Future Cities Forum's National Hospital Programme (NHP) discussion event this November

Above: gatehouse to St. Bartholomew's Hospital's historic North Wing and garden in Smithfield, close to Farringdon Station

Future Cities Forum will be holding its discussion event on the National Hospital Programme (NHP) at Barts North Wing at St Bartholomew's Hospital in London this November.

The BBC revealed recently that two of William Hogarth's masterpiece murals have opened to the public after a £9.5m restoration project: The Grade I-listed building contains the Hogarth Stair, part of architect James Gibbs' 1730s redesign, which is surrounded by the large scale paintings The Pool of Bethesda and The Good Samaritan. It reported that Prof Charles Knight, chief executive of the hospital, said' the renewal work stood "as a lasting legacy of our recent 900th anniversary, connecting centuries of medical excellence with our rich heritage".

'The North Wing was built in 1732 to help run the hospital and raise money for it, but fell into decline as the hospital prioritised clinical areas. William Hogarth offered to paint the Great Hall and staircase for free so he could make sure Italian artist Jacopo Amigoni did not win the commission - and could therefore prove an English artist could excel in grand historical painting. An ornate banquet room, a historic baroque gatehouse, a statue of King Henry VIII and Portland stonework have also being conserved in the project. This includes the intricate gilded ceiling of the Great Hall, designed by Jean Baptiste St Michell, his only work in England.'

Above: the Hogarth Stair at Bart's North Wing - courtesy Bart's Heritage

The discussion run by Future Cities Forum will ask questions about the NHP which was announced in October 2020 to deliver 40 new hospitals by 2030. Rt Hon Wes Streeting MP, Secretary of State for Health and Social Care, has stated:

'Despite the claim, there were not 40 ‘new’ schemes and some were just refurbishments or extensions. To put it simply - there were not 40 of them, they were not all new and many were not even hospitals. The spin that had been applied to the programme was widely known before the election. But even knowing that, I was shocked by what I found on entering the Department of Health and Social Care (DHSC). The programme was hugely delayed, by several years more than had already been revealed by the National Audit Office. Most shocking of all, the funding for the programme was due to run out in March of this year, with no provision for future years whatsoever. The money simply was not there. The programme was built on the shaky foundation of false hope and without the confirmed funding these building projects could not be delivered, let alone delivering them all in the next 5 years.

'If I was shocked by the state of this programme, patients ought to be furious. Not only because the promises made to them were never going to be kept. They also desperately need new buildings and new hospitals. The NHS is quite literally crumbling. I have visited hospitals where the roof has fallen in, pipes regularly leak and even freeze over in winter. As Lord Darzi found in his investigation, the NHS was starved of capital in the 2010s, with £37 billion under-investment over the 2010s. This lack of investment meant the UK construction sector did not have the appetite and capacity to build the number of concurrent hospitals required to deliver 40 new hospitals by 2030 when this promise was made. Delivery is dependent on providing certainty to develop relationships and secure investments in the supply chain which would ensure this vital hospital infrastructure is realised. 

'This review was launched for 2 reasons. First, to put the programme on a firm footing with sustainable funding, so all the projects can be delivered. Second, to give patients an honest, realistic, deliverable timetable in which they can have confidence. This government is committed to rebuilding our NHS and to rebuilding trust in government. We will never play fast and loose with the public finances or with the public’s trust. Following the review into the NHP, and the funding secured through the Spending Review, we are now publishing a credible plan and timeline to deliver the new hospital schemes.

'Working closely with colleagues in HM Treasury (HMT), we have secured 5-year waves of investment, ensuring that there is always a balanced portfolio of hospital schemes at different development stages being delivered now and into the future. This is the most efficient and cost-effective way of giving our NHS the buildings it needs, giving the construction sector the certainty it needs to deliver. We are backing this plan with investment which will increase up to £15 billion over each consecutive 5-year wave, averaging around £3 billion a year from 2030.

'I would rather take tough decisions which are the right decisions for the future, than lead patients up a garden path once more only for them to be let down again. Alongside record levels of capital investment - £13.6 billion next year, including the NHP - we have now put the NHP on a sustainable footing, with a timeline that can be met and a budget that is consistent with the fiscal rules under which the government is operating. My commitment to you is that we will deliver these hospitals and rebuild our NHS.'

The UK government has further stated:

'The government has agreed a set of realistic and deliverable assumptions around the ongoing funding envelope that will enable the programme to plan sustainably for the long term and support schemes in rolling waves of investment. The exact profile of funding will be confirmed in rolling 5-year waves at regular Spending Reviews (as with all government capital budgets in the future). Once the programme has reached a steady state in the early 2030s it can assume an overall funding envelope of £15 billion in each 5-year funding window.

'Following the review, work was undertaken to set out a realistic delivery plan. The NHP will now be delivered through consecutive waves of investment. Each wave will set construction start dates for schemes over a 5-year period.

Each wave will comprise a group of hospital schemes that will start main construction within that period, but may complete in a subsequent wave. Schemes starting in subsequent waves will have opportunities to progress work to prepare them for construction, subject to meeting value for money criteria. This may include business case development and critical work such as securing planning permission. In some cases, this may include early construction activity that is required to prepare sites such as multi-storey car parks, energy centres and demolition activity.

'The programme’s approach to standardisation, known as ‘Hospital 2.0’, has been designed with clinical and operating staff and aims to speed up construction, decrease the overall time for hospitals to be built and result in facilities that maximise modern technologies. The standard approach allows for lessons to be learnt iteratively as schemes complete within the programme, creating a repository of knowledge for future projects. A hospital built through Hospital 2.0 principles will use sustainable and modern methods of construction designed for manufacturing assembly to accelerate the building process.

Key to this approach is offering certainty to the construction industry. They are not signing up for one hospital scheme but several hospitals in a rolling programme. In a competitive construction market this level of certainty can allow industry to bid for contracts with the certainty they are in the programme for the long term. The review was initiated to give communities certainty over their local schemes, however it was also to address concerns from the construction industry and provide them with faith in this programme.'

Future Cities Forum's discussions this November 2025 will also continue with the themes of our 'Healthy Cities' and 'Science Cities' programme. These discussions have included input from hospital CEOs Bruno Holthof (formerly of Oxford University Hospitals), David Probert (formerly of Moorfields NHS Trust, now CEO of UCLH) and Sara Hanna, former CEO of Evelina London, as well as Nick Kirby, Managing Director of the Cambridge Biomedical Campus and now COO of Cambridge University Hospitals. We will be asking how we can best remodel hospital trust buildings and land for R&D and incorporate space for commercial collaboration on life sciences and for teaching.