Source · Select Committees · Public Accounts Committee
Recommendation 16
16
Accepted
Hospital 2.0 Minimum Viable Product assumptions are unrealistic, risking undersized hospitals for future needs.
Conclusion
With the aim of minimising costs while still meeting its programme objectives, the NHP team has been focusing on a basic version of Hospital 2.0, known as the ‘minimum viable product’ (MVP). Under MVP, hospitals will have the minimum viable set of services, in the minimum viable building size, built to the minimum viable specification, and at the minimum viable cost and time to build. All hospitals from cohort 3 onwards will have single rooms only, instead of open wards.29 But some of the assumptions used to determine the size of an MVP hospital are likely to result in hospitals that are too small to meet future needs, which would be a risk to efficiency and effectiveness as well as presenting clinical challenges:30 • MVP assumes there will be a 1.8% reduction each year in hospital capacity needed as a result of more people being treated outside hospital, in the community.31 This may be unrealistic because NHS England does not currently have a funded strategy to deliver such reductions and government has not produced 24 C&AG’s Report, para 6 25 Qq 29–31 26 Qq 60, 117 27 Qq 78–79 28 Q 117 29 C&AG’s Report, paras 3.9–3.11 30 Q 61; C&AG’s Report, para 24 31 C&AG’s Report, para 3.14 The New Hospital Programme 13 a long-term plan for social care. Neither does the assumption take account of a number of significant pressures outside hospitals, including in adult social care, community mental health services and GPs.32 • MVP also assumes that future patients will stay in hospital for 12% less time on average. This may be unrealistic because England already has one of the shortest lengths of stay per patient of any country in the Organisation for Economic Co- operation and Development (OECD) – 4.5 days on average in England in 2019– 20, compared with 8 days in the OECD. NHP even paid for research which did not back up this assumption.33 • Finally, MVP assumes that future bed occupancy will run on average at 95%. Once again, this may be unrealistic because England already has
Government Response Summary
The government agrees that future hospitals must be the right size, committing to keep assumptions under constant review, working with NHSE to develop long-term infrastructure modelling, and creating a bottom-up assessment model with local stakeholders.
Government Response
Accepted
HM Government
Accepted
The government agrees with the Committee’s recommendation. Recommendation implemented 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. 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. 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. 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. 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.