new hospitals.36 NHS England told us that the modelled running costs of the new buildings have shown that they are more cost effective and the Department said that …
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Written evidence we received from NHS providers noted that trusts were concerned about future financial pressures as a result of operating the new hospitals.36 NHS England told us that the modelled running costs of the new buildings have shown that they are more cost effective and the Department said that it is developing a standard operating model to check that new hospitals are economically viable to run.37 However, NHS England also acknowledged that staff may find it harder initially to observe patients in single rooms. Carrying out more checks may result in extra costs in the short-term until staff are used to working in a different way, using digital information. NHS England believes that these additional costs will “level out” over time as specific issues are resolved.38 We asked the Department how it was building flexibility into the design to ensure that the hospitals could remain technologically and clinically up to date in the future. It told us that lessons learnt from the early hospitals will be used to adapt hospitals it builds later.39 Hospital capacity
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HM Treasury
19
Conclusion
76th Report - New Hospital Programme up…
The NHP programme business case assumes a 6% average increase in overnight beds across all 28 schemes that the Department plans to build to the Hospital 2.0 design. Across eight schemes where the Department has carried out detailed modelling, the increase in the total number of beds planned for the …
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The NHP programme business case assumes a 6% average increase in overnight beds across all 28 schemes that the Department plans to build to the Hospital 2.0 design. Across eight schemes where the Department has carried out detailed modelling, the increase in the total number of beds planned for the new hospitals ranges from 1% to 34%, an average increase of 12%.40 34 Q 47 35 Letter from DHSC, 23 February 2026 36 NHS Providers (NHP0003) 37 Qq 45 and 48 38 Qq 48-49 39 Q 17 40 C&AG’s report, para 3.12 and Figure 12 14
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HM Treasury
20
Conclusion
76th Report - New Hospital Programme up…
We asked the Department how it had concluded that the new hospitals required more beds than those they were replacing given that its 10-year health plan aims to shift of care out of hospitals and into the community.41 The Department told us that, since 2023, it had updated overly optimistic …
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We asked the Department how it had concluded that the new hospitals required more beds than those they were replacing given that its 10-year health plan aims to shift of care out of hospitals and into the community.41 The Department told us that, since 2023, it had updated overly optimistic assumptions about bed capacity and future demographic growth while considering what care can be moved out of hospitals and into the community. NHS England said that underlying growth in demand was “generally the biggest variable”.42 In written evidence provided after the session, the Department explained that the 6% growth had been a broad assumption developed at the programme level, and that it was conducting further modelling to assess what size is appropriate for individual schemes.43 The Department told us that it expected the bed number forecasts to reduce during the business case process as the programme works with trusts to identify what care can be shifted into the community, highlighting Leighton Hospital as an example.44
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HM Treasury
21
Conclusion
76th Report - New Hospital Programme up…
We asked for assurance that there would be enough additional capacity outside of hospitals, given that new community services would be funded separately from the NHP. NHS England told us that this was at the heart of its 10-year plan. It acknowledged that the planning process for the NHP had …
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We asked for assurance that there would be enough additional capacity outside of hospitals, given that new community services would be funded separately from the NHP. NHS England told us that this was at the heart of its 10-year plan. It acknowledged that the planning process for the NHP had to be adaptable to local circumstances, taking account of what is being built outside hospitals and changes to clinical pathways. NHS England and the Department were working with regional teams and local NHS trusts to join this up.45 NHS England told us that it remained a big part of the 10-year plan to fund increased demand for community care and primary care by reducing spending on hospital care.46
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HM Treasury
22
Conclusion
76th Report - New Hospital Programme up…
We asked for assurance about the quality of the NHP demand and capacity model, given the importance of the output. The Department said that the model was good and had been awarded a prize by the Royal Statistical Society.47 In written evidence provided after the session, the Department assured us …
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We asked for assurance about the quality of the NHP demand and capacity model, given the importance of the output. The Department said that the model was good and had been awarded a prize by the Royal Statistical Society.47 In written evidence provided after the session, the Department assured us that the model was developed and maintained within a controlled governance and quality assurance environment.48
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HM Treasury
23
Conclusion
76th Report - New Hospital Programme up…
The Department said that it continually repeats the demand and capacity modelling to check the numbers are still right.49 When we asked whether the bed numbers for schemes that had been modelled were definitive, the 41 DHSC, Fit for the future, 10 Year Health Plan for England, CP 1350, 3 …
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The Department said that it continually repeats the demand and capacity modelling to check the numbers are still right.49 When we asked whether the bed numbers for schemes that had been modelled were definitive, the 41 DHSC, Fit for the future, 10 Year Health Plan for England, CP 1350, 3 July 2025 42 Qq 33-35 43 Letter from DHSC, 23 February 2026 44 Q 33 45 Qq 26-28 46 Q 36 47 Qq 29-30 48 Letter from DHSC, 23 February 2026 49 Q 29 15 Department told us that it had an envelope of indicative figures for wave 1 hospitals and that work on a scheme-by-scheme basis would continue as these hospitals go through the business case process.50 50 Qq 37-39 16 3 Governance of the New Hospital Programme Programme capacity and capability
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HM Treasury
24
Conclusion
76th Report - New Hospital Programme up…
In 2023 the previous Committee reported that the programme had struggled to recruit staff and had relied too heavily on external consultants.51 As of November 2025, the programme had a vacancy rate of 39%, resolution of which was being hampered by a recruitment freeze following the Department’s plans to abolish …
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In 2023 the previous Committee reported that the programme had struggled to recruit staff and had relied too heavily on external consultants.51 As of November 2025, the programme had a vacancy rate of 39%, resolution of which was being hampered by a recruitment freeze following the Department’s plans to abolish NHS England.52 These capability gaps could slow delivery, cause over-reliance on external contractors and delay later waves.53 We also received written evidence from NHS Providers raising concerns about the effectiveness of the central NHP programme team. Although trusts acknowledged that communication and engagement from the central team had improved during 2025, they considered that interactions on critical issues were still inconsistent and more streamlined governance arrangements were needed.54
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HM Treasury
25
Conclusion
76th Report - New Hospital Programme up…
The Department told us that while there had been a slight pause in recruitment, the programme was not currently under a recruitment freeze for key roles and it did not currently see resourcing as a concern.55 We challenged the Department on this, highlighting that the impact of public sector vacancies …
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The Department told us that while there had been a slight pause in recruitment, the programme was not currently under a recruitment freeze for key roles and it did not currently see resourcing as a concern.55 We challenged the Department on this, highlighting that the impact of public sector vacancies on deliverability was rated red on the programme’s risk register as at November 2025. The Department said that the programme had subsequently been on a recruitment drive, specifically looking at moving staff from across NHS England into core roles.56 The vacancy rate for the programme had now reduced below the 39% reported by the NAO, and the Department had filled all the key roles it needed to deliver the programme. The Department acknowledged that it would like to fill all vacancies within the programme, and that recruitment 51 Committee of Public Accounts, The New Hospital Programme, First Report of Session 2023–24, HC 77, 17 November 2023 52 C&AG’s report, paras 3.28-3.29 53 C&AG’s report, para 17 54 NHS Providers (NHP0003) 55 Qq 22-24 56 Q 25 17 was still ongoing.57 The Department also told us that it had established an academy which aims to build skills, training and career paths in the UK construction sector.58 Wider governance of the New Hospital Programme
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HM Treasury
26
Conclusion
76th Report - New Hospital Programme up…
The NHP programme board currently reports to the Department and NHS England boards. These boards provide scrutiny of the programme and ensure it is delivered effectively. The NHP programme board is supported by its executive committee, which in turn is supported by sub- committees that monitor various aspects of the …
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The NHP programme board currently reports to the Department and NHS England boards. These boards provide scrutiny of the programme and ensure it is delivered effectively. The NHP programme board is supported by its executive committee, which in turn is supported by sub- committees that monitor various aspects of the programme such as people and finance.59 The New Hospital Programme is also subject to wider governance arrangements. It has been a part of the Government Major Project Portfolio (GMPP) since 2021, and as such is subject to scrutiny from both the National Infrastructure and Service Transformation Authority (NISTA) and HM Treasury (HMT). In 2025 NISTA gave the NHP a delivery confidence assessment rating of ‘Amber’.60
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HM Treasury
27
Conclusion
76th Report - New Hospital Programme up…
The Government recently established new arrangements for how particularly risky, costly and complex projects (‘mega projects’) would be managed.61 Mega projects are afforded increased scrutiny and autonomy. For example, decisions at key stages involve the Prime Minister, Chancellor and relevant Secretary of State, advised by a panel including HM Treasury, …
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The Government recently established new arrangements for how particularly risky, costly and complex projects (‘mega projects’) would be managed.61 Mega projects are afforded increased scrutiny and autonomy. For example, decisions at key stages involve the Prime Minister, Chancellor and relevant Secretary of State, advised by a panel including HM Treasury, NISTA and Cabinet Office officials.62 Mega projects may also receive fixed capital funding, the freedom to determine pay when recruiting for specialist roles, and the ability to shift funding between years.63
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HM Treasury
28
Conclusion
76th Report - New Hospital Programme up…
In September 2025 we reported that some critical programmes had been left out of plans to strengthen governance of mega projects. The New Hospital Programme was not granted mega project status by the Treasury because it was considered a collection of small, standardised 57 Qq 23-25 58 Q 14 59 …
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In September 2025 we reported that some critical programmes had been left out of plans to strengthen governance of mega projects. The New Hospital Programme was not granted mega project status by the Treasury because it was considered a collection of small, standardised 57 Qq 23-25 58 Q 14 59 C&AG’s report, paras 3.6-3.7 60 C&AG’s report, para 3.3 61 C&AG’s report, para 3.5 62 Committee of Public Accounts, Governance and decision-making on major projects, Forty-fourth report of session 2024–25, HC 642, 10 September 2025 63 C&AG’s report para 3.5 18 and repeatable construction projects, rather than a singular, large, novel project, despite the value for money concerns this Committee raised in 2023.64 64 Committee of Public Accounts, Governance and decision-making on major projects, Forty-fourth report of session 2024–25, HC 642, 10 September 2025; Committee of Public Accounts, The New Hospital Programme, First Report of Session 2023–24, HC 77, 17 November 2023 19
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HM Treasury