Recommendation 4

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.