Source · Select Committees · Public Accounts Committee
76th Report - New Hospital Programme update
Public Accounts Committee
HC 1705
Published 22 April 2026
Conclusions (28)
2
Conclusion
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 …
3
Conclusion
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 …
4
Conclusion
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 …
5
Conclusion
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 …
6
Conclusion
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 …
1
Conclusion
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
7
Conclusion
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 …
8
Conclusion
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 …
9
Conclusion
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 …
10
Conclusion
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 …
11
Conclusion
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 …
12
Conclusion
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 …
13
Conclusion
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 …
14
Conclusion
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 …
15
Conclusion
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 …
16
Conclusion
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 …
17
Conclusion
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 …
18
Conclusion
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 …
19
Conclusion
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 …
20
Conclusion
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 …
21
Conclusion
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 …
22
Conclusion
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 …
23
Conclusion
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 …
24
Conclusion
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 …
25
Conclusion
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 …
26
Conclusion
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 …
27
Conclusion
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, …
28
Conclusion
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 …