Why Wes Streeting should scrap the New Hospitals Programme
Research Manager and Head of Health
Politicians, commentators and sector leaders have been quick to condemn the delay of the New Hospitals Programme (NHP) by 14 years. Let me offer an alternative perspective: it should never have been introduced in the first place.
It undermines the shift to prevention that politicians have waxed lyrical about for decades. It perpetuates a post-war model of hospitals that no longer work for modern clinical needs. And even if you ignored these criticisms, it is fundamentally poor policy design. Hospitals do need reform, and lots of it (as we are exploring in our Hospital of the Future series) but this is not it.
The modus operandi of health policy for at least two decades now has been that we need to shift to a model of prevention. The logic behind that assumption is that hospitals are less clinically and cost effective than early intervention. The public purse is not bottomless, and so the corollary of this logic is that you eventually spend less on hospitals to spend more on general practice, community nursing and social care.
The opportunity cost of this investment is enormous. The NHP is now set to cost £3 billion a year for at least the next five years, and for another decade after that given that some waves do not start until 2035–2039. To contextualise this, the cost of general practice for the whole of England in 2022–2023 was £9.7 billion. We already spend significantly more than comparator countries on hospitals and the acute sector. Just a fraction of the NHP costs could be transformative for primary care (and therefore hospitals because it would reduce demand).
Of course there are severe infrastructure problems impacting hospitals — which are significantly undermining productivity — that need fixing. But it is flawed thinking to assume that the logical answer is to build more hospitals rather than fix the current stock. Of all the policy options available, this is the least cost effective and deliverable with little added clinical benefit.
Specific maintenance problems could have been more cost effectively solved by temporary increases in capital investment over, say, five years, that enabled the renovation of current hospitals. The Government are already doing this and this could have been sufficient. Rather than a *checks notes* likely £45 billion commitment over 15 years, absorbing even more money into the acute sector at the expense of primary, community or social care — all of which are seriously underfunded.
They say to govern is to choose, and building more hospitals is not the right choice. If you are going to choose to build something in the healthcare system, it should not be hospitals but general practices or polyclinics or virtual wards.
Others might argue that we need the extra capacity, both in equipment and bed space. But the first thing anyone working in a hospital will tell you is that yes, they are running out of beds, but that is because we keep people in hospital when we do not need to. Patients with complex needs or frailty require support or adjustments in their homes, which must be arranged to ensure safe discharge. Or, also commonly, patients are taking up beds in hospital whose needs could have been met much earlier and by someone else in the health care system.
The problem is not the number of beds or wards, but the changing needs of the patients, and the fact the hospital system was designed for a post war society rather than a 21st century one.
Yet, rather than taking this opportunity to rethink the secondary care model, the NHP replicates the same post-war hospital that we know is inappropriate for an increasingly frail, multimorbid population. Our research, for example, consistently finds that the future of secondary care is not the physical hospital building, but rather in the home and community.
Evidence overwhelmingly demonstrates that secondary care needs to be adapted for modern needs. The NHP does not symbolise adaptation but rather imitation of a model that no longer works. The Secretary of State should be bold and say that.