Policy paper

New Hospital Programme: equality impact assessment

Published 20 January 2025

Applies to England

Introduction

The general equality duty that is set out in the Equality Act 2010 requires public authorities, in the exercise of their functions, to have due regard to the need to:

• eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the act
• advance equality of opportunity between people who share a relevant protected characteristic and those who do not
• foster good relations between people who share a relevant protected characteristic and those who do not

The general equality duty does not specify how public authorities should analyse the effect of their existing and new policies and practices on equality but doing so is an important part of complying with the general equality duty.

Summary of policy or proposal

The New Hospital Programme (NHP) was established in 2020 to deliver (or see through to completion) 40 hospital build projects by 2030. NHP was allocated an initial £3.7 billion to support activity over 4 years until March 2025. In 2023, the number of hospitals to be delivered through the programme increased to 46. This was due to the addition of 5 hospitals built primarily with reinforced aerated autoclaved concrete (RAAC) and the expansion of one project into 2 individual hospital schemes. It was also announced in 2023 that, due to the need to prioritise the delivery of the additional RAAC hospitals (bringing the total RAAC schemes to 7) in the programme, 9 other hospitals would be delayed past the original commitment of delivery by 2030.

In July 2024, the Secretary of State for Health and Social Care, and subsequently the Chancellor, announced that the new government would undertake a comprehensive review of the NHP to provide a realistic and affordable timetable for delivery. The review report sets out a number of possible options for shaping the programme going forward. In that context, all options reflected a realistic and deliverable schedule, and cost range. The Department of Health and Social Care (DHSC) and HM Treasury (HMT) have agreed a high-level plan for the programme which has been set within an agreed financial constraint. This will mean that some schemes will now be delivered post 2030.

This equality impact assessment (EQIA) assesses the extent to which service users might be impacted by these delivery proposals, with specific reference to the impact that those policy proposals might have on relevant protected characteristics.

The schemes in scope of the review were analysed for the purposes of the EQIA. Further information can be found in the terms of reference for the review. It is worth noting that some of these schemes are still scheduled to complete before 2030.

Effect on service users

Staff and patients will continue to work and be treated in existing hospital facilities, many of which have existing backlog maintenance issues. Following the outcome of the review, this period will be for longer than expected for some schemes. However, once the scheme is delivered staff and patients will benefit from state-of-the-art modern facilities.

Evidence

NHS hospital trusts do not have defined geographical boundaries, but by analysing the patterns of who uses which trust, it is possible to generate ‘catchment areas’. Trust catchment areas are modelled geographical areas from which the patients of a particular trust are drawn. The Office for Health Improvement and Disparities (OHID) has calculated these modelled catchment areas for the NHS Acute (Hospital) Trust Catchment Populations dashboard. Defining a geographic area for each trust allows for a client population to be defined and for the characteristics of that population to be identified and compared with England. This enables us to understand if the trust is likely to service an older or younger population compared with England, and to undertake a similar analysis for all protected characteristics for which there is data available.

This impact assessment uses data from the 2021 Census to provide insight into the protected characteristics of people within the catchment areas of each trust. This will support DHSC in understanding whether any changes to the NHP are more likely to impact on groups with specific protected characteristics within a particular population.

2021 Census data for age, sex, disability, ethnic group, gender identity, legal partnership, religion and sexual orientation was analysed for this EQIA. Details and caveats of the analysis can be found under annex A with detailed data for protected characteristics set out in the accompanying spreadsheet - New Hospital Programme: data on protected characteristics.

Analysis of impacts

Please note that the detailed plans for some new hospital schemes have not been confirmed therefore lists of schemes related to a given protected characteristic (for example, sex) may be subject to change. Additionally, some schemes will not replace existing services but instead, will create additional services to support an existing hospital facility.

We will keep the impact of the new programme delivery timetable under review, including through updates to the EQIA. If significant adverse impacts on specific groups become evident, we will consider how best to address these.

Disability

Disabled people are more likely to use hospital services and therefore they are proportionately more likely to experience a less favourable patient experience while they wait for their local new hospital to be delivered. However, this was not the intention of the NHP or the review: these schemes were in scope because their full business case (FBC) had not been approved nor were they RAAC replacement schemes. Patient safety will continue to be a key priority while the trust continues to operate out of existing hospitals. Additionally, care provision will improve once older hospitals are replaced with new hospitals fit for the future.

In the 2021 Census 17.3% of the population in England reported having a disability under the Equality Act. Among the trusts under study, this varies from 12.5% of the population served by Barts Health NHS Trust to 22.2% of the population in the Torbay and South Devon NHS Foundation Trust area. In total, 12 trusts have a statistically significant lower percentage of people reporting having a disability under the Equality Act than England, one was not significantly different and the remaining 11 trusts have statistically significant higher percentages.

Sex

There was little variance in the results related to the proportion of men and women in each scheme area.

There are several in-scope schemes which are expected to provide women and children’s specialist facilities which may be delayed as a result of the updated delivery schedule following the outcome of the review. The following schemes could particularly impact women given the specialist services they are expected to provide:

• Milton Keynes Hospital - a new women and children’s and surgery block, refurbished day surgery unit and imaging centre at Milton Keynes hospital
• North Devon District Hospital, Barnstaple - the new build acute care block will include theatres, intensive care unit, endoscopy and women and children’s services
• The Queen’s Medical Centre and Nottingham City Hospital - rebuild of both the Queen’s Medical Centre and City Hospital sites including a consolidation of maternity and women and children’s services at Queen’s Medical Centre
• Shotley Bridge Community Hospital, County Durham - a new hospital including inpatient beds, with unscheduled care, women’s services, outpatient activity, chemotherapy and diagnostics to replace the existing Shotley Bridge Hospital
• Whipps Cross University Hospital, north-east London - a new hospital at Whipps Cross, providing a range of patient services including emergency and maternity
• Women and Children’s Hospital, Cornwall - a new women and children’s hospital in the centre of the Royal Cornwall Hospital site in Truro. The new hospital will have horizontal links to the existing hospital and bring together all women and children’s services into one building

Delays to some of these schemes following the outcome of the review may result in greater impacts on women because some services planned under NHP will have specialised women’s services. Delays to some of these services may impact accessibility to specialised care and patient experience in the interim while patients wait for the new hospital to be delivered. However, this was not the intention of the NHP or the review: these schemes were in scope because they had not had their FBC approved, nor were they RAAC replacement schemes. As a result, these schemes were assessed and reprioritised as part of the review on the basis of deliverability and critical risk. Services will continue at existing hospitals in the interim and patient safety will continue to be a key priority while the trust continues to operate out of existing hospitals. Once delivered, these units will provide state-of-the-art modern facilities for patients.

Sexual orientation

These changes are not expected to have any direct or indirect negative impacts on the protected characteristic of sexual orientation.

This is because any change to the delivery schedule of NHP schemes is not expected to disproportionately impact any particular sexual orientation given that care received at these schemes is not expected to be specific to any sexual orientation.

Race

These changes are not expected to have any direct or indirect negative impacts on the protected characteristic of race. This is because any change to the delivery schedule of NHP schemes is not expected to disproportionately impact any racial groups given that care received at these schemes is not expected to be specific to any racial group.

Age

The age characteristics of the NHS trusts presented in this analysis are varied. This shows that 7 trusts have proportionately younger populations than England, 3 trusts have a larger working age population, 8 have a proportionately older population and the remaining 6 have populations similar to the England distribution.

There are several NHP schemes which are in scope of the review where certain age groups are more likely to be impacted by a delay to NHP schemes being delivered. The following schemes could particularly impact children given the specialist services they are expected to provide:

• Derriford Emergency Care Hospital, Plymouth - a new integrated emergency care hospital, bringing all urgent care into one emergency care hospital, with dedicated areas for children and frail patients
• Leeds General Infirmary - a new adults’ and children’s hospital at Leeds General Infirmary and a new pathology laboratory at St James’s Hospital
• Milton Keynes Hospital - a new women and children’s and surgery block, refurbished day surgery unit and imaging centre at Milton Keynes hospital
• North Devon District Hospital, Barnstaple - the new build acute care block will include theatres, intensive care unit, endoscopy and women and children’s services
• Queen’s Medical Centre and Nottingham City Hospital - rebuild of both the Queen’s Medical Centre and City Hospital sites including a consolidation of maternity and women and children’s services at Queen’s Medical Centre
• Whipps Cross University Hospital, north-east London - a new hospital at Whipps Cross, providing a range of patient services including emergency and maternity
• Women and Children’s Hospital, Cornwall - a new women and children’s hospital in the centre of the Royal Cornwall Hospital site in Truro. The new hospital will have horizontal links to the existing hospital and bring together all women and children’s services into one building

Delays to some of these schemes following the outcome of the review may result in greater impacts on children because some services planned under NHP will have specialised children’s services. Delays to some of these services may impact accessibility to specialised care and patient experience in the interim, while patients wait for the new hospital to be delivered. However, this was not the intention of the NHP or the review: these schemes were in scope because their FBC had not been approved nor were they RAAC replacement schemes. As a result, these schemes were assessed and reprioritised as part of the review on the basis of deliverability and critical risk.

We also know that the elderly account for 40% of hospital admissions and occupy two-thirds of inpatient beds and will therefore be disproportionately impacted by this change compared to other age groups due to the increased proportion of hospital services which are typically used by this group. However, this was not the intention of the NHP or the review: these schemes were in scope because their FBC had not been approved nor were they RAAC replacement schemes and once delivered, these units will provide state-of-the-art modern facilities for patients. Patient safety will continue to be a key priority while the trust continues to operate out of existing hospitals.

Gender reassignment (including transgender)

These changes are not expected to have any direct or indirect negative impacts on the protected characteristic of gender reassignment. This is because any change to the delivery schedule of NHP schemes is not expected to disproportionately impact cisgender or transgender groups. Additionally, none of the in-scope schemes are currently expected to provide specialised services for gender-affirming treatment.

Religion or belief

These changes are not expected to have any direct or indirect negative impacts on the protected characteristic of religion or belief. This is because the provisions an individual can access in these schemes will not be dependent on the individual’s faith background and are open to all, therefore a change to the delivery schedule is not expected to disproportionately impact any religious group.

Pregnancy and maternity

There is no data in the Census on pregnancy or maternity. However, the following in-scope NHP schemes are expected to provide pregnancy and maternity care which may be delayed:

• Hampshire Hospitals - a new hospital for north and mid Hampshire and major refurbishment at Winchester to provide specialist and emergency care including maternity services
• Leeds General Infirmary - a new adults’ and children’s hospital (including a maternity centre) at Leeds General Infirmary and a new pathology laboratory at St James’s Hospital
• Queen’s Medical Centre and Nottingham City Hospital - rebuild of both the Queen’s Medical Centre and City Hospital sites including a consolidation of maternity and women and children’s services at Queen’s Medical Centre
• Torbay Hospital, Torquay - a new build elective centre and ward block at Torbay Hospital including upgrade of the emergency department, maternity services and same day urgent care services
• Whipps Cross University Hospital, north-east London - a new hospital at Whipps Cross, providing a range of patient services including emergency and maternity
• Women and Children’s Hospital, Cornwall - a new women and children’s hospital in the centre of the Royal Cornwall Hospital site in Truro. The new hospital will have horizontal links to the existing hospital and bring together all women and children’s services into one building including maternity care

Delays to some of these schemes following the outcome of the review may result in greater impacts on those who are pregnant because some services planned under NHP will have specialised maternity services. Delays to some of these services may impact accessibility to specialised care and patient experience in the interim while patients wait for the new hospital to be delivered.

Given the time-sensitive nature of pregnancy and maternity, it’s acknowledged that some women using maternity services in the interim will miss out on using new and modern facilities. However, this was not the intention of the NHP or the review: these schemes were in scope because their FBC had not been approved nor were they RAAC replacement schemes. As a result, these schemes were assessed and reprioritised as part of the review on the basis of deliverability and critical risk. Once delivered, these units will provide state-of-the-art modern facilities for patients. Patient safety will continue to be a key priority while the trust continue to operate out of existing hospitals.

Marriage and civil partnership

These changes are not expected to have any direct or indirect negative impacts on the protected characteristic of marriage and civil partnership, to the extent that it’s relevant to the first limb of the section 149 Equality Act 2010 (the ‘public sector equality duty’). This is because hospital care is not dependent on marital status.

Engagement and involvement

Evidence and testing

Given the pace of the review, equalities stakeholders were not engaged as part of the review process. However, NHS England regional representatives were engaged on the approach of the review and had a better understanding of the demographics of their regions in more detail.

Shaping policy or proposal

The internal review was conducted jointly between DHSC and NHS England, with support and input from HMT. The development of the review was supported by engagement with representation from Cabinet Office and the Infrastructure and Projects Authority who were briefed on the methodology that would be applied.

As part of the review process, NHP engaged with NHS England regional representatives on the review, and they were supportive of the approach as appropriate for the timescales of the review. The review has considered each in-scope scheme in the programme against critical risks, including the health deprivation index, and construction deliverability which aided ministers in prioritising schemes.

Summary of analysis

Overall, those who are:

• disabled
• women
• children and the elderly
• pregnant or receiving maternity care

and live in the catchment area for one of the in-scope schemes are more likely to be disproportionately impacted by this policy change compared to the rest of the local community. However, patient safety will continue to be a key priority while the trust continue to operate out of existing hospitals.

Once the NHP schemes have been delivered, the local community will receive a state-of-the-art new hospital constructed with sustainable building materials and intelligent technology.

Overall impact

There is no indication that any of these groups will be discriminated against as a result of this policy change given that this change had to take place in order to ensure that the programme was deliverable. Patients and staff will continue to use existing hospitals, many of which will be replaced by state-of-the-art facilities.

Addressing the potential impact on equalities

The purpose of the review into the NHP was to provide a thorough, costed and realistic timeline for delivery to ensure we can replace the deteriorating hospital estate in England, ensuring staff and patients have access to the facilities they deserve. Trusts will receive funding to address backlog maintenance issues to ensure that services continue in the interim.

Everyone will benefit from hospital design expectations being strengthened due to the programme’s approach to standardising design for future hospitals, known as ‘Hospital 2.0’. This is being designed with clinical and operational staff and will mean hospitals can be built more quickly and will result in facilities for both patients and staff that are at the cutting edge of modern technology, innovation, sustainability and excellent patient care.

Additionally, the programme is proactively working with NHS England to ensure we consider inclusivity at every step of Hospital 2.0 development. Hospital 2.0 will improve access to hospitals through wayfinding, privacy and dignity through single rooms, and utilise new technologies to enable benefits for improved access to health services, while ensuring support and access for those with reduced digital access and literacy.

It is anticipated that the programme will bring positive change for all protected characteristic groups within those communities, as hospital schemes are delivered. This will advance equality of opportunity between people who share a protected characteristic and people who do not. The delay in delivering some NHP schemes is not expected to impact relations between those in different protected characteristics. However, once the schemes are delivered, this may foster more positive relations between groups given the positive impacts of investment in the region. It is also recognised that some areas will benefit from new hospital infrastructure that is modern, efficient and fit for the future at a much later date.

Monitoring and evaluation

We recognise that public sector equality duty is an ongoing duty which requires the NHP to assess equality impacts throughout the policy development, decision making and implementation phases, and beyond. The programme will continually monitor the status and delivery of schemes. If the delivery team in the programme identify adverse or disproportionate impacts on any protected characteristic groups, they should raise this with DHSC so that this impact assessment can be reviewed and updated as necessary.

Conclusion

Those who are part of some protected characteristic groups in the catchment area of in-scope schemes may be indirectly impacted compared to others in the local community, as a result of the decision to give certainty to communities over the delivery timetable for the NHP.

Our analysis, with the support from OHID, shows that some schemes have populations with higher proportions of those with certain protected characteristics. Women, children, the elderly, pregnant people and disabled people may be disproportionately impacted if their local scheme is delayed given the specialist services which the schemes are expected to provide and those who are more likely to use hospital services in general. NHP and the wider DHSC will work to ensure that trusts are supported during this change. The programme also ensured that these groups were considered in the decision making process in confirming the new delivery schedule for the programme as well as other considerations, such as critical risk and deliverability.

Annex A: supporting data

Overview

NHS hospital trusts do not have defined geographical boundaries, but by analysing the patterns of who uses which trust, it is possible to generate ‘catchment areas’. Trust catchment areas are modelled geographical areas from which the patients of a particular trust are drawn. OHID has calculated these modelled catchment areas for the NHS Acute (Hospital) Trust Catchment Populations dashboard. Defining a geographic area for each trust allows for a client population to be defined and for the characteristics of that population to be identified and compared with England. This enables us to understand if the trust is likely to service an older or younger population compared with England and to undertake a similar analysis for all protected characteristics for which there is data available.

This report uses data from the 2021 Census to provide insight into the protected characteristics of people within the catchment areas of each trust. This will support DHSC in understanding whether any changes to the NHP is more likely to impact on populations with specific protected characteristics.

Data from the 2021 Census is available for age, sex, disability, ethnic group, gender identity, legal partnership, religion and sexual orientation. The supporting data can be found in the accompanying spreadsheet. There was no Census data related to pregnancy and maternity but internal data was used to assess the impact of the review on this protected characteristic.

Appendix

Caveats

The analysis is based on the acute trust catchment areas.

Trust catchment populations give estimates for the number of people using each hospital trust or have the potential to do so. These figures are only available for a whole trust and are not available for individual sites within a hospital trust. The population served by a trust is unlikely to be geographically homogenous and populations in different areas that are served by the trust are likely to have different proportions of people with protected characteristics.

Hospitals in acute trusts have a range of specialities and the services provided by the trust affect the type of patient that use those services. An extreme example is a specialist children’s hospital, such as Great Ormond Street in London or the Women’s and Children’s Hospital Trust in the Midlands. These both have unusual trust catchments because people from a wider area are diverted to these trusts in specific circumstances. Children from across the Birmingham area will be taken by ambulance to the children’s hospital even if another hospital is closer. This impacts on the trust catchment for the more specialist trust as well as the general trust that would otherwise treat the patient. Context is important when using and interpreting the trust catchment populations.

The most recent time period that the trust hospital catchments have been calculated for is for 2020. This includes a 3-year period spanning 1 April 2018 to 31 March 2021.

The most recent trust catchment period includes the part of the COVID-19 pandemic period in England in which hospital activity was unusual.

Hospital activity since this period may have changed and if so, new trust catchment areas may have changed.

Population data

The trust catchment area calculation includes the use of population data. The data used is based on the Office for National Statistics mid-year population estimates for 2020 and therefore predates the 2021 Census. Note that these are the original population estimates rather than rebased population estimates following the 2021 Census.

Middle super output area geographies

Middle layer super output areas (MSOAs) are usually comprised of 4 or 5 lower layer super output areas (LSOAs). They contain between 2,000 and 6,000 households and have a usual resident population between 5,000 and 15,000 people. MSOAs fit within local authorities.

The data in the trust catchment population was calculated for MSOAs based on the 2011 Census. Following the 2021 Census, changes were made to some MSOAs. The 2011 MSOAs have been mapped across to 2021 boundaries to ensure that we could use the latest data from the 2021 Census in this analysis. However, the mapping process is not perfect.

Methods

Acute hospital trust catchment populations are determined in the following way:

1. Hospital Episode Statistics data is used to count the number of patients admitted to hospital from every small area in England, based on MSOAs, which are standard Office for National Statistics geographies of about 7,200 people.
2. For each MSOA, calculations are made to determine what proportion of admitted patients from that MSOA attended each hospital trust.
3. These proportions are then used to determine which trust services the highest proportion of patients in each MSOA, which then allows MSOAs to be mapped to a single trust.

The trust catchment populations therefore tell us which MSOAs are in the notional catchment area of each trust, based on actual usage rather than theoretical boundaries.

This report then takes Census 2021 data at MSOA level and calculates aggregated values for all MSOAs in each trust.