DHSC ‘playbook’ orders trusts to describe big building projects as ‘new hospitals’

The instructions for comms on the Department of Health and Social Care’s “new hospital programme”, leaked to HSJ, also state that trusts should reiterate ministers’ commitment to open “48 new hospitals by the end of the decade”.

There has been a running controversy over the description of the prominent Conservative manifesto commitment, with questions raised about how many new hospitals will be delivered in reality, and the fact that many of those planned are not full hospital builds.

Last week, Sajid Javid was criticised for describing the Northern Centre for Cancer Care — which is part of the Cumberland Infirmary in Carlisle and the first of the 48 schemes to open — as a “new hospital”. Newcastle upon Tyne Hospitals Foundation Trust, which runs it, did not describe it as a hospital.

Several others among the 48 are new units or wings, or major refurbishments of existing sites, while some are community hospital rebuilds.

’Definitions of a new hospital’

The comms guidance document, distributed to trusts this month, is titled the New Hospital Programme Communications Playbook.

The guidance instructs: “The schemes named in the announcement are not all identical and vary across a number of factors. However, they do all satisfy the criteria we set of what a new hospital is and so must always be referred to as a new hospital.”

Under the heading “Definitions of a new hospital”, it says this can include “a major new clinical building on an existing site or a new wing of an existing hospital, provided it contains a whole clinical service, such as maternity or children’s services; or a major refurbishment and alteration of all but building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure”.

The guidance says where trusts are talking about the programme, they must use the government’s line about 48 new hospitals. Its suggested “short description” of the programme is: “The government has committed to build 40 new hospitals by 2030, backed by an initial £3.7bn. Together with eight existing schemes, this will mean 48 hospitals by the end of the decade, the biggest hospital building programme in a generation.”

Under a heading “background lines - if needed” — indicating they should be given to journalists but not attributed to a spokesperson — the document adds: “The government has committed to the delivery of all 48 hospitals by 2030 — and these plans remain on track.”

‘Stretching the definition’ 

Asked about the “playbook” instructions, Nuffield Trust director of strategy Helen Buckingham said: “Stretching the definition of a ‘new hospital’ to cover all these initiatives is not going to convince the average patient or taxpayer, and might lead to a poor reception for what are actually much needed local improvements.”

There are also questions about whether all the schemes can be delivered within the decade and therefore the programme “on track”. Although the deadline is nearly a decade away, several of the early schemes have faced big delays — as is common for hospital builds — such as those in Sandwell and Liverpool, and there are concerns about construction capacity.

Several of the schemes are at a very early stage, with many not yet funded and eight not chosen.

Large hospital rebuilds can take a very long time from planning to delivery, for example the Brighton 3Ts programme began planning in 2008, and its first phase is now due to open in 2022, 14 years on, with the subsequent two phases due in the following years.

The DHSC document stresses that “all press notices [on the issue] still need clearance from DHSC”. It comes amid ongoing controversy about NHS England’s requirement that it approves a very wide range of public statements from local NHS organisations, a policy introduced when covid-19 hit England but which remains in place. 

A Department of Health and Social Care spokeswoman defended its definitions. She said: “We have committed to build 48 hospitals by 2030, backed by an initial £3.7bn. Each of the hospital building projects will be new hospitals delivering brand new, state-of-the-art facilities to ensure world-class provision of healthcare for NHS patients and staff by replacing outdated infrastructure.

“It is not uncommon for existing hospital sites to accommodate multiple hospitals and there are numerous hospitals which specialise in one area of care or are colocated — they are all nonetheless hospitals. In some cases, that will be whole new hospitals on a new site, and in other cases, a new hospital on an existing site with dedicated facilities for particular conditions, such as cancer.

“We have issued guidance to trusts in the programme to support communications around the plans for their schemes, which is standard practice.”