Transparency data

New Hospital Programme: SRO appointment letter (extension)

Updated 16 January 2024

To: Natalie Forrest, senior responsible owner for the New Hospital Programme

From: Shona Dunn, Second Permanent Secretary and Accounting Officer for the Department of Health and Social Care (DHSC) and Nick Smallwood, Chief Executive Officer of the Infrastructure and Projects Authority

8 January 2024

Extension to appointment as senior responsible owner for the New Hospital Programme

Dear Natalie,

We are writing to confirm your extension to your appointment as senior responsible owner (SRO) of the New Hospital Programme with effect from 19 September 2023. This letter sets out your responsibilities and the support you can expect from your department and the Infrastructure and Projects Authority.

As SRO, you are directly accountable to Shona Dunn, the Second Permanent Secretary and Accounting Officer for the Department of Health and Social Care and Nick Markham CBE, Minister for the Lords. Your programme forms part of the DHSC portfolio under the oversight of the Chair of the Portfolio Oversight Board and is included in the Government Major Projects Portfolio (GMPP).

You have personal responsibility for the delivery of the New Hospital Programme and will be held accountable for the delivery of its objectives, with policy intent and outcomes expected. This encompasses securing and protecting its vision, ensuring that it is governed responsibly, reported on honestly, escalated appropriately and for influencing the context, culture and operating environment of the programme. You are also responsible for ensuring the ongoing viability of the programme and recommending its pause or termination if appropriate. Where issues arise which you are unable to resolve, you are responsible for escalating these to programme board.

You remain accountable to ministers, as set out in the Civil Service Code, and should deliver the project in accordance with the objectives and policy intent as set by ministers.

In addition to your internal accountabilities, SROs for GMPP projects and programmes are personally accountable to Parliamentary Select Committees. This means that, from the date of this letter, you will be held personally accountable to and could be called by Select Committees to account for and explain the decisions and actions you have taken to deliver the New Hospital Programme. It is important to be clear that your accountability relates only to implementation, within the agreed terms in this letter; it will remain for the minister to account for the relevant policy decisions and development.

More information on this is set out in Giving evidence to select committees - guidance for civil servants, sometimes known as the Osmotherly Rules. Information on the roles and responsibilities of the SRO are detailed in the Infrastructure and Project Authority’s guidance on the role of the senior responsible owner.

You should also make yourself familiar with the Government Functional Standard for Project Delivery, the requirements of the Government Project Delivery Framework, and the guidance and requirements for project delivery as set by the DHSC Portfolio Office.

Time commitment and tenure

This will be a full-time role to enable effective delivery of the role and execute your responsibilities in full. You are required to undertake this role until 29 March 2024, the term of your secondment to the Department of Health and Social Care. Progress towards this will be reflected in your personal objectives. The role will be subject to substantive recruitment before the end of this period. It is vital to ensure that the appropriate succession planning is undertaken with the interim programme leadership, and as such you should agree a succession plan with Shona Dunn and share it with the Infrastructure and Projects Authority Review Team appointed for the programme by January 2024.

Objectives and performance criteria

The strategic policy intent supported by this programme was first published in the government’s Health Infrastructure Plan (HIP) on 26 September 2019, which references the new hospital commitment, further developed under the 2019 government manifesto and with detail on clarity around scope, timescales and funding provided in the Prime Minister announcement of 2 October 2020.

This programme formalises government plans to transform the delivery of NHS healthcare infrastructure to provide world leading experiences for as many patients and staff as possible, to meet the changing needs and rising demand the NHS is going to face in the 2030s and beyond. Any proposed changes to scope which impacts on this intent or the realisation of benefits must be authorised by the programme board and may be subject to further levels of approval.

The vision of the programme is to transform the way new healthcare infrastructure is delivered in the NHS including the building of 40 new hospitals and its 4 strategic objectives are as follows:

• by the end of the decade, new hospitals are being delivered at significantly lower cost and in significantly less time than for historical hospital delivery. Achieving this will address some of the most pressing challenges for the NHS estate - including addressing critical infrastructure risk - and will deliver significantly improved value for money, deliver a sustainable legacy and create enhanced social value
• from 2025, ensuring all new hospitals integrate innovative national standards for healthcare infrastructure (from across government). This will enable high-quality modern healthcare and the implementation of commitments supporting transformational change for each hospital, patient and staff member. The standards include reducing unwarranted variations (Getting it Right First Time) and the digitally enabled transformation of the NHS
• by the end of the decade, the initial operational capability will be in place for an enduring nationwide capability for enhanced healthcare infrastructure delivery, both in government and the private sector and across the lifecycle of projects delivered. This will enable continuous learning and offer flexibility to respond to advances in medicine over time
• supporting the co-design and co-creation of schemes in collaboration with local and regional health systems. The New Hospital Programme will build trust and constructively challenge, to achieve a high programme satisfaction rating from trusts and government stakeholders

Your personal objectives and performance criteria which relate to the programme are to:

• deliver PBC3 to the detail that it includes integrated delivery plan. Full detail of RAAC (reinforced autoclaved aerated concrete) schemes now joining the programme and level of commercial detail to facilitate the programme delivery partner procurement
• develop Hospital 2.0 which maximises speed, efficiency and delivery of healthcare benefits through centralised standards with limited scope for variation, centralised design, modelling and assumptions, with repeatable learning and efficiencies applied to the pipeline of hospital builds in the programme. Develop centralised procurement strategy that will reset how goods and services are purchased in support of this
• publish the New Hospital Programme governance agreement, to ensure that the management and governance of the programme is articulated clearly for all. This will be essential to ensure that the mandate for the NHS to deliver the infrastructure using strategy set by government is adhered to. It will also make clear the sponsor requirements and levels of delegated approvals between HM Treasury, DHSC, Cabinet Office and NHS England
• drive at pace the procurement of a world class delivery partner for the programme - a partner that will ensure delivery of the programme objectives by having financial targets and deliverables set into the contract
• continue to ensure that stakeholder engagement, across government, Parliamentarians, the NHS and the public remains a constant priority, especially with an election on the horizon next year

Additionally, you are expected to ensure value for money of the programme, both by bearing down on costs and improving benefits, where possible. This assessment of value for money should take into account both upfront investment cost and the whole life cost of the new hospitals being delivered.

You are expected to run your project in accordance with the Government Functional Standard for Project Delivery, the other Functional Standards as applicable to this programme and the requirements of the Government Project Delivery Framework.

Extent and limit of accountability

Finance and controls

HM Treasury spending controls will apply on the basis set out within the department’s delegated authority letter. Where the programme exceeds the delegated authority set by HM Treasury, the Treasury Approval Point process will apply, and the details of each approval process must be agreed with your HM Treasury spending team. You should consult departmental finance colleagues on how to go about this.

You should note that where expenditure is considered novel, contentious, repercussive, or likely to result in costs to other parts of the public sector, HM Treasury approval will be required, regardless of whether the programme expenditure exceeds the delegated authority set by HM Treasury. If in doubt about whether approval is required you should, in the first instance, consult departmental finance colleagues before raising with the relevant HM Treasury spending team.

The overall estimated budget, resourcing requirements and tolerances for your project or programme will be agreed as part of the approval process. You will be expected to deliver within these tolerances and report quarterly on these as part of GMPP reporting.

You should operate at all times within the rules set out in Managing public money. In addition, you must be mindful of, and act in accordance with, the specific HM Treasury delegated limits and Cabinet Office controls relevant to The New Hospital Programme. Information on these controls can be found at Cabinet Office controls.

Delegated authority

You are authorised to:

• approve expenditure associated with the direct running of the programme in line with the Standing Financial Instructions of DHSC
• in relation to individual scheme business cases, make formal recommendations to the programme Investment Committee in line with agreed governance and departmental delegations as set by HM Treasury (per above)
• agree project rescheduling within the financial profile agreed with HM Treasury at Spending Review 2020 (or subsequent fiscal events should this supersede the Spending Review 2020 agreement)

Where rescheduling is driven by individual schemes exceeding agreed business case tolerances agreed via HM Treasury approval, this would require agreement by both the programme board and HM Treasury in line with departmental delegations.

You are also responsible for recommending to Shona Dunn and the Health Infrastructure Portfolio Board the need to either pause or terminate the programme where necessary and in a timely manner.

These authority limits are subject to change and other conditions or tolerances may be set as part of the business case approval and ongoing monitoring processes which you should then operate within. Where issues arise which take you outside of these authority limits which you are unable to resolve, you are responsible for escalating these issues to the Second Permanent Secretary and Accounting Officer Shona Dunn and the programme board.

Appointments

You should appoint a full-time programme director to support you in the management of this programme and make other appointments as required for the control and delivery of your programme within your delegated authority.

Governance and assurance

You should pay attention to ensuring effective governance for your programme, including the establishment of a programme board with appropriate membership and clear terms of reference. As primary owner, you must ensure that the programme secures business case approval from the Investment Committee, Cabinet Office and HM Treasury. You should also ensure that the programme remains aligned to the strategic outcomes, costs, timescales and benefits in line with the approved business case as well as monitoring the context within which the programme is being delivered to ensure it remains valid. Where a change impacts the scope, costs, benefits or planned delivery milestones agreed as part of an agreed business case, you are responsible for following the agreed change request approval process and setting a new, approved, business case baseline.

You should ensure that an accounting officer assessment is completed alongside the approval of the outline business case and that this is published on GOV.UK as part of the government’s transparency requirements on major projects. You are responsible for bringing to the attention of the accounting officer any material changes in the programme which could require a new accounting officer assessment to be completed and published. Guidance on completing accounting officer assessments for major projects is available from HM Treasury.

Although you are directly accountable for this programme, you are also expected to support delivery of the department’s overall strategic objectives. This means that you are expected to work collaboratively with other SROs and project directors in adjacent projects and programmes and with the DHSC portfolio, portfolio management office and portfolio director to manage dependencies, resources, schedules and funding to support delivery of the overall change the department needs to achieve its strategic objectives.

You should ensure that appropriate and proportionate assurance is in place and agree on the level and frequency of assurance reviews through the maintenance of an integrated assurance and approvals plan. You should develop this plan and its maintenance in collaboration with the Departmental Assurance Co-ordinator and the Infrastructure and Projects Authority.

Programme status, reporting and transparency requirements

The programme status at the date of your appointment is reflected in the most recent quarterly return on the programme to the Infrastructure and Projects Authority and is the agreed position as you assume formal ownership of the programme.

You are responsible for ensuring the honest and timely reporting on the position of the programme to the Infrastructure and Projects Authority while it remains on the GMPP and for providing reports and information to the DHSC portfolio management office as required. Reporting should include carbon measurement and other sustainable development goals demonstrating evidence that the project contributes to an overarching environmental strategy and is aligned with defined Net Zero pathways. Information on the programme will be published annually by the Infrastructure and Projects Authority.

As part of the government’s commitment to transparency on major infrastructure projects, you are responsible for publishing on GOV.UK:

• a summary of the accounting officer assessment completed in line with the approval of the outline business case and summaries of any subsequent assessments should they be required
• a summary of the HM Treasury approved full business case
• a close out report after the programme has completed

Development and support

As a graduate of the Major Projects Leadership Academy, you are expected to maintain your continuing professional development as a project leader, including your status as an accredited assurance reviewer. To maintain your accreditation, you will be required to participate in a review at least once every 12 months.

The department will assist you in securing the necessary resources to support the programme, and will set clear guidance, requirements and standards, which align to the Government Functional Standard on Project Delivery, to enable good governance and effective delivery. You will be part of the department’s cohort of major project leaders who will be expected to support each other, share good practice and lessons learned and to collectively develop solutions. You should liaise with the department’s Head of Profession for project delivery to discuss the maintenance and development of your delivery and leadership skills.

The Infrastructure and Projects Authority will be available to you for support, advice, and assurance throughout the programme’s time on the GMPP. Following approval of the business case and entry onto the DHSC portfolio, the Portfolio Oversight Board provide ongoing oversight and support and will take steps to help resolve and escalate risks, issues or constraints that are acting as a blocker to successful delivery.

We would like to take this opportunity to wish you every success in your role as SRO.

Yours sincerely,

Shona Dunn, Second Permanent Secretary and Accounting Officer for the Department of Health and Social Care

Nick Smallwood, Chief Executive Officer, Infrastructure and Projects Authority

Confirmation of acceptance of appointment

I confirm that I accept the appointment of senior responsible owner for the programme, including my personal accountability for implementation, as set out in the letter above.

Natalie Forrest