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The Parliament Brief: We still don’t know the extent of hospital Raac, say NHS bosses

Healthcare chiefs are operating in the dark over crumbling concrete in NHS buildings.

By Zoë Grünewald

Welcome to the Parliament Brief, where Spotlight, the New Statesman’s policy section, digests the latest and most important committee sessions taking place across the House of Commons and House of Lords. Further editions can be found here.

Who? The Commons Public Accounts Committee took evidence from NHS and Department of Health and Social Care (DHSC) officials.

Witnesses included: Shona Dunn, permanent secretary, DHSC; Natalie Forrest, senior responsible owner for the New Hospitals Programme, DHSC; Amanda Pritchard, chief executive, NHS England; Julian Kelly, chief financial officer and deputy CEO, NHS England; and Professor Stephen Powis, national medical director, NHS England.

When? Thursday 7 September 2023 at 10am.

What was discussed? The session covered the ongoing reinforced autoclaved aerated concrete (Raac) crisis in hospital buildings as well as the government pledge to build 40 new hospitals in England by 2030, as part of its New Hospital Programme.

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Why did this come up? Earlier this week it emerged that many public buildings, including schools and hospitals, had been built with dangerous, degrading concrete known as Raac; 147 schools are impacted, affecting 100,000 children, meaning many schools have had to close or decant into temporary buildings, for fear that the buildings would collapse.

The news brought attention to the fact that many hospitals are also impacted by Raac. A National Audit Office report, published in July, found that 41 buildings at 23 hospital trusts contained the material, and seven hospitals have Raac throughout, putting them at risk of collapse.

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Though the Public Accounts Committee had originally organised the session to examine whether the New Hospital Programme was likely to achieve value for money, the committee, understandably, spent a good chunk of the session quizzing the bosses on how they are responding to the immediate crisis.

What is the New Hospital Programme? In 2020 the government announced it would build 40 new hospitals in England by 2030, as per the 2019 Conservative manifesto commitment. These are expected to represent over £20bn of investment into new hospital infrastructure, with the first building works commencing in 2025.

But things have since got more complicated. Earlier this year, the government announced that five hospitals constructed using Raac will also need to be rebuilt by 2030 as part of the programme. This number has since become higher, with seven hospitals containing Raac to be replaced through the New Hospital Programme by 2030. One of those hospitals, the Queen Elizabeth Hospital in King’s Lynn (former prime minister Liz Truss’s constituency), reported last year that 79 per cent of its buildings contained Raac planks.

So what did they say? There were a number of admissions from the NHS bosses yesterday. The most significant came from Julian Kelly, chief financial officer and deputy CEO for NHS England, who said that a number of additional hospitals have told NHS England they may have Raac, and it is still expecting “tens” more to come forward.

[See also: The great crack-up]

Kelly also revealed that health services are being forced to close units and theatres “all the time” because of building safety issues, telling the committee: “This is happening day in and day out.”

Although the panel agreed that they were on track to eradicate all Raac in hospital buildings by 2035, Kelly explained that full structural surveys had not been carried out for each hospital. He told MPs: “I don’t want to absolutely say we know by when it’ll be done, but there is a commitment to do it by 2035 and there is nothing to lead me to believe that that is not possible.”

He added that NHS England is aiming to have the full surveys done for all sites “in a matter of weeks”, but that he couldn’t confirm timing because it needed to ensure that they “have the resource”.

MPs quizzed the witnesses over the speed and resource available for the eradication methods, with Meg Hillier, the Public Accounts Committee chair, pointing out that dealing with Raac was costing the NHS millions of pounds, and large sums of money were being spent on quick fixes in buildings where Raac had been found. On resource, Kelly agreed that the NHS was in competition with schools for construction work from specific companies. “It’ll be the same firms, there is a limited number of these specialist engineers so we will all be talking to the same firms, that has to be true.”

When asked whether she was confident that it was safe for hospitals to remain open, DHSC permanent secretary Shona Dunn said that “you can never be 100 per cent certain that hospitals are safe”, but that hospitals are following “the appropriate specialist advice and guidance”.

Any conclusions? The panel were about as senior as it gets in the NHS, and were up against the typically thorough and tenacious Hillier and her committee.

It was clear that NHS bosses didn’t have as many answers as MPs may have wanted, in part because they are still waiting for the remaining hospitals to be surveyed. Identifying Raac usually requires a specialist surveyor, meaning the total number of buildings affected may take weeks to ascertain. In the meantime, many hospitals are still operating without full knowledge of the extent of the problem, with some in fear that buildings could collapse imminently. NHS England has told hospitals that they should be ready to evacuate if buildings start crumbling.

However, while officials conceded that they are still in the dark about how realistic the projected timescales, costs and resources might be, they were confident that Raac would be eradicated from the NHS estate by 2035.

What next? There are no plans for another session on Raac in hospitals, but the Public Accounts Committee will discuss concerns around the concrete with senior officials from the Department for Education (DfE) at 3pm on Monday 11 September, as part of its ongoing inquiry into the condition of school buildings.

There is also likely to be a report on the topic, but no timetable yet. Watch this space.

[See also: How Conservative complacency left schools to rot]

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