The government is set to finish only 32 of its promised new 40 hospitals by 2030 as part of an over-budget and hard-to-deliver scheme, that might result in medical facilities that are “too small”, according to a “damning” report.
The National Audit Office (NAO) has completed an investigation into the programme, initiated by the 2019 Conservative manifesto and reaffirmed in October 2020.
The report lays out myriad difficulties the government faces in completing a promise first made by Boris Johnson and often repeated by the Conservative Party since.
The investigation found the government is now set to miss the 40 hospitals by 2030 pledge – with at least eight facilities set to miss the close of the decade target, and it has also highlighted problems with a government plan to use mass-produced, preconstructed hospitals that could see patients unable to be treated.
Shadow health secretary Wes Streeting branded the results “shocking” and “damning”.
Image: A map showing the location of the 40 new hospitals. Pic: National Audit Office
The promise
One of the central tenants of Mr Johnson’s 2019 election win was a pledge to build 40 new hospitals.
More on Boris Johnson
Related Topics:
Even at the time, there were questions about what this actually meant and how achievable it was.
In October 2020, Mr Johnson said he wanted to build the new hospitals by 2030. In November 2020 Rishi Sunak – then chancellor – told parliament they were increasing capital spending to “fund the biggest hospital building programme in a generation – building 40 new hospitals and upgrading 70 more”.
Advertisement
The NAO points out that, after Mr Sunak made that announcement, the definition of a new hospital was changed to include a whole new hospital, a new clinical building or wing, or a major refurbishment and alteration of “all but the main structure of an existing hospital”.
The audit also points out that, at the time of Mr Johnson’s October commitment, “for most of the schemes the issue of affordability had not yet been considered”.
The report states the scheme to build the 40 new hospitals by 2030 was always “likely” to change the timescale or scope, and “this was not made clear to the public at the time”.
Image: Health Secretary Steve Barclay at one of the few finished hospitals
What is being built?
The scheme was initially split into four cohorts, although this was later expanded to five.
A total of 48 hospitals make up the cohorts, as there are eight facilities which already had plans in place.
Of the eight projects in the first cohort, only one counts towards the total of 40 – as the other seven were already in progress.
The other four cohorts are not set to start construction until at least next year, with one of the cohort two projects also making up the eighth previously planned hospital.
Cohort three and onwards are set to use “hospital 2.0” guidelines – where blueprints of the hospitals and construction are standardised and partially made off-site.
The plans for this project have not yet been published, and there are concerns from the construction sector about whether it will be feasible to build.
Furthermore, the NAO criticised a lack of transparency in how the 40 new projects were chosen, saying there was “a failure in record keeping” and they cannot say how the hospitals were chosen.
Image: Boris Johnson promised the hospitals in 2019 and again in 2020
Hospitals ‘too small’
As part of its design for the new “hospital 2.0”, the government came up with plans for what would be the minimum viable hospital – the cheapest functioning facility.
But the NAO states that this specification risks being “too small”, and the estimated capacity of new hospitals is based on assumptions that “may be unrealistic” about the number of people able to be moved out of hospitals for social care.
And estimates by the government that average stays will fall by 12% “seem poorly supported by the evidence”.
Furthermore, when the Department for Health and Social Care went to the Treasury for funding, it asked for £21.3bn, but was instead given £18.5bn.
In order to find savings, the government may need to move even more schemes into the 2030s, or lower the lowest specification of the new-style hospitals further to save money, the NAO said.
Spreaker
This content is provided by Spreaker, which may be using cookies and other technologies.
To show you this content, we need your permission to use cookies.
You can use the buttons below to amend your preferences to enable Spreaker cookies or to allow those cookies just once.
You can change your settings at any time via the Privacy Options.
Unfortunately we have been unable to verify if you have consented to Spreaker cookies.
To view this content you can use the button below to allow Spreaker cookies for this session only.
One of the key factors in the delays, according to the NAO, is issues with reinforced autoclaved aerated concrete.
This material, used extensively, has now been found to be unsuitable for building past around 30 years.
As announced earlier this year, an extra five hospitals with the concrete have been added to the new hospitals scheme.
According to the NAO, only 32 of the previously promised hospitals will now be complete by 2030 to make space for the new five projects – and the eight others will be finished in the next decade.
Even this estimate is generous, as it includes regenerating facilities not previously included and splitting one project into two parts to up the figures from 31 to 32.
A lack of construction contractors has also been raised – with infrastructure projects like HS2 and a lack of clarity over what the designs will be causing uncertainty.
Image: Projects like HS2 are taking up building resources
When will they be built, and how much will it cost?
The NAO has taken an estimate of costs and time frames.
Back in 2020, the government estimated it needed between £20bn and £30bn to build the 40 hospitals promised – plus the eight already started – by 2030.
It wanted between £3.7bn and £16bn for the first five years – and was given £3.7bn by the Treasury under Mr Sunak.
As such, a decision was taken to do smaller projects first and aim at completing large ones later in the decade.
In the first three years, “slow progress” was made on the hospitals – but three opened by June of this year, although none of them were part of the 40 new hospitals.
The other five suffered delays of between one and 16 months.
Cohort two was expected to start in 2022, but as of May 2023 no building had started, although £11m of preconstruction work had taken place.
The first of the 40 new hospitals is expected to open in late 2023, and the second in late 2025.
Cohorts three and four were expected to start in 2025, and the fifth later in the 2020s.
Now, the NAO reckons Cohort three will not open until 2029 or 2030.
Please use Chrome browser for a more accessible video player
2:25
The state of the NHS explained
In terms of cost, both cohorts one and two have risen by almost 50%, overrunning by a total of £1.2bn.
On top of the £3.7bn for the first half of the 2020s, the Treasury has indicated it will supply £18.5bn for the rest of the scheme – but this was only up to 2031, and with the overrun more money could become available.
Inflation will also eat into the budget, and the NAO suggest the Treasury and health department might have to renegotiate the budgets.
Gareth Davies, the head of the NAO, said: “The programme has innovative plans to standardise hospital construction, delivering efficiencies and quality improvements. However, by the definition the government used in 2020 it will now deliver 32 rather than 40 new hospitals by 2030.
“Delivery so far has been slower than expected, both on individual schemes and in developing the hospital 2.0 template, which has delayed programme funding decisions.
“There are some important lessons to be drawn for major programmes from the experience of the New Hospital Programme so far. These include strengthening the business case process to improve confidence on affordability and delivery dates, and improving transparency for key decisions.”
Please use Chrome browser for a more accessible video player
1:57
Blair on current state of NHS
Shadow health secretary Wes Streeting said: “This shocking report could not be more damning of the failing new hospitals programme.
“The so-called 40 new hospitals are over-budget, behind schedule, and may be too small. Many are not ‘new’, others are not ‘hospitals’, and there aren’t 40 of them. In fact, just one hospital is on track to be built by the next election.”
A DHSC spokesperson said: “The NAO’s report acknowledges that despite changes to the original programme, 40 new hospitals are still expected to be delivered by 2030 and praises the programme’s innovative plans to standardise hospital construction, deliver efficiencies and improve quality.
“We remain firmly committed to delivering these hospitals, which are now expected to be backed by over £20bn of investment – helping to cut waiting lists so people can get the treatment they need quicker. Three new hospitals have already opened and more will open this year so patients and staff can benefit from major new hospital buildings, equipped with the latest technology.”
Tulip Siddiq has told Sky News her “lawyers are ready” to handle any formal questions about allegations she is involved in corruption in Bangladesh.
Asked whether she regrets apparent links with the Bangladeshi Awami League political party, Ms Siddiq said “why don’t you look at my legal letter and see if I have any questions to answer… [the Bangladeshi authorities] have not once contacted me and I’m waiting to hear from them”.
Lawyers acting for Ms Siddiq wrote to the Bangladeshi Anti Corruption Commission (ACC) several weeks ago saying the allegations were “false and vexatious”.
The letter said the ACC must put questions to Ms Siddiq “by no later than 25 March 2025” or “we shall presume that there are no legitimate questions to answer”.
More on Bangladesh
Related Topics:
Please use Chrome browser for a more accessible video player
1:45
Staff from the NCA visited Bangladesh as part of initial work to support the interim government in the country.
In a post online today, the former minister said the deadline had expired and the authorities had not replied.
Sky News has approached the Bangladeshi government for comment.
The allegations against Ms Siddiq are focused on links to her aunt Sheikh Hasina – who served as the prime minister of Bangladesh for 20 years.
She is accused of becoming an autocrat, with politically-motivated arrests, extra-judicial killings and other abuses allegedly happening on her watch. Hasina claims it’s all a political witch hunt.
Ms Siddiq was found to have lived in several London properties that had links back to the Awami League political party that her aunt still leads.
She referred herself to the prime minister’s standards adviser Sir Laurie Magnus who said he had “not identified evidence of improprieties” but added it was “regrettable” Ms Siddiq had not been more alert to the “potential reputational risks” of the ties to her aunt.
Ms Siddiq said continuing in her role would be “a distraction” for the government but insisted she had done nothing wrong.
Cryptocurrency exchange OKX reportedly hired former New York Governor Andrew Cuomo to advise it over the federal probe that resulted in the firm pleading guilty to several violations and agreeing to pay $505 million in fines and penalties.
Cuomo, a New York-registered attorney, advised OKX on legal issues stemming from the probe sometime after August 2021 when he resigned as New York overnor, Bloomberg reported on April 2, citing people familiar with the matter.
“He spoke with company executives regularly and counseled them on how to respond to the criminal investigation,” Bloomberg said.
The Seychelles-based firm pled guilty to operating an unlicensed money-transmitting business in violation of US Anti-Money Laundering laws on Feb. 24 and agreed to pay $84 million worth of penalties while forfeiting $421 million worth of fees earned from mostly institutional clients.
The breaches occurred from 2018 to 2024 despite OKX having an official policy preventing US persons from transacting on its crypto exchange since 2017, the Department of Justice noted at the time.
A spokesperson for Cuomo, Rich Azzopardi, told Bloomberg that Cuomo has been providing private legal services representing individuals and corporations on a variety of matters since resigning as New York governor.
“He has not represented clients before a New York city or state agency and routinely recommends former colleagues for positions,” Azzopardi added.
OKX reportedly wasn’t willing to comment on its relationships with outside firms.
Cuomo also influenced OKX to make executive appointments: Bloomberg
Cuomo, who is now running for mayor of New York City, also advised OKX to appoint his friend US Attorney Linda Lacewell to OKX’s board of directors, Bloomberg said.
Lacewell, a former superintendent of the New York Department of Financial Services, was added to the board in 2024 and was named OKX’s new chief legal officer on April 1, according to a recent company statement.
After the investigation concluded, OKX said it would seek out a compliance consultant to remedy the issues stemming from the federal probe and bolster its regulatory compliance program.
“Our vision is to make OKX the gold standard of global compliance at scale across different markets and their respective regulatory bodies,”OKX CEO Star Xu said in a Feb. 24 X post.
United States President Donald Trump signed an executive order establishing reciprocal tariffs on trading partners and a 10% baseline tariff on all imports from all countries.
The reciprocal levies on will be approximately half of what trading partners charge for US imports, Trump said. For example, China currently has a tariff of 67% on US imports, so US reciprocal tariffs on Chinese goods will be 34%. Trump also announced a standard 25% tariff on all automobile imports.
Trump told the media that tariffs would return the country to economic prosperity seen in previous centuries:
“From 1789 to 1913, we were a tariff-backed nation. The United States was proportionately the wealthiest it has ever been. So wealthy, in fact, that in the 1880s, they established a commission to decide what they were going to do with the vast sums of money they were collecting.”
“Then, in 1913, for reasons unknown to mankind, they established the income tax so that citizens, rather than foreign countries, would start paying,” Trump said.
Full breakdown of reciprocal tariffs by country. Source: Cointelegraph
Trump presented the tariffs through the lens of economic protectionism and hinted at returning to the economic policies of the 19th century by using them to replace the income tax.
Trump proposes eliminating federal income tax and replacing it with tariff revenue
Trump proposed the idea of abolishing the Internal Revenue Service (IRS) and funding the federal government exclusively through trade tariffs while still on the campaign trail in October 2024.
US President Donald Trump addresses the media about reciprocal trade tariffs at the April 2 press event. Source: Fox 4 Dallas
The higher range of the tax savings estimate will only occur if other wage-based taxes are eliminated at the state and municipal levels.
Commerce Secretary Howard Lutnick, who assumed office in February, also voiced support for replacing the IRS with the “External Revenue Service.”
Lutnick said that the US government cannot balance a budget yet consistently demands more from its citizens every year. Tariffs will also protect American workers and strengthen the US economy, he said.