Both the Conservative and Labour Party have committed to deliver the New Hospital Programme; the programme set up in 2020 to fulfil the Conservative manifesto to build 40 new hospitals in England by 2030. Last year, a further seven hospitals were added to the programme – these were the hospitals that needed rebuilding because they contained reinforced autoclave aerated concrete (RAAC) and posed a safety risk. This is good news for our public health service, but what will it mean in practice? We discuss some of the issues below and thoughts for the future.
The NHP Programme has been mired in controversy. The Public Accounts Committee has expressed concerns about the lack of progress made and sufficiency of the programme's funding. However, despite this, Labour – a previous critic - has now committed to progress the programme if elected.
What is apparent to both sides is that investment in hospital infrastructure and facilities is desperately needed if the NHS estate has any chance of being 'fit for the future' or even, dare we say it, 'fit for the here and now'.
Since the current Government scrapped the use of the controversial private finance initiative (PFI) in 2018 – a long-term contract between a private party and the public sector where the private sector designs, builds, finances, and operates a public asset and related services for a monthly charge (like a mortgage if you will; but with operational services included) – there has been very little capital investment in the NHS estate. It is an estate containing many old buildings, much of which is in a state of disrepair and falling short of required standards. The cost of backlog maintenance – the maintenance required to restore these buildings to a suitable working condition – is estimated to run into the billions.
In its response to the Conservative manifesto, NHS Providers – the membership organisation for NHS acute, ambulance, community, and mental health services – says:
"Trust leaders will be encouraged by commitment to NHS funding needs and the promise to deliver the New Hospital Programme by 2030. With vital parts of the NHS crumbling due to years of inadequate investment and hospital, mental health and community trusts facing an eye-watering £11.6bn backlog of essential repairs, an infrastructure programme for the NHS cannot be delivered soon enough."
The fact that the Labour Party has also committed to delivering the New Hospital Programme will no doubt be welcome news to Trusts, particularly those in the programme who have developed their schemes and desperately await funding.
Beyond the New Hospital Programme, the case for private finance to best support the building and maintenance of healthcare infrastructure remains ever-present. Given the level of funding that is now required by the NHS, you have to ask, would it be right to look again at public private partnerships? Whilst PFI was not perfect, inspiration for infrastructure investment might be taken from the bits that worked well and from other subsequent models, such as the Welsh Mutual Investment Model.
We are looking forward to lots of renewed investment in health infrastructure in whatever funding model is proposed. In the meantime, the focus is on the New Hospital Programme to plug the gap and deliver the much-needed investment in NHS infrastructure.
DAC Beachcroft is advising a number of NHS Trusts on their schemes under the New Hospital Programme and has an experienced and knowledgeable PFI/PPP and infrastructure projects team, including commercial, construction, real estate, procurement and finance specialisms. For further information on how we can help please contact any of the authors on this article.
