Key takeaways
NHS England’s abolition creates uncertainty for NHP
Local leaders face budget cuts and staffing challenges.
Centralised delivery model may be disrupted
Programme-wide coordination risks being weakened by reforms.
Legal support can help navigate infrastructure change
Expert guidance ensures continuity amid NHS restructuring.
The New Hospital Programme
The New Hospital Programme (NHP) was announced in October 2020. The aim was to deliver forty new hospitals by 2030. The NHP itself covers the refurbishment, extension and regeneration of various NHS facilities across England and Wales.
As industry professionals will be aware, the NHP scheme is greatly delayed, and the funding was set to run out in March 2025. This lack of investment, and funding, combined with significant delays in approval processes and a pause following the election of the Labour Government, has meant that NHS will now not deliver on the forty “new hospitals” by 2030 benchmark.
On 20 January 2025 the Government produced a policy paper on the NHP to try and ensure this vital hospital infrastructure is realised. After discussion between His Majesty’s Treasury and Department for Health and Social Care (DHSC), the recommendations and outcomes of the policy paper state that there should be a fund of three billion pounds per year once the programme has exited the pre-construction phase and continues to grow at a steady pace. However, the NHP is currently only in the pre-construction phase for most of the schemes and it is only forecasted to reach the three billion pounds per year mark in the early 2030s.
A further recommendation of the policy paper is to have a central team which will manage the NHP schemes as an overall programme, rather than a series of individual projects. This central team will also develop a system of key components to be used by all trusts and ICBs to deliver such projects. The programmatic approach is to enable “strategic engagement with the market to deliver key aspects of the procurement and commercial strategies which are critical to the delivery of multiple schemes concurrently.”
NHS England
In 2012 following the Health and Social Care Act reforms, the recently established arm’s length body now known as NHS England was given more autonomy in an attempt to drive change and allow the NHS to make decisions without the interference of politicians and excessive red tape. NHS England is made up primarily of managers and civil servants, not front-line staff. As part of their role, NHS England was (last year) allocated one hundred and thirty-four billion pounds of funding agreed by government and Parliament to local NHS systems to enable the NHS to deliver high quality care. This includes the capital budget for the construction of new projects for NHS services.
In the Darzi Review (issued in November 2024) Lord Darzi found that even though the NHS is in critical condition it is not the fault of managers and bureaucrats. Furthermore, Lord Darzi notes “While a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable, there is more work to be done to clarify roles and accountabilities…”. So, the question is why is NHS England being abolished?
On 13 February 2025, The Prime Minister described NHS England as an example of over-regulation and duplication of bureaucracy. The aim of abolishing NHS England will be to bring the NHS back into democratic control within the DHSC. The Secretary of State then went on to say that NHS England staff have been set up to fail and that the abolition of NHS England is “…not a reflection on them.” In fact, many of the NHS England functions will be brought into the DHSC.
So, what about the NHP?
As discussed above, the NHP policy paper indicated a central team would be required to facilitate the NHP schemes. With integrated care boards (ICBs) and trusts being given a system by which to implement the NHP schemes at a project level.
The Secretary of State indicated the abolition of NHS England will set the local NHS leaders free from centralisation and will give local NHS leaders the tools needed to deliver on the DHSC’s plans for the NHS. However, following the Prime Ministers announcement, the ICBs and provider trusts have been told to make further cuts to their outgoings. ICBs have been asked to make fifty percent reductions in their overall running costs by the end of 2025/2026 and NHS trusts have been told that they must cut their corporate services’ budgets back to the pre-pandemic levels. This may lead to staff cuts and may make implementing change at local level a challenge. The NHS finds itself in a position of significant uncertainty: a difficult backdrop against which to deliver a once in a generation infrastructure programme.
Any transition can cause disruption and difficulty. Abolishing NHS England within the next two years will likely have an impact on the NHP and its programmatic approach to carrying out the NHP schemes, especially if the local NHS leaders suffer staff cuts and are expected to markedly slash their budgets. At Hill Dickinson LLP the Health Real Estate team and Construction team work together to assist the NHS in the acquisition and construction of many new projects across England and Wales. Our teams work together to assist with the projects from start to completion and provide support to our NHS clients throughout.
