Foreword

Following the 2024 General Election, the Chancellor and I set out to undertake a review of the New Hospital Programme (NHP) to provide a realistic and affordable timetable for delivery.

The NHP was announced in October 2020 to deliver 40 new hospitals by 2030. Despite the claim, there were not 40 ‘new’ schemes and some were just refurbishments or extensions. To put it simply - there were not 40 of them, they were not all new and many were not even hospitals.

The spin that had been applied to the programme was widely known before the election. But even knowing that, I was shocked by what I found on entering the Department of Health and Social Care (DHSC). The programme was hugely delayed, by several years more than had already been revealed by the National Audit Office. Most shocking of all, the funding for the programme was due to run out in March of this year, with no provision for future years whatsoever. The money simply was not there. The programme was built on the shaky foundation of false hope and without the confirmed funding these building projects could not be delivered, let alone delivering them all in the next 5 years.

If I was shocked by the state of this programme, patients ought to be furious. Not only because the promises made to them were never going to be kept. They also desperately need new buildings and new hospitals.

The NHS is quite literally crumbling. I have visited hospitals where the roof has fallen in, pipes regularly leak and even freeze over in winter. As Lord Darzi found in his investigation, the NHS was starved of capital in the 2010s, with £37 billion under-investment over the 2010s. This lack of investment meant the UK construction sector did not have the appetite and capacity to build the number of concurrent hospitals required to deliver 40 new hospitals by 2030 when this promise was made. Delivery is dependent on providing certainty to develop relationships and secure investments in the supply chain which would ensure this vital hospital infrastructure is realised. 

This review was launched for 2 reasons. First, to put the programme on a firm footing with sustainable funding, so all the projects can be delivered. Second, to give patients an honest, realistic, deliverable timetable in which they can have confidence.

This government is committed to rebuilding our NHS and to rebuilding trust in government. We will never play fast and loose with the public finances or with the public’s trust.

Following the review into the NHP, and the funding secured through the Spending Review, we are now publishing a credible plan and timeline to deliver the new hospital schemes.

Working closely with colleagues in HM Treasury (HMT), we have secured 5-year waves of investment, ensuring that there is always a balanced portfolio of hospital schemes at different development stages being delivered now and into the future. This is the most efficient and cost-effective way of giving our NHS the buildings it needs, giving the construction sector the certainty it needs to deliver. We are backing this plan with investment which will increase up to £15 billion over each consecutive 5-year wave, averaging around £3 billion a year from 2030.

I would rather take tough decisions which are the right decisions for the future, than lead patients up a garden path once more only for them to be let down again. Alongside record levels of capital investment - £13.6 billion next year, including the NHP - we have now put the NHP on a sustainable footing, with a timeline that can be met and a budget that is consistent with the fiscal rules under which the government is operating.

My commitment to you is that we will deliver these hospitals and rebuild our NHS.

Rt Hon Wes Streeting MP
Secretary of State for Health and Social Care

Summary

This government inherited a programme that was unfunded beyond 2025, which meant schemes did not have the funding confirmation they needed to deliver.

The review was conducted by DHSC and NHS England, with support and input from HMT, using existing and, where possible, publicly available information. The review fed into the Spending Review process for the Autumn 2024 Budget, where decisions on the outcome were taken in the round.  

We are committing to deliver all schemes that have previously been included as part of the NHP.

The 7 hospitals constructed primarily using reinforced autoclaved aerated concrete (RAAC) will continue to be prioritised in the programme and we will continue to address the highest risk elements as early as possible.

The government has agreed a set of realistic and deliverable assumptions around the ongoing funding envelope that will enable the programme to plan sustainably for the long term and support schemes in rolling waves of investment. The exact profile of funding will be confirmed in rolling 5-year waves at regular Spending Reviews (as with all government capital budgets in the future). Once the programme has reached a steady state in the early 2030s it can assume an overall funding envelope of £15 billion in each 5-year funding window.

Following the review, work was undertaken to set out a realistic delivery plan. The NHP will now be delivered through consecutive waves of investment.

Each wave will set construction start dates for schemes over a 5-year period.

Each wave will comprise a group of hospital schemes that will start main construction within that period, but may complete in a subsequent wave. 

Schemes starting in subsequent waves will have opportunities to progress work to prepare them for construction, subject to meeting value for money criteria. This may include business case development and critical work such as securing planning permission. In some cases, this may include early construction activity that is required to prepare sites such as multi-storey car parks, energy centres and demolition activity.

About the New Hospital Programme

Programme background

In summer 2019, NHS England provided DHSC with a list of 56 priority schemes, selected based on age, existing running costs, backlog costs and critical infrastructure risk. In October 2019, DHSC published its Health Infrastructure Plan (HIP). Based on these criteria, DHSC identified 6 Health Infrastructure Plan 1 projects to be delivered between 2020 and 2025. A further 24 projects were identified for Health Infrastructure Plan 2, which were scheduled to develop their plans between 2025 and 2030. The schemes to be included were identified by DHSC based on a combination of criteria, including the level of critical infrastructure risk and an overall regional breakdown of projects.

In October 2020, the NHP was established as part of the previous government’s commitment to build 40 new hospitals by 2030 and the programme was tasked with identifying ways to improve the efficiency and quality of hospital construction through a centralised approach. In addition to the 32 hospitals announced in 2020, the NHP also encompassed 8 schemes that had existed prior to the 2019 HIP (Brighton 3Ts (trauma, teaching and tertiary care), Royal Liverpool Hospital, Midland Metropolitan Hospital, Care Environment Development and Re-provision (CEDAR) Programme, National Rehabilitation Centre, Greater Manchester Major Trauma Centre, Oriel Eye Hospital, Northern Centre for Cancer Care) and a process was set up to determine a further 8 hospitals to join the programme in the future.

In May 2023, the previous government announced that 5 additional hospitals constructed primarily using RAAC would be brought into the NHP to be rebuilt by 2030, in addition to the 2 RAAC schemes already in the programme. The RAAC schemes were prioritised due to risks these buildings pose to patients and staff, as construction of new hospitals was the most beneficial and cost-effective option to remove and mitigate fully the RAAC risks. At this announcement the previous government said the programme would be backed by over £20 billion of investment. However, this amount was never formally agreed through the required programme business case process, a Spending Review or Budget.

A programmatic approach

Historically NHS hospitals have been built individually by trusts, with projects often over budget and with delayed time frames. NHP’s standardised approach sets out to:

• leverage economies of scale
• standardise hospital designs
• improve productivity
• ensure value for money
• support delivery

The standardised approach also supports engagement with the construction market, which is key to ensuring the number of hospitals that are required to be built at the same time can be delivered.

The programme’s approach to standardisation, known as ‘Hospital 2.0’, has been designed with clinical and operating staff and aims to speed up construction, decrease the overall time for hospitals to be built and result in facilities that maximise modern technologies. The standard approach allows for lessons to be learnt iteratively as schemes complete within the programme, creating a repository of knowledge for future projects. A hospital built through Hospital 2.0 principles will use sustainable and modern methods of construction designed for manufacturing assembly to accelerate the building process.

Key to this approach is offering certainty to the construction industry. They are not signing up for one hospital scheme but several hospitals in a rolling programme. In a competitive construction market this level of certainty can allow industry to bid for contracts with the certainty they are in the programme for the long term. The review was initiated to give communities certainty over their local schemes, however it was also to address concerns from the construction industry and provide them with faith in this programme.

Waves of delivery

The tables below show the current expectations for delivery of schemes, and cost estimates, based on current assessments as of January 2025, following the review into the NHP and agreement to 5-year waves of investment. Delivery expectations may be subject to change depending on local and national factors and the programme reserves the right to adjust the delivery plan as schemes develop in the future. Due to the substantive safety risks of RAAC, these schemes will continue to proceed at pace. The site-by-site survey report on RAAC hospitals commissioned by the Secretary of State will help inform individual development plans, which includes continued mitigation works as well as addressing the highest risk elements as early as possible through phasing of works.

Note 1: these schemes were announced before the establishment of the NHP in October 2020 and therefore NHP estimated costs are not complete.

Table 1: wave 0 schemes (already under construction)

Scheme	Cost estimate
Alumhurst Road Children’s Mental Health Unit, Dorset	£500 million or less
Royal Bournemouth Hospital, Dorset	£500 million or less
St Ann’s Hospital, Dorset	£500 million or less
Dorset County Hospital, Dorchester	£500 million or less
CEDAR Programme	Cost estimate not given [see note 1]
Oriel Eye Hospital	Cost estimate not given [see note 1]
National Rehabilitation Centre	Cost estimate not given [see note 1]

Table 2: wave 1 schemes (to start construction between 2025 and 2030)

Scheme	Expected construction start date (post-NHP review)	Cost estimate
Poole Hospital, Dorset	2025 to 2026	£500 million or less
Derriford Emergency Care Hospital, Plymouth	2025 to 2026	£500 million or less
Cambridge Cancer Research Hospital	2025 to 2026	£500 million or less
Shotley Bridge Community Hospital, Durham	2026 to 2027	£500 million or less
Milton Keynes Hospital	2027 to 2028	£500 million or less
Women and Children’s Hospital, Cornwall	2027 to 2028	£500 million or less
Hillingdon Hospital, north-west London	2027 to 2028	£1 billion to £1.5 billion
North Manchester General Hospital	2027 to 2028	£1 billion to £1.5 billion
West Suffolk Hospital, Bury St Edmunds (RAAC)	2027 to 2028	£1 billion to £1.5 billion
Hinchingbrooke Hospital (RAAC)	2027 to 2028	£501 million to £1 billion
James Paget Hospital, Great Yarmouth (RAAC)	2027 to 2028	£1 billion to £1.5 billion
Queen Elizabeth Hospital, King’s Lynn (RAAC)	2027 to 2028	£1 billion to £1.5 billion
Leighton Hospital (RAAC)	2027 to 2028	£1 billion to £1.5 billion
Airedale General Hospital (RAAC)	2027 to 2028	£1 billion to £1.5 billion
Frimley Park Hospital (RAAC)	2028 to 2029	£1.5 billion to £2 billion
Brighton 3Ts Hospital	2026 to 2027	Cost estimate not given [see note 1]

Table 3: wave 2 schemes (to start construction between 2030 and 2035)

Scheme	Expected construction start date (post-NHP review)	Cost estimate
Leeds General Infirmary	2032 to 2034	£1.5 billion to £2 billion
Specialist Emergency Care Hospital, Sutton	2032 to 2034	£1.5 billion to £2 billion
Whipps Cross University Hospital, north-east London	2032 to 2034	£1 billion to £1.5 billion
Princess Alexandra Hospital, Harlow	2032 to 2034	£1.5 billion to £2 billion
Watford General Hospital	2032 to 2034	£1.5 billion to £2 billion
Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital	2032 to 2034	£1 billion to £1.5 billion
Kettering General Hospital	2032 to 2034	£1 billion to £1.5 billion
Musgrove Park Hospital, Taunton	2032 to 2034	£501 million to £1 billion
Torbay Hospital	2032 to 2034	£501 million to £1 billion

Table 4: wave 3 schemes (to start construction between 2035 and 2039)

Scheme	Expected construction start date (post-NHP review)	Cost estimate
Charing Cross Hospital and Hammersmith Hospital, London	2035 to 2038	£1.5 billion to £2 billion
North Devon District Hospital, Barnstaple	2035 to 2038	£1 billion to £1.5 billion
Royal Lancaster Infirmary	2035 to 2038	£1 billion to £1.5 billion
St Mary’s Hospital, north-west London	2035 to 2038	£2 billion or more
Royal Preston Hospital	2037 to 2039	£2 billion or more
Queen’s Medical Centre and Nottingham City Hospital	2037 to 2039	£2 billion or more
Royal Berkshire Hospital, Reading	2037 to 2039	£2 billion or more
Hampshire Hospitals	2037 to 2039	£2 billion or more
Eastbourne District General, Conquest Hospital and Bexhill Community Hospital	2037 to 2039	£1.5 billion to £2 billion

Background to the review

The terms of reference for the review were agreed by the Secretary of State for Health and Social Care and the Chief Secretary to the Treasury and published on 20 September 2024.

The review considered several options which provided indicative schedules and costs for their delivery.

Schemes in scope of the review

As set out in the terms of reference, in scope of the review are 25 out of a total of 46 hospitals in the NHP.

The 21 out-of-scope schemes within the programme have continued work during the review period and would continue to be delivered in any circumstances.

Out-of-scope schemes include:

• 14 schemes which are either open to patients, are in construction or have had their main build full business case approved
• 7 schemes which will replace RAAC hospitals which need to proceed at pace due to substantive safety risks

Of the 25 in scope of the review, 7 schemes are due to start construction in the upcoming wave of construction (2025 to 2030) and the remaining 18 schemes are planned to start in the subsequent wave of construction. Nine of these schemes (including the Royal Preston and Royal Lancaster NHP scheme which was split into 2 schemes in December 2023) were moved into subsequent waves of construction in May 2023 to respond to the introduction of 5 additional RAAC schemes into the programme at that time. This change recognised that these schemes were the largest and most complex schemes and had significant development work to do prior to being ready for construction.

In parallel to this review, the Secretary of State has commissioned an updated site-by-site report of the RAAC hospitals to better understand the impact of the substantial mitigation work that has taken place since May 2023 and to inform decisions in the delivery of the replacement hospitals. The report and findings are due in summer 2025.

Figure 1: map of NHP schemes categorised by schemes which are in and out of scope. RAAC hospitals (all out of scope) are highlighted separately (note: given the scale of the map, scheme locations are indicative only)

Figure 1 description: map showing NHP schemes in the different regions of England, with colour-coding to categorise their status as in or out of scope of the NHP review, with RAAC hospitals highlighted separately.

The map shows 25 schemes in scope of the review, with 5 in the south-west, 5 in the south-east, 4 in London, 4 in the east, 2 in the west Midlands, 3 in the north-west, 1 in Yorkshire and the Humber and 1 in the north-east.

The map also shows 16 schemes out of scope of the review, with 4 in the south-west, 2 in the south-east (one being a RAAC schemes), one in London, 4 in the east (all RAAC schemes), 2 in the west Midlands (one being a RAAC scheme), one in the east Midlands, one RAAC scheme in Yorkshire and the Humber, and one out-of-scope scheme in the north-east. The map does not show out-of-scope schemes that were completed prior to the NHP Review (note: given the scale of the map, the scheme locations are indicative only).

Limitations to scope

The scope was limited to schemes that have previously been announced as part of the NHP. Additionally, detailed plans for delivery at scheme-level (for example, whether these could be further divided into smaller schemes) were not within the remit of this review.

The scope and scale of the NHP in all options continue to require a centralised, programmatic approach so there was no proposed change to the assumptions regarding the programme’s delivery and commercial strategy - in particular the requirement for a programme delivery partner and a collaborative contractor’s framework, now known as the Hospital 2.0 Alliance. It was noted that flexibility to the current scope of the contracts may be needed once the final approach is selected by ministers.

Funding assumption

The review assumed that the majority of NHP funding will be from the public dividend capital, with some modest contributions from land sales and charitable donations.

Review options

Options identification

It was assumed all options must reflect a realistic and deliverable schedule, and prudent cost range. It was also assumed that the amount of funding within a given year will be the key constraint.

The approach to the review has focused on delivering the 37 schemes that were either in construction or were due to start in the upcoming Spending Review 2025 to 2030 period. This includes the 21 out-of-scope schemes, as well as 16 other schemes:

• Derriford Emergency Care Hospital
• Cambridge Cancer Research Hospital
• Shotley Bridge Community Hospital
• Women and Children’s Hospital (Cornwall)
• Milton Keynes Hospital
• Hillingdon Hospital
• North Manchester General Hospital
• Specialist Emergency Care Hospital (Sutton)
• Leicester General Hospital
• Watford General Hospital
• Princess Alexandra Hospital
• Whipps Cross University Hospital
• Leeds General Infirmary
• Torbay Hospital
• Kettering General Hospital
• Musgrove Park Hospital (already in the programme)

For the 9 schemes already proposed to start after 2030, following the May 2023 announcement, there was consideration whether any were sufficiently high risk to substitute in the place of any of the 16 schemes in the upcoming wave of construction. These 9 schemes are:

• Charing Cross Hospital and Hammersmith Hospital
• North Devon District Hospital
• Royal Lancaster Infirmary
• Royal Preston Hospital
• St Mary’s Hospital, north-west London
• Queen’s Medical Centre and Nottingham City Hospital
• Royal Berkshire Hospital, Reading
• Hampshire Hospitals
• Eastbourne District General, Conquest Hospital and Bexhill Community Hospital

The review considered a range of annual funding constraints against the profile of delivery to show the impact on sequence and timescales.

From this, 5 funding profile options were agreed by DHSC and HMT to reflect a reasonable range of financial constraints which might apply to the programme. These were not exhaustive but gave an appropriate range against which to identify a way forward.

Given the time available to conduct the review, the data used on the individual size and scope of schemes was from currently available sources and existing assumptions and information.

Criteria to decide scheme prioritisation and waves

A multi-criteria decision support analysis (MCDA) tool was used to prioritise schemes to support the development of the funding options. This tool had previously been used by the programme from May 2023 to prioritise scheme sequencing when the further RAAC schemes were added to the programme.

The input data and scoring mechanism within the MCDA was reviewed with NHS England and DHSC colleagues to validate its appropriateness.

As far as possible, input data for the MCDA was obtained from publicly available sources, including:

• NHS England Estate Return Information Collection (ERIC) and Patient-Led Assessments of the Care Environment (PLACE) - this data is collated and submitted by trusts for their sites, then consolidated by NHS England
• Office for National Statistics (ONS) who maintain relevant statistics on a local authority basis

Some data was generated by NHP, including:

• scheme deliverability which has been evaluated by scheme leads within the NHP team

• data on the impact of estate condition. This had previously been completed by the NHP clinical team in conjunction with trusts, as part of site inspections. This was not available for the 4 cohort 2 schemes within scope of the review:

  • Derriford Emergency Care Hospital, Plymouth
  • Cambridge Cancer Research Hospital
  • Shotley Bridge Community Hospital
  • Women and Children’s Hospital, Cornwall

Input data contributing to the MCDA model, its source and its relevance is shown below.

Table 5: MCDA input data

High level input data	Input data sources
Risk mitigated	Number of clinical incidents caused (as a result of infrastructure, staffing, facilities and environment) per square meter (from ERIC data) Clinical service incidents caused by estates and infrastructure failure (number) (from ERIC data) Privacy, dignity, wellbeing, and condition, appearance and maintenance scores - from PLACE data Health deprivation index (short to medium term risk) (per local authority from ONS data) Trust-recorded impact of estates (generated by NHP clinical team with trusts)
Deliverability	Complexity of site acquisition (assessed by NHP delivery team) Maturity of planning permission - assessed by NHP delivery team Site constraints (assessed by NHP delivery team) Maturity of business case development (assessed by NHP delivery team) Progress against public consultation and risk (assessed by NHP delivery team) Weighted average of estate - from ERIC data Removed critical infrastructure risk/square meters - from ERIC data
Transformation opportunity	Site development type (greenfield, brownfield) (assessed by NHP delivery team) Trust single oversight framework - from NHS England published data Number of beds per £1,000 - assessed by NHP finance team

The MCDA criteria was separately weighted to demonstrate varying priority scenarios, testing whether there was a meaningful change in MCDA outcome resulting from changing priorities. The options analysis initially tested 3 scenarios where each scenario weighted the MCDA input data differently so that there was more focus on a particular factor:

• scenario 1: balanced scorecard
• scenario 2: deliverability focus
• scenario 3: risk focus

The MCDA then set out for each of the 3 scenarios, whether a scheme falls in the upper, middle, or lower third of prioritisation scoring.

The scenario outcomes showed 2 main considerations:

• Derriford, Cambridge Cancer Centre and Shotley Bridge were skewed in the analysis due to their high deliverability, but low available data as the first 2 are not replacing an existing facility and Derriford, as an emergency care facility, scored lower due to having few inpatient beds. They were therefore considered differently
• there was limited variability in scheme rankings between the balanced scenario and the other 2 scenarios. Although the results for a small number of schemes did vary, the outputs were then further validated through stress testing to confirm their rankings. The schemes have been allocated a high, middle or low-ranking relative position to reflect the similarity in scoring across all schemes and the relatively limited differentiation within a small total number of schemes

Stress testing approach

Using MCDA alone has limitations, including that the input data set cannot account for wider context factors which do not appear in the public data. There are also limitations in the data itself as a result of some being trust-reported and not validated independently. The review used professional expertise and judgment of clinical, programme, construction and finance colleagues from within NHP, DHSC and NHS England to identify and overlay other factors of concern into the final options by reviewing the output of the MCDA and completing a further degree of testing to validate the results and identify anomalies.

Recommendation and outcome

Spending Review outcome and final agreed option

As part of the review a range of delivery options for the programme were considered, which included a series of funding envelopes. Options to proceed took into account the funding constraint as well as the need to increase market capacity, to ensure an affordable and deliverable programme. Following discussions on NHP funding between HMT and DHSC ministers, it was agreed through phase one of the Spending Review that the programme should plan the phasing of schemes on the basis of a funding envelope of £3 billion per year once the programme has grown to steady state from the pre-construction phase. The exact profile of funding for the programme in any given year will be agreed as part of Spending Reviews which will also confirm the funding for the individual waves.

The government has committed to give more certainty to infrastructure programmes by setting departmental capital budgets for rolling 5-year windows at regular Spending Reviews every 3 years. As a result, further analysis has been undertaken to assess what this means for the schedule and pace of the programme, and timescales for individual hospital schemes. The programme is currently in the pre-construction phase for most schemes and it is expected that it will only reach £3 billion per year in the early 2030s.

This approach reflects the ongoing need to deliver new hospital infrastructure with other key priorities in health spending, such as funding to enable the Secretary of State’s 3 shifts (from hospitals to the community, analogue to digital and treatment to prevention) to help create a service that is fit for the future. The programme has flexibility at this stage to plan on the basis of a total spend of £15 billion in each 5-year Spending Review period after it has reached steady state in the early 2030s. This will allow the programme to retain flexibility to deliver through consecutive waves, while also ensuring an efficient spending profile.

Successful delivery of the NHP relies on the programmatic approach - that is, a central team which will manage the schemes as an overall coherent programme rather than a series of autonomous projects, including developing and delivering key components which are used by all trusts to deliver their schemes, such as standardised design products (Hospital 2.0). The programmatic approach also enables strategic engagement with the market to deliver key aspects of the procurement and commercial strategies which are critical to the delivery of multiple schemes concurrently.