Recommendations & Conclusions
5 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