We’ve heard the word “deliver” an awful lot in recent times. Rishi Sunak is always “delivering”. Boris Johnson delivered his farewell speech on the steps of 10 Downing Street on 6 September 2022. In keeping with his record, Johnson’s adieu was delivered with half-truths, untruths, evasions, and misleading boasts. He claimed his government got “this economy moving again … in spite of all opposition, all the naysayers.”
This was egregious given the actual state of the economy, the number of desperate people and closing businesses, and the plummeting value of sterling. Yet the resigning PM claimed just a fortnight earlier that the UK government was “delivering on those huge manifesto commitments.” One of those commitments was to deliver 40 new hospitals in England. The NHS is a 21st century service run out of 19th century buildings. Will 40 hospitals do the trick? Are they even real, or likely? And why does that matter to Wales?
Satisfying the criteria
The NHS has been under stress since its 1948 founding. As a child in 1974, I went on a march with my nurse mum, holding a placard saying, “Underpaid, Understaffed, Under stress, Understand?” Past concerns seem trivial, however, compared to current crises. Sticking plasters will no longer do, but you can’t put a cast on tectonic plates.
The UK government knows of the widespread affection for the health service, so it makes huge promises about future investment. Notoriously, many were enticed into voting for Brexit by guarantees on a campaign bus that hundreds of millions more would be invested. The Department of Health and Social Care (DHSC) upped the number of ‘new hospitals’ pledged for England to 48, by adding eight existing ‘schemes’, all to be delivered by 2030.
The DHSC issued communications guidance in August 2021 to all English NHS trusts, stating: “The schemes named in the announcement are not all identical and vary across a number of factors. However, they do all satisfy the criteria we set of what a new hospital is and so must always be referred to as a new hospital.”
These criteria include: “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; or a major refurbishment and alteration of all but building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure.”
Does that fit within your understanding of ‘new hospital’? No, me neither. Lest you think I’m splitting hairs, healthcare think tank the Nuffield Trust agrees, defining a new hospital as “a new building on an entirely new site”.
Gas and air, nurse!
By this definition, of the UK government’s 40 ‘new’ hospitals, 22 can be classed as rebuilding projects; 12 as new wings of existing hospitals; three rebuilds of non-urgent care hospitals; and three can truly be termed ‘new’ as people who speak the English language understand that word. Oh, but two of the three actually-new hospitals will open as old ones close, as replacements. Both were planned anyway, before 2019.
NHS Providers is the membership organisation for NHS acute, ambulance, community and mental health services treating patients and service users. With respect to the “initial” £3.7bn investment pledged by the government for the above schemes, it said an actually-new mid-sized hospital costs circa £500mn. So 40 actually-new hospitals would require £20bn.
In July 2022, NHS England managers warned the programme was “moving at a glacial pace”. Some schemes were as much as four years behind schedule due to lack of funding, construction delays, and huge cost increases, in part due to inflation. The chief executive of the NHS Confederation expressed the same concerns. An NHS Providers survey found that half the trusts involved didn’t believe the money needed would ever materialise. Leeds General Infirmary alone estimated the cost for two new buildings to be £75mn more than budgeted, thanks to delays in construction and the rising costs of works and materials.
The programme was given a ‘Code Red’ by the Infrastructure and Projects Authority (IPA), which carried out two reviews and found it “appears to be unachievable”. A red rating means “major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable”.
You have to wonder if the UK government is playing a shell game, assuming the general public is thick and regulators unserious, or if it really is numerically illiterate and project planning-incontinent. The eternal leadership question: evil or stupid?
Hospitals and honesty
Yet as Johnson shambled off into a sunset of after-dinner speeches, he reaffirmed the UK government’s commitment to this shambles and the gaslighting about it. “Yes we will have… 40 more hospitals by the end of the decade… [laid on] great solid masonry on which we will continue to build together”. At the time he delivered that, there were 6.8mn waiting for NHS England appointments, a severe shortage of ambulances and beds, 132,000 NHS vacancies, and real-terms wage cuts.
The National Audit Office (NAO) announced in July 2022 that it would carry out a “value for money review” into the programme. A year on, unsurprisingly, it no longer talks about 48 hospitals, but is back to 40. Its research finds delays and lack of value for money, and says only 11 projects are wholly new builds, which is generous. But a DHSC spokesperson basically breezed past all that, portraying the “this is fine” everything-on-fire meme in human form. This is not fine.
Health and social care are of course devolved matters, accounting for nearly half the Welsh Government budget. Social care for older people and others sees increasing demand and delays. Mental health services suffer decline and shortages even as the need for them grows. Waiting times are longer for NHS Wales services than in England, and we have a higher rate of treatable mortality than England or Northern Ireland, on a par with Scotland. We have our own problems.
Does that mean crumbling infrastructure in England, built on lies and fudges, doesn’t matter in Wales? Well, aside from the obvious – there are English people living in Wales, Welsh people living in England, including family members and friends – Conservatives are currently the second-most supported Welsh party. They hold 14 of 40 Welsh seats in the House of Commons, and 16 of 60 seats in the Senedd. According to the Electoral Reform Society, only 3.7% of Peers live in Wales.
While Wales is part of the United Kingdom, governed fiscally and in other ways by Westminster, the lies told to and public service problems inflicted on England matter here. While the party leading England down the garden path, tripping on broken flagstones, represents many people in Wales, and stands behind these 40 fabricated buildings, it’s delivering dishonesty to us, too.
This is an updated version of an article published in Byline Times in 2022. Read the original article here.
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