With the New Hospital Programme on pause as the government seeks to conserve public finances, NHS leaders have restressed concerns that the lack of capital funding will only compound capacity demand and waiting list spikes. Looming winter pressures mean the NHS has no time to lose, so what role could short-term building solutions play in providing an interim answer to its building crisis?
The government’s unearthing of a £22 billion ‘black hole’ in public finances has firmly put the brakes on the construction of 40 new hospitals promised to the NHS in 2020. Originally due to complete in 2030, just eight of the proposed hospitals have been built or are pending, with the full rollout and conclusion of the scheme yet to be confirmed.
This has come at a significant cost to NHS trusts and patients alike. Many healthcare buildings are outdated and in need of renovation or repair, whilst 54 hospital sites were found to contain RAAC as of February this year and are now part of the government’s remediation scheme.
The picture painted of the NHS can be critical, but the reality is that years of chronic underfunding and limited access to capital have destabilised the organisation’s performance and ability to improve its infrastructure. The change in government appears to have upped cross-party impetus to rectify the NHS’ position, but with public sector budget shortfalls unveiled, long-term initiatives such as the New Hospital Programme cannot relieve urgent, frontline pressures.
The greatest drivers for NHS trusts to invest in their estates is typically the need to increase the capacity or quality of space. This could be on a large scale, such as the construction of a new hospital, or at smaller level, such as the introduction of community health centres and practices. Whilst highly specialist facilities such as operating theatres are typically earmarked as permanent builds, the scope for using shorter-term building solutions to meet needs quickly is broad.
Typical examples include the use of rental building solutions to expand ward space, establish bespoke facilities (for example, PET-CT scanning units or endoscopy units) and ancillary space, like consultation rooms or waiting areas. The opportunities for using rental building solutions extend to larger, combined multi-use buildings too. Hospitals are not off the table and can be constructed for short-term or long-term needs. Such projects may require a collaboration between the contractor’s in-house design teams and an architect but will be delivered to the same high spec as any other modern hospital.
Where modern methods of construction (MMC), such as offsite manufacturing, are applied, healthcare facilities can be produced from reused stock to a new standard. MMC rental building solutions can therefore afford the NHS two significant benefits: speed and sustainability, without a quality compromise. Naturally, the production of components offsite lends itself to less disruption on site with this time period limited to the installation, groundworks and fit out of buildings. The process also reduces a project’s carbon emissions through the low-waste manufacture of building parts and the limited transportation of goods and personnel to site.
Such building solutions offer a faster, interim answer to the NHS’ hospital crisis but close collaboration between key stakeholders is still essential for specific trust needs to be met. Holding discussions early on between relevant trust teams and suppliers, such as contractors and architects, allows logistical issues to be identified and addressed. An example of this was the logistical planning Premier Modular undertook with stakeholders in late August 2024 to safely transport modules to the Isles of Scilly for the Cornwall Partnership NHS Foundation Trust’s new integrated health and social care facility. Everything from the specialist sleeves covering the modules to their position in the ship’s hold was coordinated to the letter, ensuring the building components were transferred to site on time.
Whilst a unique example, such planning is necessary for land-based movements too. Hospital sites in particular often feature several emergency care services including ambulance bay areas, intensive care units and A&E departments that cannot be disrupted. Where installation work is occurring in the proximity of these areas, key stakeholder input is critical to ensure interruptions are avoided or kept to an absolute minimum. MMC is well-suited to this challenge and can be delivered within a small window to mitigate interference to patient care. Any rental solution should follow a strict installation programme which trust stakeholders can feed into and provides clarity on specific timeframes, from manufacture to completion.
In the current climate, funding is still the main barrier to building investment, but the nature of rental solutions allows costs to be distributed over a longer period of time. Capital funding is the go-to for the NHS, but the government’s hesitation to reallocate further spending means an extended budget plan is becoming the more viable option to trusts. Dipping into operational expenditure (OpEx), which is typically used for everyday costs such as equipment, inventory spending and marketing, could make building investment more accessible for trusts. The ability to recycle and relocate rental building solutions also means facilities can be flexibly procured and used to meet changing demands across the NHS estate.
With the future of the New Hospital Programme and further capital funds still pending, shorter-term building solutions could be pivotal to keeping NHS infrastructure afloat. If the government’s concern of public finances is anything to go by, the current road to new hospitals will be long and arduous.
Article submitted by Mark Rooney – hire divisional director at offsite manufacturer, Premier Modular.
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