Fever pitch: can the government deliver 40 hospitals by 2030?

Meeting the government’s 2030 deadline to build 40 new hospitals will rely on intense activity from construction firms. Greg Pitcher takes the programme’s temperature

Time flies when you’re having fun, but slips away alarmingly fast when trying to meet a target for hospital construction while battling the effects of a global pandemic. Building 40 new hospitals in a decade seemed an ambitious goal when Matt Hancock first announced the government’s Health Infrastructure Plan in September 2019.

Almost three years on, and with Hancock’s stint as health secretary now firmly in the past, how much progress has been made?

As the headlines tracked the spread of COVID-19, shortages of PPE, the feat of the Nightingale hospitals, and Hancock’s illicit relationship with an aide, work steadily progressed on the New Hospital Programme. Now details are slowly emerging and the picture of the programme is becoming clearer.

Gathering momentum

A commercial pipeline was published in March, setting out the progress made so far and the timeline for future projects. The 40 hospitals were split across five ‘cohorts’, with just one scheme – the Royal United Bath Hospital – coming from the first of these, which is otherwise made up of previously announced schemes.

A second cohort will see 10 “early” schemes get under way on site by September 2024 and be completed by the end of 2026 – nine under the New Hospital Programme. A main contractor was appointed to one of these in May, with a joint venture of Vinci Construction UK and Sir Robert McAlpine selected to deliver the £100m National Rehabilitation Centre in the East Midlands.

A further eight projects – to be known as “pathfinders” for the programme’s dedicated approach – sit just behind in the pipeline, with completion dates of between 2026 and 2028. This leaves two waves to start on site in the second half of the 2020s – first a swell of 14 projects from Torbay to Lancashire, followed by a final eight schemes that have yet to be chosen. These are known as cohorts four and five, or the “full adopters”.

National Rehabilitation Centre – Vinci Construction UK and Sir Robert McAlpine JV

With more than half of the programme to be fully delivered in the last five years of the decade, it is clear that the Department of Health and Social Care (DHSC) is pinning its faith on the industry’s ability to learn as it goes and gather momentum. To try to ensure this happens, a standalone delivery board has been established across the DHSC, NHS England and NHS Improvement.

Registered nurse and former hospital chief executive Natalie Forrest, who led the construction of London’s Nightingale hospital at the Excel convention centre in the early days of the pandemic, was appointed early last year to lead the new delivery panel. She immediately stated her ambition of building the facilities “cost-effectively and at speed” while creating “an ecosystem that owns, learns from and improves healthcare design”.

Forrest’s appointment came just weeks after former Heathrow expansion chief Emma-Jane Houghton took the role of commercial director for the New Hospital Programme at the Cabinet Office.

Houghton told delegates at a briefing event in April that the eight pathfinder schemes would be delivered through an alliance framework. This would then be “developed cohort by cohort”, she added, with later iterations of the framework delivering the final two waves of the programme.

Houghton said the alliance framework would unlock modern methods of construction (MMC), attract new entrants and funding, foster innovation, build intelligent teams and deliver early supply-chain involvement. The delivery unit wants to move away from looking at each scheme individually towards “a new programmatic drum beat”, she added in her presentation.

Building an alliance

New Hospital Programme head of procurement Stuart Powls said a position on the first iteration of the framework, expected to be awarded by next spring, would allow contractors through the door to compete for more than £1bn of building work.

Anastasia Chrysafi, Willmott Dixon

It is clear that a new approach will be required to deliver to the government’s target, according to Anastasia Chrysafi, national account manager for health at contractor Willmott Dixon.

“It is a huge challenge to build 40 hospitals by 2030, and it will only be done by working together as an industry to bring in efficient processes,” she says. “Things will have to be done differently to the past.”

About 20 contractors are expected to be appointed to the first-generation alliance framework and Chrysafi says open communication is the key to success.

“The construction playbook sets out the principles of contractors learning from each other,” she says. “I could see conversations taking place between us and another contractor if we’re working on similar hospitals in different parts of the country, for example. The alliance framework will set the forum for doing that. Contractors will be appointed as collaboration partners to share knowledge and intelligence, and work on issues together.”

“It is a huge challenge to build 40 hospitals by 2030, and it will only be done by working together as an industry to bring in efficient processes”

Anastasia Chrysafi, Willmott Dixon

Chrysafi expects joint ventures to emerge from the framework to work on individual projects, with broader discussions taking place across a cohort of schemes. “It has not been done before in this way, but I think it is the best approach,” she says. “It will bring smaller contractors and suppliers in early, which is the right way to drive partnerships and capacity in the market.”

Bam Construct UK new business development manager Matthew Beal gives his backing to the way the delivery unit is setting up the programme.

“The procurement is a lot different to what we’ve seen before,” he says. “There is a new team, which is experienced and approaching things differently. It gives me confidence. They have some key individuals with expertise from the NHS operations perspective and others who have delivered strong programmes. It is a breadth of experience.”

While acknowledging the scale of the challenge, Beal is pleased to see the clear structure of the delivery programme. “We know the schemes that are coming online, so we can organise ourselves to have the right teams in place to bid and, if successful, deliver the work,” he says.

Going modular

Delivery as well as procurement is expected to be different for the new hospitals. “The language we are hearing is better, faster, greener,” says Beal. “Better quality in faster timescales and with sustainable solutions.”

David Hartley, MTX Contracts

MMC is likely to play a huge role in achieving this. “There is a large opportunity to do more work offsite in this programme,” says Beal. “All hospitals have offices, single rooms, theatres, receptions – it is a jigsaw and some of it will be modular. Perhaps we will see prefabricated plant rooms and service rooms. We are working with our supply chain to look at what is available.”

One firm hoping to take advantage of the increased onus on modular building is Cheshire-based healthcare specialist MTX Contracts.

Managing director David Hartley is “excited” by the opportunities offered by the New Hospital Programme. While MTX Contracts can work as a main contractor on medium-sized projects, Hartley also sees a role partnering other modular specialists to deliver elements of a larger scheme.

“We have just handed over a £24m critical care unit for the John Radcliffe Hospital in Oxford – a five-storey extension,” he says. “We are about to start on a £44m project in Colchester. On the larger projects a tier one is likely to be the primary vehicle and we could fit into that. There is a huge challenge for the government to achieve what it wants to. You could have a large atrium from a tier one and then an MMC company doing ward areas, another doing A&E, and so on. You could maximise use of the supply chain, deliver quickly and get SMEs involved – it’s a win-win.”

“You could maximise use of the supply chain, deliver quickly and get SMEs involved – it’s a win-win”

David Hartley, MTX Contracts

Standardising designs not only within a big hospital project but across several schemes within a cohort could ramp up benefits, Hartley says. “There must be frustration for the taxpayer that every single operating theatre we’ve ever built has been different. Yet they all perform the same operations. We reinvent the wheel every time, creating cost wastage throughout design and build. Can you imagine if Henry Ford did that when making cars? There is a huge opportunity to reduce costs and increase speed and quality control.”

Leicester Royal Infirmary – MTX

But he raises concerns that individuals at each hospital will wield too much power, setting out specific demands that rule out a standardised approach. “A directive is needed from the top that says, ‘you will have one of these theatres – pick from a list – but they will look like X, Y or Z’,” he says.

Modular construction can also help with the other key priority for the programme, Hartley adds. “We can help decarbonise. On a traditional building, everything is being delivered from multiple places with people travelling from all over the country to site. If the majority is built in a factory environment, you can use local labour and materials suppliers. There is also a greater opportunity for recycling.”

It is not only the specialists who are leading the way on MMC – main contractors are also getting in on the act. “We have a repeatable community healthcare hub that’s pre-designed and speeds up pre-construction considerably,” says Chrysafi about Willmott Dixon’s MMC offering. “We know how long it will take to build and the cost; it just needs tweaking in light of site survey results and that type of thing. Using that principle, we will be looking at repeatable design to bring efficiencies.”

Tessa Jowell Health Centre in Dulwich – Willmott Dixon

Willmott Dixon formed a partnership with Mace Construct in 2021 to collaborate on health projects and the team was awarded a number of places on the £30bn ProCure 23 framework earlier this year. This panel will be used to deliver some of the first tranche of new hospital projects – as was its predecessor, ProCure 22, and the Crown Commercial Service’s Construction Works and Associated Services framework.

A partnering agreement is being put in place for these projects, with the aim of creating a positive relationship between trusts, contractors and the government’s central delivery unit, which will build towards the framework alliance to be used on the later cohorts.

Willmott Dixon believes its partnership with Mace puts it in a good position to compete for work on the 40 new facilities. “We work in collaboration [with Mace] in line with the Construction Playbook to deliver hospital infrastructure,” says Chrysafi. “It provides comfort to NHS customers to have two stable companies working together and learning from each other. We will look at elements of the New Hospital Programme; there are some projects we’ve been following and targeting.”

Sustainable future

As well as using MMC, Chrysafi says more hi-tech, pandemic-savvy solutions are required. “We are seeing changes post-COVID, such as considering access and egress, one-way routes, different zones, more PPE storage and digital consultation – that is another key focus of the programme,” she says. “We won’t revert to how we did things before. What we are delivering is becoming more hi-tech.”

Willmott Dixon has a firm eye on sustainability too. “We want all projects we deliver to be net-zero carbon in operation by 2030,” Chrysafi says. “It is about looking at renewable energy as much as possible – that’s the key. There are also moves to use different materials to reduce embodied carbon.”

The Pears Building – Willmott Dixon

Beal says Bam, which secured spots on ProCure 23, is taking a similar approach. “We are looking at how we can get to zero carbon in operations. Embodied carbon will also play a huge part – we are being challenged to break away from the norm. That is an opportunity for the supply chain and new things are coming on the market all the time.”

“We are looking at how we can get to zero carbon in operations. Embodied carbon will also play a huge part – we are being challenged to break away from the norm”

Matthew Beal, Bam Construct UK

Standardising hospital design is another area where suppliers can make a difference, Beal adds. “Some of what is needed is on the market; other parts need to be developed. We are all looking to innovate, so that might need us to find new supply-chain partners with a great product or capability. Contractors will know they can’t stick to the same supply chain as they have done in the past.”

Bam is looking at “a few” of the early wave projects, Beal says, and believes the strength of the UK part of Royal Bam Group stands it in good stead.

Looking ahead to the delivery of the full 40 hospitals by the end of the decade, Beal describes himself as an optimist. “We have seen a step-change in approach, which is positive and gives me confidence. How the procurement shapes up will give us an insight into how achievable the ambition is. I would love to think we can roll our sleeves up and do what’s needed to get it done.”

Leave a comment