Health Policy September 30, 2019
40 new hospitals for our NHS: Dissecting the political spin

By Ben Howlett - Accountable Care Journal

A Conservative Party Conference without the press release “we are the party of the NHS” is like a reception without the warm white wine. Unheard of at Manchester conference.

I have now attended every Conservative Party Conference since 2003 when Iain Duncan Smith attempted to “turn up the volume” and every year the Conservative Party tries - and unfortunately fails - to explain that they have the answers and money to solve significant problems within the NHS. In line with the new Prime Minister’s interest in the NHS, this year a new rabbit has been pulled from the budgetary hat in the form of “40 new hospitals”.

To the untrained eye, this sounds like a fantastic announcement - giving positive headlines at a time when the whole Westminster Lobby is on the train to Manchester. Such a headline gives the public, who religiously believe in the NHS, something to vote for other than Brexit.

However, fellow cynics might wonder why it took several minutes to trawl the usual sources of government press releases to find the devil in the detail on the Conservative HQ press office website, not even their front page. After 30 minutes of searching and reading, I am not surprised why the public is so distrustful of Westminster and the political class.

I will come on to explain why I think a focus on hospital building is the wrong approach, but will first focus on the spin. There is nothing like a commitment to build 40 new hospitals. In fact, only 6 will be built ‘immediately’ within the next 5 years. The lucky hospitals are Whipps Cross Hospital, Epsom and St Helier Trust, West Hertfordshire Trust, Princess Alexandra Hospital Trust, University Hospitals of Leicester Trust, and Leeds Teaching Hospitals Trust.

In fairness to the Government, they have given an additional £2.7 billion cash injection to pay for these new capital projects. The “largest hospital building programme in a generation” headline is far from the reality - let’s not forget the huge number of hospitals built under Blair and Brown 1997-2010.

However, the commitment to the other 34 hospitals only stretches as far as “seed funding”. A quick call to a number of hospital estates directors revealed the government has only committed to consider architect designs, the repair of an outpatients waiting room and the delivery of a new bucket for a leaky roof. I suspect this example may be more than a little tongue-in-cheek - but the detail behind the headline shows that today’s announcement is straight from the spin textbook.

Assessing priorities: Primary or secondary 

It is surprising that a Secretary of State who has championed prevention and out of hospital care is touring TV studios to sell more money for new hospitals. The direction that Simon Stevens set out in the NHS Long Term Plan and prevention green paper, was anchored around addressing the determinants of health. Instead of building new hospitals, therefore, it would make much more sense for £2.7 billion to be spent on keeping people out of hospitals in the first place. Indeed, only last week was Sir Robert Naylor, National Estates advisor to the Government, made the case for additional capital spending in the out-of-hospital sector at a Hosptial Times Estates Seminar.

Hospitals in the UK do need more investment. Virtually every report shows underinvestment in hospital equipment. Endoscopy equipment is nearing the end of its sell-by date, MRI scanners are increasingly inefficient compared with more modern equipment, and new robotic surgery equipment is unobtainable based on current capital spending. However, the Government must take the debate back to the public and explain that investment in hospitals is an inefficient way of improving patient outcomes.

This is a difficult task so close to an election. However, there is a public appetite for securing GP practices. Is evidence-based policymaking too much to ask for?

Spin doctors at Number 10 need to reconsider their approach fast before the public realises there is little substance behind the headlines. 40 new hospitals means 6, tens of billions of pounds of new funding is £2.7 billion, and the largest hospital building programme in a generation means since 2010. With public trust in politicians at an all-time low, spending must be focussed on areas that generate improved patient outcomes.

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