Capital programmes need whole system change

Samuel Rose, director, health strategy, IMPOWER Consulting, and Dr Nicole Samuel, commercial director for the National Centre for Child Health Technology at Sheffield Children’s NHS Foundation Trust, present findings from a qualitative research programme examining how clinical and digital transformation can be embedded within large-scale healthcare capital programmes. Drawing on case study reviews, interviews with programme leaders and CEOs, and analysis of hospital openings, their research reveals a persistent and dangerous gap between the transformational ambitions built into business cases and the operational reality that new hospitals face at opening.

When a new hospital opens its doors, the assumption is that things will get better — for patients, for staff, and for the health system. New facilities are conceived to solve longstanding problems: ageing estates, fragmented care pathways, rising demand, and a workforce stretched to its limits. Yet the uncomfortable truth, borne out by hard evidence from recent major hospital openings, is that a new building can make things worse before they get better — sometimes significantly so — if the transformation required to make it work is not planned, funded, and delivered in parallel with the bricks and mortar.

This is the central finding of research conducted by IMPOWER Consulting, working in collaboration with UCL's Bartlett School of Sustainable Infrastructure. The study examined three recent major hospital openings — the Royal Adelaide Hospital in Australia, the Royal Liverpool University Hospital, and the Midland Metropolitan University Hospital in the West Midlands — alongside interviews with approximately eight New Hospital Programme (NHP) programme leaders and a survey of programme directors on transformation readiness. What the research reveals is not just an observation about past projects, but an urgent warning for every capital programme currently under development in the NHS.