Public Accounts Committee report on New Hospital Programme warns of likely further delays and raises doubts around new Hospital 2.0 designs.
There remains a risk of serious deterioration from crumbling concrete in seven hospitals, the cost of ensuring safety in which is now expected to cost £1 billion.
In its report on the New Hospital Programme (NHP), the Public Accounts Committee (PAC) is calling for an annual report to parliament on the progress of replacing reinforced autoclaved aerated concrete (RAAC) hospitals, with details of any cost increases, any delays, and the impact of such timetable slippages on the risk to staff and patients.
In February, Healthcare Today reported that although the government put the NHP on a more realistic timetable last year, and the replacement schemes for hospitals built with reinforced aerated autoclaved concrete (RAAC) are now expected in 2032-2033, a tight construction schedule overall with little contingency in the next five years means that there are significant delivery risks.
A 2022 independent report recommended that RAAC hospitals should be replaced by 2030 at the latest, while a report last year concluded that they could stay operational past 2030, but with significant risk and cost. The government’s new timetable has final RAAC replacement schemes due to finish in 2033. This is two to three years later than originally planned.
“Every year that sees delays to the replacement of RAAC hospitals is a year of borrowed time. This is time borrowed at the expense of the safety of patients and staff, and from the taxpayer in the costs of mitigation and maintenance,” said Geoffrey Clifton-Brown, chair of the Public Accounts Committee.
Risks remain
The government has already spent £500 million on maintenance and mitigation to ensure patient and staff safety for RAAC hospitals, with the PAC’s inquiry told that trusts with RAAC hospitals will receive a further £440 million.
The PAC received evidence highlighting that such maintenance reduces risk in RAAC hospitals, but cannot remove it where RAAC planks are inaccessible. Between 1% and 6% of RAAC planks are inaccessible at each RAAC hospital. The PAC calls on the government to learn the lessons from RAAC on the importance of investing in the NHS estate in a timely manner, and to publish a strategy for investing in NHS capital assets.
The PAC’s report on the programme raises a further significant risk that the massive programme will fall further behind. Government plans to spend £8.9 billion between now and 2029-30 as it works on the next wave of the NHP, which will include sixteen more schemes than anything delivered so far.
The Department for Health and Social Care (DHSC) has set aside very little contingency funding for the 2025-26 to 2029-30 period – only 3% of total funding compared to a total contingency of 21%. If the NHP faces unexpected cost increases in the next few years, the report warns there is very little buffer to absorb these, with knock-on delays to subsequent hospitals likely.
Single bedroom wards
These hospitals will be delivered to the new and what the committee calls “unproven” Hospital 2.0 design, about which the PAC raised concerns in 2023. A key aspect of Hospital 2.0 is wards consisting of solely single bedrooms, which DHSC expects will result in fewer infections and shorter stays. The report also argues that the DHSC has not focused enough on the unexpected downsides of 100% single bedroom wards. Some patients, particularly those who are frailer or more vulnerable, may feel alienated being alone and monitored remotely. NHS providers told the PAC’s inquiry that trusts were concerned about future financial pressures as a result of operating the new hospitals. NHS England also acknowledged that staff may find it harder initially to observe patients in single rooms, with necessary extra checks potentially resulting in higher costs in the short-term until staff are used to working in a different way, using digital information.
The PAC’s report calls for the government to explain how it expects the new design to lead to measurable benefits for patients, and to allow an independent assessment of whether the benefits are being realised following the opening of the first hospitals.
“We further have deep concerns that providing solely single bedrooms in the new Hospital 2.0 model risks isolating more frail and vulnerable people, in particular. The previous Committee’s visit to Denmark found that standard hospital design in that country has improved the delivery speed and unit cost of new hospital buildings,” said Clifton-Brown.
