A report today from the National Audit Office (NAO), the government spending watchdog, says that the current Labour government has put the new hospital programme in England on firmer footing with its rescheduling but RAAC-affected buildings will miss the 2030 replacement deadline.
Last year鈥檚 reset of the new hospital programme (NHP) has given it a more realistic timetable, the NAO says. However replacement schemes for hospitals built with reinforced aerated autoclaved concrete (RAAC) have been given too tight a construction schedule and with little contingency in the next five years, there are significant delivery risks.
The NAO has published an update to its 2023 report on the new hospital programme on the back of the new government resetting the programme. The reset covers 41 hospital schemes across England, ranging from whole new buildings to major refurbishments, and will be carried out in four waves over the next 20 years. An additional five schemes were already complete and open when the programme was reset in January 2025.
The final hospitals are expected to be completed in 2045-46.
Government has allocated around 拢2bn a year to the programme from 2025-26 to 2029-30, rising to 拢3bn a year from 2030-31. An estimated total capital funding of around 拢56bn will be required. More realistic planning assumptions mean that this is a 拢33.8bn increase on the capital funding proposed in 2023. A 拢12bn contingency (21%) has been built in to reflect inflation, market pressures, engineering challenges and environmental requirements.
An independent 2022 report recommended that the seven hospitals predominantly built from RAAC should be replaced by 2030 at the latest. While these are now prioritised in the revised NHP, they will not be replaced by that date, the NAO says. A further report concluded that, with mitigations and sustained maintenance, these hospitals can remain operational beyond 2030. However, these hospitals will face significant costs and operational risks including safety risks to patients. By 2025, the seven hospitals had required more than 拢500m of investment to prevent structural failure.
Trusts whose new hospitals or refurbishments will open later will face additional costs to maintain ageing buildings for longer - estimated by government at between 拢100m and 拢140m a year.
The programme plans to introduce a more standardised approach to design and construction. The new 鈥淗ospital 2.0鈥� design is also working to improve efficiency and patient care; this should include each patient having their own room, shorter walking distances for staff, paperless patient records, and technologies such as infrared sensors to alert staff when a patient falls.
Since the new plan and funding commitments were announced, the programme has had expressions of interest from more than 20 potential main contractors and is taking 16 pre-qualified bidders through 鈥榗ompetitive dialogue鈥� to help develop solutions and technical specifications prior to submitting final tenders.
warns that the construction schedule over the next few years is challenging as hospital schemes adapt to the new approach. If early schemes fall behind, there are risks of delivery dates slipping and work may bunch up later. This could lead to budget pressures on later hospital waves.
The programme also continues to face workforce challenges. As of November 2025, NHP had 138 vacancies out of 357 posts, a vacancy rate of 39% for public sector roles with gaps in digital, legal, commercial, project delivery and technical roles.
The NAO has several recommendations for the Department of Health & Social Care (DHSC) and its new hospital programme team. These include:
- maintain rigorous programme oversight to keep delivery on track, learn lessons between schemes and respond to changes in healthcare needs.
- get the Hospital 2.0 design right by allowing enough time for testing and ensuring strong input from trust staff and leaders.
- strengthen long term cost estimates and align delivery and funding profiles, weighing any acceleration of schemes against delivery risks, industry capacity and price pressures.
- share the future demand model widely across the NHS and government, ensuring consistent local decision making and continuous model refinement.
- monitor the shift to community care closely to avoid under sized hospitals, refining demand assumptions and developing clear contingency plans across the wider health system.
Gareth Davies, head of the NAO, said: 鈥淭he reset of the new hospital programme gives the department a firmer platform to deliver long term improvements, and its ambition to transform hospital infrastructure has real potential provided designs are rigorously tested and programme delivery is well managed."
Sir Geoffrey Clifton-Brown, chair of the House of Commons Committee of Public Accounts, said: 鈥淣ew hospitals are desperately needed to address the longstanding backlog of investment. 鈥淲hen the Committee of Public Accounts last reported on the new hospital programme in 2023, we found no confidence that the promises made in the programme were deliverable. DHSC has since reset the programme, providing a more realistic delivery timetable and cost estimates. Current projections indicate that the schemes will cost 拢60bn in total. This represents a 拢33.8bn 聽increase on the capital funding proposed in 2023. 鈥淒HSC's more centralised approach has the ability to deliver a greater return on investment, enhanced digital technology and improved emergency performance, with the longer-term funding commitment helping to secure increased commercial interest. However, further delays in fully addressing crumbling RAAC in hospitals pose significant clinical and cost risks, which must be addressed as a matter of urgency.
鈥淚t is imperative that DHSC maintains rigorous oversight over the programme so that patients and clinicians do not wait even longer for their new hospitals to be completed.鈥�
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