Source · Select Committees · Public Accounts Committee
Recommendation 2
2
Accepted
DHSC lacks proper records to justify Health Infrastructure Plan scheme selections.
Conclusion
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 that became the main basis for selecting schemes for NHP. In finalising the schemes for announcement, DHSC removed seven of the 20 schemes from the shortlist for HIP and added another 14 that had not been recommended. DHSC told us it was satisfied that those decisions were made on an appropriate basis, but it admitted that no documentation whatsoever existed to explain the decisions. We are troubled that a gap like this can occur regarding such an important investment, particularly since at least some of the seven excluded schemes are known to have an urgent need for major investment or rebuilding. This Committee has previously expressed concern about a lack of evidence to justify scheme selection, and a lack of transparency in selection processes, for the Towns Fund in 2020 and for levelling-up funding in
Government Response Summary
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.
Government Response
Accepted
HM Government
Accepted
The government agrees with the Committee’s recommendation. Recommendation implemented The department accepts that there was an omission in record keeping around the final selection of schemes that would be included in the Health Infrastructure Plan in 2019. However, the process was based on clear criteria and the department, NHSE, HM Treasury and No10 Downing Street agreed that the final list of schemes was the right one. The government regularly sets out the selection process for major capital programmes before bids are invited and decisions are made. Selection criteria for schemes to take forward will vary but will consistently consider the strategic context, economic impact and risks, commercial factors, financial factors and deliverability; in line with HM Treasury’s Five Case Model as recommended by the Green Book. Scheme selection decisions in major capital programmes are inherently complex, requiring comparison between different criteria and consideration of their relative value. The department also considers the advice of NHSE when allocating funding for major capital programmes. The department is committed to ensuring its practices, procedures, and advice result in rational decisions made through an appropriate process that take account of the right criteria. As a result, the department will be able to provide evidence on decision outcomes as needed, balanced against its responsibilities to protect certain types of information, such as commercially sensitive information. would work in a variety of schemes, and working closely with clinicians, NHS trusts, Royal Colleges, patient and public groups, and the supply chain to gather best practice to include in Hospital 2.0. 4.4 The standardised reference designs are being tested for fit against the constraints and contexts of specific types of hospital schemes, including low-rise and high-rise hospitals. This will provide learning on how Hospital 2.0 designs may need to be adapted when applied to other settings. 4.5 The NHP intends to test and further develop Hospital 2.0 designs through more established prototyping facilities from late 2024, subject to business case processes and approvals, alongside ongoing design work and anthropometric studies. These prototyping facilities aim to engage patients, clinicians and manufacturers in improving the designs of key elements, such as operating theatres, and aid training and familiarisation to support commissioning and efficient roll-out of services in new hospitals. 4.6 The NHP will feed back all learning from different schemes as aspects of Hospital 2.0 designs are applied into a continuous learning process. 4.7 In 2023, the NHP launched a library of Hospital 2.0 products to trusts, external parties and industry, supporting planning and scheme development, before a detailed release of Hospital 2.0 in May 2024. so it does not result in future hospitals that are too small, and should set out clearly how these future hospitals fit into its assessment of total required hospital capacity nationally and by region. 5.1 The government agrees with the Committee’s recommendation. 5.2 The government agrees that it is vital that future hospitals are the right size and it will keep the assumptions on size of future hospitals under constant review. 5.3 The NHP is working jointly with wider NHSE to develop its modelling and ensure fit with regional and national modelling on the long-term infrastructure needs of the NHS, across acute, community and primary care settings. NHP is also putting forward different options on programme scope, as is normal practice, as part of its programme business case, which is due to be agreed by May 2024. 5.4 To tailor its central modelling to local needs, NHP is also developing a standardised, bottom-up model to assess the most probable net demand, jointly with NHS trusts and integrated care boards. This work requires a high level of collaboration with a wide range of local NHS and other stakeholders to combine national expertise and best practice with local knowledge. 5.5 As well as ensuring that hospitals are not too small, this approach will also ensure that hospitals are not too big, thus avoiding unnecessary capital costs and ensuring that trusts can afford the running costs of the new facilities. 5.6 One of the principles of Hospital 2.0 is that it should maximise the opportunity for future expansion, and this has been factored in standard designs to ensure this can happen for minimum cost and operational disruption.