only 10 of Boris Johnson’s promised 40 new hospital projects have planning permission

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Only a quarter of the 40 hospital construction projects at the center of Boris Johnson’s 2019 general election manifesto have received full planning permission. Observer may reveal, amid angry claims from NHS figures, the plans will not be delivered on time.

Ministers have repeatedly claimed the hospitals will be delivered by 2030, despite concerns from health chiefs and economists that “woefully inadequate” funding and rising costs will thwart the plan and jeopardize the capacity of the NHS.

But an investigation by the Observer has revealed that only 10 of the 40 projects have the full building permits they need to proceed. Those involved in some projects said they had already experienced long delays, leaving them with dilapidated and often unusable buildings.

“There is a 0% chance that there will be 40 new hospitals by 2030,” said the head of one of the NHS trusts in anticipation of a new hospital. We are lucky to have eight. Right now, we’re constantly doing a lot of maintenance work, trying to figure out roofs and theaters and all those things. Some hospitals are literally collapsing.”

Analysis by the Observer, combined with official data obtained by the deputy leader of the Lib Dem, Daisy Cooper, reveals that some projects only have outline planning permission, which is insufficient to begin construction work. Many of the projects do not have a building permit at all.


“This is really outrageous,” Cooper said. “The Conservative government is on track to break their flagship NHS pledge and refuse to admit it. Communities already experiencing dangerously long ambulance wait times are left with crumbling hospitals bursting at the seams. The government needs to raise money to keep aging hospitals running and ensure that patients are treated in a safe environment.”

The program has been controversial since Johnson pledged to build “40 new hospitals” in the 2019 Conservative manifesto. It has since become apparent that many of the proposed projects are not new hospitals, but extensions or renovations. The independent Court of Audit is also investigating the programme.

According to the latest notifications, 13 of the projects do not have a building permit. Another 17 have only made some kind of preliminary agreement or have no confirmed consent. Several of the NHS trusts involved said they were waiting for a funding arrangement from the government to proceed with the planning and design stages of their proposed projects.

One of the most concerning projects is the redevelopment of Epsom and St Helier Hospital in South London, which has already been delayed. “The development is needed now more than ever,” said an official. “We have crumbling, cramped buildings, many pre-dating the NHS. Our patients deserve a better environment in which to be treated. Our employees deserve a better environment to provide care.”

Any delay poses a significant political problem to Prime Minister Rishi Sunak. A board chairman with a plan in the program said anonymously, “Let’s say there’s an election in 2024, 2025, if they had eight or a dozen or 20 hospitals that were well on their way to building and you had cranes outside, there would be get a lot of good pictures out of it. But with the best will in the world you just get a few hospitals with a hole in the ground. I think they missed their chance to take advantage of this politically.”

Another said: “Our own hospital is crumbling before our very eyes – so much so that parts are completely unusable. Delays are hugely inefficient and cost millions, hurting the economy, taxpayers and the health of our patients.”

In England there are still 284 hospital buildings that pre-date 1948 when the NHS was founded. Most of the hospitals to be replaced in the new hospital program had buildings built prior to the service’s inauguration. The latest estimates put the maintenance backlog for the NHS estate at £10.2 billion in 2021-2022, more than twice what it was a decade ago. With inflation in the construction sector reaching 10% in September 2022, the cost of clearing the maintenance backlog could rise even further.

Laurie Rachet-Jacquet, an economist at the Health Foundation, said: “Last year we estimated that, depending on NHS productivity, we would need 23,000-39,000 new beds in England by 2030: this equates to around 38-64 medium-sized hospitals. Hospital costs vary enormously, but based on an estimated cost of around £450m, then it’s around £17bn – £29bn over the next seven years.

“The new hospitals committed to the government’s program fall at the lower end of this range. But the delays and uncertainty about funding are worrying. The money allocated so far is woefully insufficient and given rising inflation it will still yield less than expected and it is not clear whether the government’s proposals go far enough to meet future hospital care needs.

Saffron Cordery, the deputy chief executive of NHS Providers, said: “Trusts need government clarity and commitment on the much-delayed New Hospitals Program (NRP). Shovels and picks at the ready, trusts in the NRP are ready to get to work, but still awaiting confirmation of funding. Those forced to delay for many months are now facing soaring inflation-driven cost increases well above initial projections. The NRP has the potential to transform healthcare by providing much-needed innovation for acute, mental health, community and ambulance services. But we must persevere.”

A spokesperson for the Department of Health and Social Care said: “We are investing £3.7bn over the first four years of the new hospital program and remain committed to all plans announced as part of it. Building permit requirements depend on construction timelines throughout the decade and we continue to work closely with trusts on their plans. We are developing a national approach to the construction of new hospitals so that schedules can be built faster and value for money can be guaranteed.”

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