Delivering the next generation of hospitals

Scale and opportunity

Years of work go into planning, designing and building healthcare facilities. And with dozens of new and upgraded National Health Service (NHS) hospitals set to be opened across England this decade, a programmatic approach is unlocking significant benefits. As well as economies of scale, there are efficiencies in design and procurement, and the ability to use manufactured components and digital technologies.

This is the idea behind the New Hospital Programme (NHP), the biggest hospital building initiative in a generation. Since October 2020, the NHP has been working with NHS trusts, government and industry to bring about a dramatic shift in how healthcare facilities are delivered, setting new standards that will transform the sector.

Traditionally each new hospital would have been designed, developed and built as a standalone project with a bespoke approach, for an individual NHS trust (the local, specialist organisations that administer public healthcare in England and Wales, of which there are more than 200). In contrast the NHP is ensuring that it captures the scale and opportunities of a long-term, coordinated, national plan. Not only will hospitals under the programme be built better, faster and with a sustainable legacy, they will also have integrated digital technology that enables more intelligent healthcare and a higher quality of service for patients.

Saurabh Bhandari, programme director for the New Hospital Programme, said: “We are creating an enduring legacy of skills, relationships and productivity in the industry while maximising the socioeconomic benefits for the communities our hospitals serve.

“These new facilities will be smarter, easier to operate and create a platform for the NHS to deliver the best care effectively and efficiently. Our vision and ambition for this programme – improving the supply chain, increasing standardisation, building fully digital, intelligent hospitals that improve the environment for patients and staff – is vast and the teams working with us to develop Hospital 2.0 are playing a vital role.”

The NHP is a joint venture between the Department of Health & Social Care (DHSC) and NHS England; it is funded directly by HM Treasury, with an initial budget of £3.7bn over its first four years (2020 to 2024). Mott MacDonald leads the interim delivery partner team (the IDP) which works with the NHP to provide delivery support, including project delivery advice, programme management office, digital advice, design support and clinical support.

The IDP works alongside an interim commercial partner team (the ICP) led by KPMG. These interim services play a vital role in securing capability during the procurement process, which will see a permanent delivery partner for the programme chosen in due course.

Shared ambitions

The switch to a programmatic approach is a huge change for the NHS, as well as a huge opportunity. “The scale of the undertaking provides the confidence to push boundaries, with change and innovation able to be rolled out more quickly; while for individual health trusts, it puts within reach ambitions they could not have achieved alone,” says programme manager Katie Hislop.

“There hasn’t ever been a programme of investment in as many hospitals and healthcare buildings as this in the life of the NHS, other than at the point the NHS was created,” says Ian Chapman, our design commission lead. “It’s having this level of investment that provides the opportunity for standardisation, modernisation and the transformation of patient care. You can’t overstate what a big change that is.”

Climate sustainability in the form of net-zero emissions is one of the key ambitions of the programme. The NHS has an overarching commitment to net-zero which is being driven at a high level, but being part of a co-ordinated programme of hospital projects all seeking similar outcomes, with shared approaches and expertise, gives a greater prospect of success.

Another area of shared ambition is in a commitment to improved social outcomes. Our work to assure and develop the business cases of projects in the programme has helped many trusts to improve the way they engage with and create value for all sections of the community.

It is only by consulting with and listening to a range of stakeholders that project teams can be confident the eventual solution is inclusive and creates the maximum value for everybody. The NHP is helping to ensure a consistently high-quality approach is pursued at all times.

Getting with the programme

A major challenge in knitting together so many projects is that they are at different stages of planning, design and delivery. The new and upgraded hospitals in the NHP are therefore divided into four cohorts depending on their delivery timescale (see panel ‘Project cohorts of the NHP’).

Cohort One includes hospitals that were already nearing completion, such as the Royal Liverpool Hospital, which opened in 2022, and the Midland Metropolitan University Hospital, opening in 2024. The NHP’s influence on these projects was therefore limited but the intention is to apply examples of best practice, innovations and lessons learned to subsequent schemes. Cohort Two projects, while well developed, offer more flexibility, while it is the third and fourth cohorts that will benefit most from the NHP’s transformative work.

This categorisation into cohorts was key to how we organised the interim delivery partner team (the IDP) when given the responsibility for leading it on behalf of the NHP.

The IDP has two primary functions: transformational design (such as digitalisation and standardisation), and programme management. It is a rare combination which adds to the complexity of the challenge: we’re working to transform how healthcare is delivered, at the same time as delivering an extensive programme of healthcare infrastructure projects.

One of our priority tasks within programme management was to set up ongoing reporting of project information via the programme management office (PMO), with dashboards showing project milestones and schedule, budgetary information and other performance metrics. These are viewed regularly by the NHP executive team, HM Treasury and the secretary of state for health so they can compare progress across the portfolio and direct attention where needed. Each project in the first two cohorts has been assigned a project director – either a Mott MacDonald employee or one of our subcontractors – who works directly with the relevant NHS trust and oversees delivery.

Envisaging Hospital 2.0

The transformational design element of the programme involves setting out a shared vision of ‘Hospital 2.0’. Each hospital in the programme will be designed to give optimal value over its whole lifecycle and to play its part in an integrated healthcare system.

What this means in practice is that many design decisions, from how to heat and insulate a building for maximum efficiency, to room dimensions and equipment locations, are decided at the programme level, unlocking design savings and aiding constructability.

“Everybody gets the logic of standardising,” says Ian Chapman. “However, every trust is in a different part of the country, on sites that have different needs. So what we’re doing is creating a kit of parts that will allow the trusts to commission their own design teams who can use it to assemble the right hospital for them.” By using the kit, with some bespoke aspects unique to each site, they will achieve compliance with the programme and meet its ambitions.

The use of a single alliance framework for procurement means contractors and suppliers can have the confidence to invest in continuous improvement. Benefits will continue when the hospitals are operational because the assets will be easier to maintain, replace and upgrade.

Standardisation is not just about physical components, explains Ian. “For example, there’s no reason why car parking at hospitals can’t be controlled and managed in the same way everywhere in the country; the same goes for many functions in and around a building. Our focus is on making the patient experience the best it can be.”

We’ve worked with subcontractor BDP on a prototype for the kit of parts, with our experts providing technical assurance and NHS trusts giving input and feedback. Further design work has concentrated on establishing the kit’s ideal scope and size – should it be extensive and prescriptive, or limited to a narrow set of key components that will make the biggest difference?

As development of the kit progresses, we’ll consult with manufacturers to test the viability of its components being mass produced and the extent to which this can reduce costs and achieve the programme’s ambitions for climate sustainability.

We’re also leading the creation of a ‘hospital playbook’ or manual: a central suite of reference documents to guide NHS trusts through the development stages of their hospital project and ensure they meet the programme’s requirements. It will set minimum standards, describe best practice and share lessons learned.

Towards intelligent hospitals

The digital workstream of the NHP is focused on creating intelligent hospitals that harness the power of digital technology and data to provide better operational outcomes. The target outcomes are joined-up care for patients, a smoother experience for staff, and better performing, smarter buildings with interoperable systems that talk to each other.

A key part of making care more joined up is the concept of ‘hospitals without walls’. Our digital healthcare lead, Abhi Shekar, explains: “One of the fundamental principles of the NHP is that the hospital doesn’t exist in isolation. It’s part of the wider health ecosystem. What we are adding through digital is the connectivity between the hospital and that wider system.”

The aim, says Abhi, is for the hospitals “to learn from each other, and to be interoperable to improve care and match the population they serve”. Some of the key digital technologies reach beyond the walls of the hospital: for instance, remote monitoring and virtual appointments. These can minimise the time patients need to spend in the hospital as part of their health journey.

The digital chapter of the NHP manual outlines a set of essential technologies that trusts should incorporate into their hospital designs to achieve connectivity. They include technologies embedded in the fabric of the building, such as smart heating, as well as those concerned with the flow of staff and patients, for instance smart scheduling.

It’s envisaged that these technologies will feed two interconnected digital twins – one for the physical assets and the other for the clinical workings of the hospital – which will supercharge its efficient management through a control centre in the hospital. The NHP manual also advises trusts on workforce requirements: what roles and skills they need to hire or develop to use the digital technologies effectively.

The digital system, which will be accessible to patients as well as staff, will improve patient experiences as well as facilities management. It’s about putting the patient at the heart of how hospitals are operating, making it a better experience for them, and also a better experience for the staff. How a hospital operates will radically change – and Hospital 2.0 is going to be the vehicle by which we get there.

Delivery through better business cases

While future projects will see the greatest benefits from the transformative aspects of the NHP, we’re also helping trusts to do better in the here and now. In mid-2022, we were commissioned to work in partnership with the trusts in Cohort Two to technically assure their early business case development, aligning it with the programme’s aims where practically possible.

“Each of the trusts [in Cohort Two] had set out what they wanted from their hospital projects and were keen to get on and deliver them,” says John Gardner, senior associate project manager. “But as the New Hospital Programme, we have ambitions for digital, for net zero, for modern methods of construction, economies of scale and standardisation. We needed to match those elements up and build into their scope the ambitions of the programme.”

To achieve this, we distilled the ambitions and goals of the NHP into 13 criteria, covering expectations around standardisation, modern methods of construction (MMC), net-zero carbon, social outcomes, workforce management and more. These criteria formed a scorecard that could be used to assess each trust’s business case and were the basis of detailed feedback.

“Our technical assurance people were key, because they established some very fruitful relationships with the trusts and looked from a technical perspective at what they were trying to achieve, then made suggestions as to where they could improve,” says John. “What we ended up with, for each of the hospitals within Cohort Two, was a bespoke package of scope and ambition that we could bake into each of them.” We then consulted with the senior leadership team of the NHP to make sure this matched their financial envelope.

After working with each trust individually to understand their strengths and areas for improvement, we helped them implement this knowledge and better achieve their aims, through various means of support such as workshops, meetings, briefing notes and technical advice on specific issues. Because the trusts each had different skills gaps and requirements, a flexible approach was essential to ensure that programme aims were met and no trust was left behind.

Delivery arrangements and support will continue to evolve for Cohorts Three and Four. A minimum viable product (MVP) approach – a structured process that identifies the right facility profile and budget to deliver an optimised set of clinical services and meet a set of minimum requirements for smarter, more efficient infrastructure – is expected to be applied to the NHP criteria, with some agreed minimum standards and then a degree of flexibility in other areas.

Assuring better social outcomes

A particular area of improvement for many of the trusts was that we were able to enhance business cases to target better social outcomes, according to stakeholder manager Jason Kirkham.

“There’s no question that some of the trusts had propositions for social outcomes that could be strengthened in terms of detail and metrics,” he says. “We provided a briefing note on the subject, talked them through what good looks like, and how they could capture deliverables.” For example, a trust might have merely stated an intention to create apprenticeships, but it ought to say how many, by when, and how that fits into its overall strategy.

“And it’s not enough to show that you have engaged with the community about your plans – you need to show that you’ve used a mix of methods, like events, advertising and digital, to be inclusive and reach different types of people.” We used stakeholder maps to ensure the trusts were consulting all the relevant groups, and as a result, says Jason, “what they were delivering through the project was far deeper and more prescriptive after we’d finished working together”.

“Our expertise took the trusts on a learning journey that ensured they could meaningfully deliver in the early development of the business case,” Jason adds. As we move through the later stages of project delivery, we’ll continue to check that their intent and commitment towards social outcomes remain on track.

Thanks to our assurance work, all the business cases for the projects in Cohort Two gained the support of the NHP leadership and were able to progress to external scrutiny by regional authorities, the Joint Investment Committee and HM Treasury. Through advice, design evolution and coaching on business case submissions, we have enhanced individual trusts’ propositions in a way that has added value as well as delivering on ministerial priorities and the ambitions of the New Hospital Programme.