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The reset covers 41 hospital schemes, which range from whole new buildings to major refurbishments, and will be carried out in four waves over the next 20 years.
Five schemes were already complete when the programme was reset in January 2025.
Despite being prioritised, seven hospitals predominantly built from RAAC are now expected to open in 2032-33.
Significant costs and operational risks
In 2022, an independent report for NHS England and DHSC recommended replacement by 2030, although more recent analysis concluded the buildings can remain operational beyond that date with continued mitigation and maintenance.
However, the report indicated that these hospitals will face significant costs and operational risks, including safety risks to patients. By 2025, more than £500m had already been spent on preventing structural failure at the sites.
The government has allocated around £2bn a year to the programme from 2025-26 to 2029-30, rising to £3bn a year from 2030-31.
Total capital funding of £56bn is expected to be required, including a £12bn contingency to reflect inflation, market pressures and engineering challenges.
The programme is moving towards standardised ‘Hospital 2.0’ designs, which the NAO said could deliver efficiencies and create a stronger pipeline for contractors, provided programme oversight and workforce capacity issues are addressed.
However, the watchdog warned that a tight construction schedule over the next five years leaves little contingency if early schemes are delayed.
Key recommendations
NAO recommendations for DHSC and NHP 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 undersized hospitals, refining demand assumptions and developing clear contingency plans across the wider health system.
Gareth Davies, head of the NAO, said: “The 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.”
