76th Report - New Hospital Programme update — Select Committees

2 Recommendation Accepted

With little contingency up to 2029–30, there is a risk that delays and cost overruns...

Recommendation

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 … Read more

Government Response 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 through existing processes.

HM Treasury

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3 Recommendation Accepted

There is a risk that the new Hospital 2.0 design might not benefit some patients...

Recommendation

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 … Read more

Government Response 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 post-occupancy reviews.

HM Treasury

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4 Recommendation Accepted

The Department has not yet developed a convincing rationale for the proposed size of new...

Recommendation

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 … Read more 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. Show less

Government Response 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 care.

HM Treasury

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5 Recommendation Accepted

The Department has been slow to develop the capacity and capability it needs to deliver...

Recommendation

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 … Read more

Government Response 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.

HM Treasury

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6 Recommendation Accepted

The 46 hospital schemes must deliver quality hospitals on time and on budget over 25...

Recommendation

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 … Read more 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 Show less

Government Response 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 Projects Review Group oversight.

HM Treasury

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76th Report - New Hospital Programme update

Recommendations & Conclusions

With little contingency up to 2029–30, there is a risk that delays and cost overruns...

There is a risk that the new Hospital 2.0 design might not benefit some patients...

The Department has not yet developed a convincing rationale for the proposed size of new...

The Department has been slow to develop the capacity and capability it needs to deliver...

The 46 hospital schemes must deliver quality hospitals on time and on budget over 25...