Lessons from the last hospital building programme, and recommendations for the next

As lockdown restrictions are eased, attention is turning to economic recovery and the government’s manifesto commitment to build 40 new hospitals. A new discussion paper by Nigel Edwards assesses what might be learned from the last time a British government committed to a major hospital building scheme, arguing that we should not be tempted to forgo quality for speed – particularly in the midst of a pandemic.


Published: 16/07/2020

Read the discussion paper [PDF 128.1KB]

Last year, amid claims from hospital trust leaders that the poor quality of hospitals was a threat to patient safety, the UK government announced a major new 5-year scheme to upgrade and redevelop NHS hospitals.

But the NHS has been through a similar process in the recent past: 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 are many lessons to be learned from this previous process, but very little formal research or evaluation of the former project has been carried out. This paper gathers together the views of a number of experts who were involved in the previous phase of hospital development. Contributors include NHS project directors, architects, health planners, researchers and consultants.

This paper sets out a number of key issues of relevance to both policymakers and managers as they embark upon the new Health Infrastructure Plan. It also explores the lessons of the current Covid-19 pandemic for hospital building, offering a series of recommendations as the government prepares to announce further detail on the development of the Plan.

Key lessons from the previous phase of hospital building include:

  • Health care planning leaders in the NHS should avoid making over-optimistic assumptions about future demand for health care and health system performance. Previous building planning has failed to fully consider the potential emergence of new diseases or possible changes in disease management drugs, technology or the labour market, instead being driven by a need to reduce bed numbers in order to suit the financial envelope.
  • Hospital redevelopment should be understood in the context of a plan for the wider health and social care system. In the past, hospital buildings have been viewed in isolation from other services and from the wider economy, contributing to false assumptions about health care demand and 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 building programmes suffered from shortage of individuals with knowledge of strategy, capital, workforce and operational issues, resulting in projects being delivered late and significantly over budget.

Suggested citation

Edwards N (2020) Lessons from the last hospital building programme, and recommendations for the next. Discussion paper, Nuffield Trust.