Much of England’s 1500-strong hospital estate is old and deteriorating. Many hospitals, in fact, are so old that they are not worth refurbishing.
After years of underinvestment, these buildings can experience problems such as flooding, leaks, electrical problems and equipment failure. A handful of the more serious cases are at risk of collapse.
These problems cause spiraling maintenance costs and interfere with patient care: a major obstacle to efforts to reduce waiting lists that have risen dramatically during the pandemic.
In 2020, the prime minister at the time, Boris Johnson, promised to build 40 new hospitals by the end of the decade in an effort to modernize the country’s facilities.
But due to delays and meanderings about what is a “new hospital” the program looks different from those initial promises.
And, as new report from the National Audit Office Watch, that headline target of “40 hospitals” is now very unlikely to be missed altogether. This is despite the fact that the program has since been expanded to include more construction projects, including several hospitals built from a type of concrete that is now at risk of total failure.
The agency predicts that the government will build 32 new hospitals by 2030, with most of the construction taking place in the second half of the decade.
This in itself is a cause for concern for auditors, who say it could be difficult to find enough builders for the successive projects, pushing up costs.
The agency warned against grouping major reconstructions together again in future programs.
Gareth Davies, who leads the NAO, said in a statement: “The program has innovative plans to standardize hospital construction, to deliver efficiencies and quality improvements. However, according to the definition used by the government in 2020 it will provide 32 new hospitals rather than 40 by 2030.”
Part of the reason behind the slow delivery of these hospitals, he said, is the development of a standardized hospital construction template called “Hospital 2.0”, which policymakers hope will enable faster construction and better value for money.
But the report’s authors warn that these cost-cutting efforts could lead to hospitals that are too small to meet the increased demands of an aging population.
Nigel Edwards, who heads the health policy think tank, Nuffield Trust, said in a statement that the government started with a “big vague promise” that was “confused” from the start.
“While there has been a significant amount of rebuilding and development, many of the projects are not new hospitals on new sites,” he said. “It is very unlikely that ministers will achieve their target of completing the program by 2030, and the NAO report casts even more doubt, especially given how slowly this ailing program has progressed so far. “
Edwards pointed out that funding had not come earlier, describing the past decade as “a decade of lost investment” in England’s hospital buildings.
“If the money that is being promised now had been invested ten years ago there is no doubt that the National Health Service would be in a much better position,” he said. “Because hospital buildings have been allowed to deteriorate for too long, the critical high-priority list for repairs has evolved.”
Rather than being able to decide which areas of investment would provide the best care for patients in the long term, he said, “We are able to spend money on whichever hospital is most dangerous or most likely to collapse. “