Race for Downing Street: The New Hospitals Programme – what does the future hold?

As an ex-NHS employee and LCA’s lead on a number of hospital development projects in London, one of the key takeaways for me personally from the election so far is Labour’s manifesto commitment to delivering the New Hospitals Programme (NHP).

It seemed to slip in under the radar slightly, maybe because Labour doesn’t want to shout too much about continuing a flagship Boris Johnson promise or because it is a huge spending commitment, but the promise has been made.

Wes Streeting, Shadow Health Minister, has even gone further and named the London hospitals that Labour is committed to rebuilding, including St Mary’s, Charing Cross, and Epsom and St Helier.

Labour likes to see itself as the traditional party of the NHS, so it’s unsurprising that a key attack line for the party during this election campaign has been Tory management of the health service. With the number of people waiting for treatment hitting 7.57 million at the end of April 2024 (compared to 2.3m in 2010 and 4.6m in 2019), defending against these attacks is not particularly easy for Rishi Sunak or the Conservatives.

Indeed, Sunak himself previously admitted his administration has failed in attempts to reduce waiting lists and claims they are coming down were mocked by audiences in recent televised debates. Throw in striking junior doctors, staff shortages and concerns regarding adult social care, and it is starting to look like the political equivalent of shooting fish in a barrel for Keir Starmer.

Those with long memories will remember that this is playing out in a similar way to the last time Labour was looking to oust the Conservatives from a long period of power. In 1997, Tony Blair and New Labour had seized on the challenges in the health service and the third of their five election pledges promised to ‘cut NHS waiting lists by treating an extra 100,000 patients’. The Labour manifesto at the time spoke about ending mismanagement and cutting red tape with savings going straight back into patient care. Little, if any mention, was made of hospitals and other health service buildings in which the care was being delivered.

Back to 2024, Labour has again five pledges – number five is ‘Build an NHS fit for the future’. Perhaps, as a comms professional, I’m reading too much into this, but for me the word ‘build’ is key. It gives recognition to the fact that a huge amount of the NHS estate in this country falls a long way short of providing facilities suitable for the delivery of modern, high quality healthcare. It has almost become an accepted reality that staff are expected to deliver 21st century care in buildings that, in too many cases, pre date the existence of the NHS itself.

Boris Johnson recognised this back in 2019 when he introduced the NHP, pledging to build 40 hospitals by 2030. However, since then, promises made as part of the programme have largely failed to materialise and the Government has been accused of ‘delay and indecision’, with NHS Providers stating that health trusts are picking up the tab for increasing costs and a number of hospital builds now delayed to beyond 2030. Indeed, through LCA’s work with the NHS in London, it is obvious that the investment and change that NHP would bring is vital, and it will be the same across the country.

In London, the specific challenges are not unique to the NHS and many in the public sector (whether local councils, the Met, TfL, or Network Rail) would be able to tell you a similar story. They own out-dated and crumbling estates or buildings, but with insufficient capital to make the upgrades required. But the land they are sat on is generally extensive, valuable and could be more effectively used to generate income and pay for the improved buildings and facilities required to deliver better services. For hospitals in the capital, this requires sensitive and careful management amidst accusations of selling off the family silver, but a lot can already be learned from the GLA family (particularly TfL and the Met) who are already a bit further down the road in rationalising their estates.

The level of significant capital investment required to deliver well-designed, modern hospitals can also have a knock-on effect on those other areas of stress in the health service. Better buildings where staff want to work will make it easier to recruit, train and retain staff. Flexible, modern wards and single rooms will help with infection control. Well-designed buildings save space, with room to provide additional services, and reduce maintenance costs. And rationalising hospital estates, will provide opportunity to deliver other types of development such as housing or life sciences, enabling the NHS to benefit from private sector investment.

As Keir Starmer has reminded us in the TV debates, the Conservatives have been applying a short term sticking plaster to the NHS in the hope that it limps on (and on and on). The Labour manifesto states that the party has ‘saved the NHS before, and the next Labour Government will do so again’. So, when the dust settles after the general election, and in anticipation that the polls are accurate, I’ll be waiting to see if Labour are going to embrace this challenge and set-out what the next steps are for NHP, whether the deadlines will be met, and (perhaps most importantly) how the programme will be funded.

The future of the NHS depends on it.