Is the government going to build 48 new hospitals by 2030?

In its 2019 manifesto, the Conservative Party pledged to build 40 new hospitals across the country. Since then, Prime Minister Boris Johnson has variously claimed that the government is building “48 new hospitals” or “40 new hospitals” by 2030, but this has been a matter of contention.

It is correct that the government is funding a large number of building projects for hospitals around the country, however there is some debate over whether these projects really constitute “new hospitals”.

The majority of the projects are either replacements for existing hospitals, new wings or buildings for existing hospitals, or refurbishments. The government defines all these projects as “new hospitals”, but critics of the programme disagree.

On Saturday, 2 July, it was revealed that the National Audit Office (NAO) is set to hold a “value for money review” of the New Hospitals Programme.

The NAO told Full Fact it could not yet confirm the scope of its investigation, which is expected to report its findings in 2023. However, the Observer reports that in a letter to Labour shadow health secretary Wes Streeting, the watchdog’s comptroller Gareth Davies acknowledged concerns over the project’s budget, delays and definition of “new hospital”.

He said: “In particular, I note your comments about the implications of delay for increasing costs at this time of high inflation and the matter of whether all projects truly meet the classification of ‘new hospitals’.”

Mr Streeting has said in a tweet that “the only place these hospitals exist is in the Prime Minister’s imagination”.

The Department of Health and Social Care (DHSC) told Full Fact that the government is “on track to deliver 40 new hospitals by 2030.” They added that the final eight selected hospital schemes are due to be announced later in the year.

What is the New Hospitals Programme?

In its initial Health Infrastructure Plan, published in September 2019, the government announced it would be “giving the green light to more than 40 new hospitals”.

The plan initially included £2.7 billion in funding to be allocated to six major hospital rebuilds due for completion by 2025, with a further £100 million in seed funding granted to develop plans for up to 34 hospital sites.

In October 2020, the Prime Minister announced that the budget for the Health Infrastructure Plan had increased to £3.7 billion. Of the plans given seed funding, it was confirmed “25 new hospitals” would be fully funded. An additional hospital in County Durham was added to the programme following the initial launch, bringing the total number of hospitals funded under the Health Infrastructure Plan to 32.

At this time, Mr Johnson also announced the government would solicit proposals for an additional eight projects which the DHSC says are due to be confirmed later this year, to bring the total number of “new hospitals” to 40.

In the same announcement the government said it would ultimately fund 48 new hospitals by 2030, a number which includes the 40 hospital projects mentioned above, as well as a further eight projects which were either already under construction or awaiting final approval in 2020, but were not included in the initial Health Infrastructure Plan. The figure of “40” and “48” new hospitals has been used interchangeably by many people since.

What is a ‘new hospital’?

In guidance sent to NHS trusts by the Department of Health and Social Care last year, a new hospital was defined as any one of the following:

• a whole new hospital site on a new site or current NHS land (either a single service or consolidation of services on a new site),
• a major new clinical building on an existing site or a new wing of an existing hospital (provided it contains a whole clinical service, such as maternity or children’s services),
• a major refurbishment and alteration of all but the building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure.

The guidance also stresses that while the projects “vary across a number of factors”, each “must always be referred to as a new hospital.”

Since the plans were first announced in 2019, the government has faced questions over its definition of “new hospitals”.

This point has been raised by Labour leader Sir Keir Starmer, who during Prime Minister’s Questions on 8 June 2022 described the plan as “paint jobs and fix-ups, pretending that is the same as building new hospitals.” This was denied by Mr Johnson at the time, who insisted: “What we are doing instead is building 48 new hospitals”. 

The Nuffield Trust defines a “new hospital” as a “new building on an entirely new site”.

Using this definition, the BBC has found that the 40 confirmed new hospitals include:

• 22 rebuilding projects
• 12 new wings within existing hospitals
• three non-urgent care hospital rebuilds
• three “new hospitals” (two general hospitals and one non-urgent care hospital)

Both of the new general hospitals—Midland Metropolitan University Hospital in Smethwick and the new Royal Liverpool Hospital—were initially funded by private finance initiative (PFI) contracts, and were intended to open before Boris Johnson became Prime Minister, but have experienced significant delays following the collapse of the construction company Carillion in 2018. 

A number of other hospitals are undergoing major or total rebuilds on their existing sites, while others are earmarked for partial or total refurbishments of existing hospital buildings. As a number of the projects are still in the planning stages, it’s possible that some may select proposals to move to a new site.

Several of the projects are new wings for existing hospitals, with a number of specialist facilities, like mental health hospitals, also set to undergo refurbishments or rebuilds.

Nuffield Trust CEO Nigel Edwards told Full Fact: “The definitions used in this programme are not very clear. There is a substantial amount of new hospital building, but only two of the projects are new general hospitals on new sites.

"The rest are a combination of substantial rebuilds, new wings and a range of major developments. These types of projects are very welcome, given the UK’s huge underinvestment in health infrastructure compared with other high-income countries, but it is inaccurate to say that 40 entirely new hospitals are being built.”

With many of the projects still in early planning stages, it is difficult to say for certain what many of the developments will ultimately entail.

Full Fact has looked at the proposals for the projects listed by the government and found at least one additional project in Harlow that could be categorised as a new general hospital.

The programme also includes at least two major new specialist hospital sites, namely the National Rehabilitation Centre and Oriel, a project to move London-based specialist eyecare facilities to a site in north London. 

What can be said with more certainty is the government is not building “48 more hospitals” as the Prime Minister has previously claimed, as many of these projects involve replacing existing hospitals or buildings.

Additionally the government has said it is upgrading the facilities at 20 other hospitals.

Concerns over the project’s timeline

A DHSC spokesperson told Full Fact that the government was “on track to deliver 40 new hospitals by 2030”.

They added: “We are working closely with the NHS and trusts on the development of their building plans. Each of the building projects will be new hospitals providing brand new, state-of-the-art facilities to ensure world-class provision of healthcare for NHS patients and staff by replacing outdated infrastructure.” 

A July 2021 report by the Infrastructure and Projects Authority (IPA) watchdog rated the New Hospitals Programme “amber”, meaning “successful delivery appears feasible but significant issues already exist.”

In November 2021 the Health Service Journal reported that the IPA had downgraded its assessment of the New Hospitals Programme to “red” indicating the project “appears to be unachievable.” The DHSC says that this report is inaccurate.

The Sunday Times has reported that several of the projects are facing delays because their funding has yet to be approved by the Treasury department.

The first of the government’s “new hospitals” to be completed include the Midland Metropolitan Hospital, which is set to open in 2024, the new Royal Liverpool Hospital, which health secretary Sajid Javid has said will open later this year, and the Northern Centre for Cancer Care, which was opened by Mr Javid last year. 

Two more—Greater Manchester Major Trauma Centre and Dyson Cancer Centre— are expected to open in 2023. However, all five of these hospitals have been in the pipeline since well before the government made its pledge in 2019.

Image courtesy of Adhy Savala