Significant risk and cost of unsafe concrete in hospitals must be disclosed to the public - says PAC report

- PAC report on New Hospital Programme warns of likely further delays - raises doubts around new Hospital 2.0 designs 

There remains a risk of serious deterioration from crumbling concrete in seven hospitals, the cost of ensuring safety in which is now expected to cost £1bn. In its report on the New Hospital Programme (NHP), the Public Accounts Committee (PAC) is calling for an annual report to Parliament on the progress of replacing reinforced autoclaved aerated concrete (RAAC) hospitals, with details of any cost increases, any delays, and the impact from such timetable slippages on the risk to staff and patients.

Buildings constructed from RAAC are susceptible to structural failure, and schemes to replace RAAC hospitals need to proceed at pace. A 2022 independent report recommended that RAAC hospitals should be replaced by 2030 at the latest, while a 2025 report concluded that they could stay operational past 2030 but with significant risk and cost. The government's new timetable has final RAAC replacement schemes due to finish in 2033. This is two to three years later than originally planned.

Government has already spent £500m on maintenance and mitigations to ensure patient and staff safety for RAAC hospitals, with the PAC's inquiry told that trusts with RAAC hospitals will receive a further £440m. The PAC received evidence highlighting that such maintenance reduces risk in RAAC hospitals, but cannot remove it where RAAC planks are inaccessible. Between 1% and 6% of RAAC planks are inaccessible at each RAAC hospital. The PAC calls on government to learn the lessons from RAAC on the importance of investing in the NHS estate in a timely manner, and to publish a strategy for investing in NHS capital assets.

The PAC's report into the programme raises the further significant risk that the massive programme will fall further behind. Government plans to spend £8.9bn between now and 2029-30 as it works on the next wave of the NHP, which will include sixteen more schemes than anything delivered so far. The Department for Health and Social Care (DHSC) has set aside very little contingency funding for the 2025-26 to 2029-30 period - only 3% of total funding compared to a total contingency of 21%. If the NHP faces unexpected cost increases in the next few years, the report warns there is very little buffer to absorb these, with knock-on delays to subsequent hospitals likely.

These hospitals will be delivered to the new and unproven Hospital 2.0 design, about which the PAC raised concerns in 2023. A key aspect of Hospital 2.0 is wards consisting of solely single bedrooms, which DHSC expects will result in fewer infections and shorter stays. However, DHSC has not focused enough on the unexpected downsides of 100% single bedroom wards. Some patients, particularly those that are frailer or more vulnerable, may feel alienated being alone and monitored remotely. NHS providers told the PAC's inquiry that trusts were concerned about future financial pressures as a result of operating the new hospitals. NHS England also acknowledged that staff may find it harder initially to observe patients in single rooms, with necessary extra checks potentially resulting in higher costs in the short-term until staff are used to working in a different way, using digital information. 

The PAC's report calls for government to explain how it expects the new design to lead to measurable benefits for patients, and to allow an independent assessment of whether the benefits are being realised following the opening of the first hospitals.

There are also questions as to why bed capacity for hospitals in the NHP needs to increase by 6%, when government has also committed to spending more on care outside hospitals relative to what it spends in hospitals. DHSC has not yet developed a convincing rationale for the proposed size of new hospitals, and government must show how each individual scheme has taken expected changes to community care into account when deciding bed numbers.

Sir Geoffrey Clifton-Brown, Chair of the Public Accounts Committee, said: “Every year that sees delays to the replacement of RAAC hospitals is a year of borrowed time. This is time borrowed at the expense of the safety of patients and staff, and from the taxpayer in the costs of mitigation and maintenance. Such maintenance cannot de-risk this material entirely; indeed, our report finds that up to 6% of failure-prone RAAC in hospitals cannot be accessed. We are glad government agrees that RAAC in hospitals must be addressed as soon as possible, but our Committee is seeking to bear down further on this issue. Government must be straight with the public through annual reports to Parliament on its progress in stripping RAAC out of the hospital estate entirely.

“Per our findings this much-overdue programme faces likely further delays, particularly in today's volatile economic environment from a lack of contingency funding. There are also concerns about what these new hospitals will look like – the rationale behind extra beds being provided in the context of a continual insistence of care moving to the community looks dangerously like potentially wasted resource in the future. We further have deep concerns that providing solely single bedrooms in the new Hospital 2.0 model risks isolating more frail and vulnerable people in particular. The previous Committee's visit to Denmark found that standard hospital design in that country has improved the delivery speed and unit cost of new hospital buildings. We will continue to monitor hospital building programmes around the world and to see what lessons can be learned for our own - government should do the same. RAAC itself is a hard lesson in overall NHS estate management and investment. We hope that government begins to show more signs of learning these lessons.”

PAC report conclusions and recommendations 

Slow progress to date means the RAAC hospitals will be replaced two to three years later than originally planned, resulting in greater cost to the taxpayer from mitigating risks to patients and staff. Buildings constructed from Reinforced Autoclaved Aerated Concrete (RAAC) are susceptible to structural failure. In 2022 an independent report recommended that hospitals built from RAAC should be replaced by 2030 at the latest. A subsequent 2025 report concluded that with mitigations and maintenance, the RAAC hospitals can stay operational past 2030 but with significant risk and cost. Under the Department's new timetable for the programme, the final RAAC replacement schemes are due to finish in 2032-33. The Department has already spent £500 million on maintenance and mitigations to ensure patient and staff safety and expects to spend a further £440 million. While unavoidable at this point, such reactive spending does not represent good value for money and, given a £15.9 billion maintenance backlog across the wider NHS estate, there are clearly lessons to be learned for timely investment in the estate. The Department has still not published a capital funding strategy, even though the previous Public Accounts Committee raised concerns about this in 2020.

Recommendation 1. The Department recognises it should complete the RAAC hospitals schemes as soon as possible. It should:

1. a) report to Parliament annually on the progress of projects to replace RAAC hospitals with details of any timetable slippage, cost increase and the impact of any slippages on risk to staff and patients and the cost of maintaining existing hospitals; and
2. b) learn lessons on the importance of investing in the NHS estate in a timely manner. As highlighted by the previous Committee, the Department should publish its strategy for investing in the NHS's capital assets. The strategy should include implementing a property replacement and maintenance plan and set out the annual funding flows that it will put in place to reduce the maintenance backlog.

With little contingency up to 2029-30, there is a risk that delays and cost overruns in the early years will have knock on effects on subsequent hospital schemes. Although some of the early hospital schemes in the programme (known as 'wave 0') are open or due to complete soon, enabling works for many hospital schemes in the next wave ('wave 1') are yet to start. Wave 1 contains the first schemes to be built to the Hospital 2.0 design which will be more complex. The Hospital 2.0 design is novel and it is taking time to finalise. Wave 1 will include 16 more hospital schemes than anything delivered so far, with a planned spend of £8.9 billion from 2025-26 to 2029-30, compared to £720 million for schemes in wave 0. Despite these challenges, the Department has set aside very little contingency funding for 2025-26 to 2029-30, just 3% of total funding for the period. If the programme faces unexpected cost increases in the next few years, there is very little buffer to absorb them, and knock-on delays to subsequent hospital schemes are likely.

Recommendation 2. The Department must closely monitor progress to ensure knock-on effects are managed effectively by:

1. a) using an assessment of progress on the early schemes to re-estimate the hospital opening dates and costs for later schemes; and
2. b) improving transparency by reporting publicly on progress and spending every year for each scheme, and explaining any significant variances and the consequences for the programme.

There is a risk that the new Hospital 2.0 design might not benefit some patients or may add cost. The Hospital 2.0 design was originally due to be ready in December 2023 but, following multiple delays, the Department will not finalise the design until summer 2026 at the earliest. A key aspect of the design is that wards will consist of solely single bedrooms. The Department expects single bedrooms to lead to efficiencies such as fewer hospital acquired infections and shorter hospital stays for patients. However, some research has indicated that the clinical and economic impact of single bedrooms may be modest. The Department has not clearly explained what metrics it will use to assess whether it is realising benefits, nor has it sufficiently focused on unexpected downsides of 100% single bedroom wards. For example, some patients, particularly those that are frailer or more vulnerable, may feel alienated being alone and monitored remotely. The Department acknowledges that the new hospitals may incur more staff costs until new ways of working are embedded.

Recommendation 3. The Department must ensure the new hospital design delivers benefits. It should:

1. a) alongside its Treasury Minute response to this report, the Department should write to the Committee with details of how it expects the new design to lead to measurable benefits for patient experience, patient outcomes and operational efficiencies;
2. b) identify tangible risks to achieving these benefits and seek to manage these; and
3. c) commission and report the results of an independent assessment of whether the benefits are being realised following the opening of the first hospitals built to the new Hospital 2.0 design.

The Department has not yet developed a convincing rationale for the proposed size of new hospitals or how larger hospitals complement aspirations for new models of care and reducing demand in hospitals. Shifting care out of hospitals and into the community is one of the key features of the NHS 10-year plan, but the Department has assumed that larger hospitals will be needed. The Department has not clearly explained why bed capacity for hospitals in the New Hospital Programme needs to increase by 6% when it has also committed to spending more on care outside hospitals relative to what it spends in hospitals. The Department has engaged with NHS trusts to ensure that plans to provide care within and outside hospital settings are joined up, but local community care projects will be difficult to align with the New Hospital Programme as funding is separate. Some hospitals may require additional capacity to improve flow of patients in and out of the hospital, but we see a risk that hospitals will fill to the number of beds available with a knock-on impact on running costs. Bed numbers for wave 1 hospitals are not yet completely finalised, even though some of these hospitals are due to start construction in 2027-28. On its visit to Denmark in the last Parliament, the Committee learned that the Danish hospital rebuilding programme aimed to reduce significantly the total numbers of beds.

Recommendation 4. Once the new design for hospitals is finalised, the Department should write to the Committee to:

1. a) provide further assurance on the bed capacity needed in new hospitals given its wider focus on shifting care out of hospitals and into the community;
2. b) explain the new model of care that will be employed in these hospitals and how each individual scheme has taken expected changes to community care into account when deciding bed numbers; and
3. c) in cases where increases are necessary, explain how this is needed to optimise the flow of patients through hospital and quality of care.

The Department has been slow to develop the capacity and capability it needs to deliver such a complex programme. The Department's central programme team for the New Hospital Programme will require significant technical expertise to deliver successfully. Prior to the 2025 reset, the programme had struggled to recruit staff and had become reliant on external contractors. By November 2025, the programme team was still struggling with a vacancy rate of 39% due to an ongoing recruitment freeze in the wake of plans to dissolve NHS England. Following the end of the freeze, the Department is now confident that it has filled all key roles. However, we remain sceptical that the programme has the expertise it needs given that the risk that vacancies will delay the programme had been rated red, the scale of recruitment required to close the gap from November, and the time new staff will need to get up to speed.

Recommendation 5. The Department must provide greater assurance that it has the skills and capability it needs for the programme. It should:

1. a) be clear on the programme's critical path and what this means for its staffing requirements; and
2. b) develop a clear plan to address skills shortages, which could include working with other departments who are taking forward initiatives to develop key skills. Once completed, it should write to the Committee with the details.

The 46 hospital schemes must deliver quality hospitals on time and on budget over 25 years and for £60 billion. Given its cost and importance, and that the design concept of Hospital 2.0 remains unproven, we are concerned that the New Hospital Programme is not being treated in government as a 'mega project'. The programme has been high-risk since its inception and beset with delays. It is currently in the Government Major Projects Portfolio and subject to scrutiny by the National Infrastructure and Service Transformation Authority (NISTA). However, in September 2025 we reported our concerns that significant programmes, including the New Hospital Programme, had not been afforded 'mega project' status. The Government has made changes to how particularly risky, costly and complex projects - mega projects - would be managed including greater parliamentary scrutiny and more streamlined decision making. Mega projects also benefit from fixed capital funding, flexibility to move funding between years and freedom to determine pay for specialist roles. The governance and performance failures to date add to the already very strong case for the New Hospital Programme is sufficiently risky to need mega project status. The programme has many hallmarks of a mega project, such as strategic importance, level of spend, unified procurement, a singular design and a centralised programme team. Delays or cost increases to one scheme are likely to have knock-on effects on other hospital schemes.

Recommendation 6. This programme requires an appropriate level of oversight and scrutiny commensurate with its risk, size and complexity. As the programme develops, HM Treasury and the Mega Project Decision Panel should assess whether this should be overseen as a mega project – at least up until the point that Hospital 2.0 is a proven concept - and advise ministers accordingly, who should regularly update Parliament.