Government hospital building plan will not succeed if lessons from Covid-19 and recent history are ignored

Nigel Edwards warns that the plan could fall flat if we don't learn from the ‘optimism bias’ that has plagued previous programmes.

Press release

Published: 16/07/2020

The Government’s flagship hospital building programme is in danger of falling flat unless the changes equip hospitals to better cope with Covid-19 infection control measures and avoid the ‘optimism bias’ that has plagued previous programmes.

There is also a warning that the NHS is currently lacking the people it needs with more relevant planning, project management and construction skills, according to a discussion paper examining lessons from the NHS’s previous hospital building work by Nuffield Trust Chief Executive Nigel Edwards.

Lessons from the last hospital building programme, and recommendations for the next, sets out the key issues that must be considered as the Government embarks on its Health Infrastructure Plan (HIP) to upgrade and redevelop NHS hospitals. It also explores the lessons of the current Covid-19 pandemic for hospital building, offering a series of recommendations as the Government is poised to announce further detail on the development of the Plan.

Key lessons from the previous phase of hospital building include:

  • Planners in the NHS need to avoid making over-optimistic assumptions about future demand for healthcare and health system performance. Planning for new buildings in the past often did not fully consider the emergence of new diseases or possible changes in disease management drugs, technology or the labour market and were driven by a need to reduce bed numbers in order to suit the financial envelope on offer.
  • Hospital redevelopment should be understood in the context of a plan for the wider health and social care system. In the past, hospital buildings were often viewed in isolation from other health and social care services and from the wider economy. This contributed to false assumptions about healthcare demand, as well as poor links between hospitals and local authorities, housing and voluntary sector organisations.
  • The NHS needs to invest in people with a wider range of skills and expertise. The previous programmes suffered from a shortage of individuals with a knowledge of strategy, capital, workforce, operational and space planning, as well as experienced project directors.
  • Care is needed to ensure high quality design and construction. There is a risk the speed with which the hospital building programme is being approached may repeat previous problems of poor design and construction leading to buildings not fit for purpose or requiring high levels of repair and modifications.

The paper also argues that the Covid-19 pandemic has exposed weaknesses in the way many hospitals are designed and equipped, including a lack of spare beds and capacity, crowded wards and waiting rooms, and a striking lack of single rooms. These need to be “designed out” of new facilities, with more flexible and convertible space and infection prevention and control “designed in”.

Nuffield Trust Chief Executive Nigel Edwards said:

“As the lockdown restrictions are eased and attention is turning to economic recovery, the lessons of history tend to show that the PM’s ambition to build “bigger, better and greener” could too easily fall victim to building “faster” and cheaper. This would be disastrous for the NHS, which faces a monumental challenge in upgrading buildings whilst living with the reality of Covid-19 and enhanced infection control for the foreseeable future.

“If this pandemic has shown us anything, it brought home the importance of having flexible capacity inside hospitals and a more holistic view of the ways in which hospitals interact with the wider health and social care system. The success of the hospital infrastructure plan will depend on how well it heeds the lessons of the past and ensures we avoid the pitfalls of poor planning and inadequate hospital design that have plagued the NHS for so long.”

Notes to editors

  • Lessons from the last hospital building programme, and recommendations for the next is written by Nuffield Trust Chief Executive Nigel Edwards
  • The paper was informed by a series of discussions and interviews drawing on the views and experience of NHS project directors, architects, health planners, researchers and consultants involved in the previous phase of hospital buildings
  • In October 2019, the British government announced the Health Infrastructure Plan (HIP) – a major new 5-year scheme to upgrade and redevelop NHS hospitals. HIP wave 1 gave the green light to six hospitals that had existing plans that were ready to move forward. In addition, 21 schemes were cleared to proceed to the next stage, bringing a total of over 40 different schemes forming part of a ‘rolling programme of investment in health infrastructure’.
  • Between 1997 and 2010, there were over 50 major schemes to redevelop acute hospitals at a total cost of over £10 billion, mostly financed through PFI. There were parallel investments in mental health, community and primary care buildings
  • The Nuffield Trust is an independent think tank. We aim to improve the quality of health care in the UK by providing evidence-based policy analysis and informing and generating debate.