Only a quarter of the 40 hospital construction projects that were at the heart of Boris Johnson’s 2019 general election manifesto have secured full planning permission, the Observer can reveal, amid angry claims from NHS figures that there is no chance the schemes will be delivered on time. Ministers have repeatedly claimed that the hospitals will be delivered by 2030, despite concerns from health chiefs and economists that “woefully insufficient” funding and rising costs will scupper the plan and put NHS capacity at risk. However, an investigation by the Observer has revealed that only 10 of the 40 projects have the full planning permissions they need to go ahead. Those involved in some of the projects said they had already faced lengthy delays, leaving them with decrepit and often unusable buildings. “There’s a 0% chance there’s going to be 40 new hospitals by 2030,” said the boss of one of the NHS trusts awaiting a new hospital. “We’ll be moderately lucky to have eight. At the moment we’re doing loads of maintenance work on an ongoing basis, trying to sort out roofs and theatres and all those things. Some hospitals are literally falling down.” Analysis by the Observer, combined with official data obtained by the Lib Dem deputy leader, Daisy Cooper, reveals that some projects only have outline planning permission, which is insufficient to allow building work to commence. Many of the projects have no planning permission at all. “This is truly scandalous,” said Cooper. “The Conservative government is on course to break their flagship NHS promise and refuse to admit it. Communities already suffering from dangerously long ambulance waiting times are also left with crumbling hospitals which are falling apart at the seams. The government needs to stump up the cash to keep ageing hospitals running and ensure patients are treated in safe environments.” The programme has been beset with controversy ever since Johnson pledged to build “40 new hospitals” in the 2019 Conservative manifesto. Since then, it has emerged that many of the proposed projects are not new hospitals, but extensions or refurbishments. The independent National Audit Office is also investigating the programme. According to the latest filings, 13 of the projects have no planning permission. Another 17 have only secured some kind of preliminary agreement, or have no confirmed permission. Several of the NHS trusts involved said they were awaiting a funding settlement from the government to progress the planning and design stages of their proposed projects. One of the projects causing most concern is the redevelopment of Epsom and St Helier hospital, south London, which has already been hit with delays. “The development is needed now more than ever before,” said an official. “We have crumbling, cramped buildings, many of which pre-date the NHS. Our patients deserve a better environment to receive treatment. Our staff deserve a better environment to deliver care.” Any delays pose a significant political problem for the prime minister, Rishi Sunak. One trust chief executive with a scheme in the programme, speaking anonymously, said: “Let’s say there’s an election in 2024, 2025, if they had eight or a dozen or 20 hospitals that were well on the way to construction and you had cranes outside, you’d get loads of good photos out of that. But with the best will in the world, you’re just going to have a few hospitals with a hole in the ground. I think they’ve lost their opportunity to maximise political benefit around this.” Another said: “Our own hospital is crumbling before our eyes – so much so, that parts are completely unusable. Delays are hugely inefficient and are costing millions which is bad for the economy, taxpayers and the health of our patients.” In England, there are still 284 hospital buildings pre-dating 1948, when the NHS was created. Most of the hospitals due to be replaced in the new hospital programme have buildings constructed before the service’s inauguration. Latest estimates suggest the maintenance backlog for the NHS estate reached £10.2bn in 2021-22, more than twice as high as it was a decade ago. With inflation in the construction sector reaching 10% in September 2022, the cost of clearing the maintenance backlog might yet increase further. Laurie Rachet-Jacquet, an economist at the Health Foundation, said: “Last year we estimated that, depending on NHS productivity, we would need 23,000-39,000 new beds in England by 2030: this is equivalent to around 38–64 average sized hospitals. Hospital costs vary greatly but based on an estimated cost of around £450m, then this is approximately £17bn–£29bn in the next seven years. “The promised new hospitals for the government’s programme fall within the bottom of this range. But the delays and uncertainty about funding are worrying. The money allocated thus far is woefully insufficient and given rising inflation will deliver still less than anticipated and it is not clear that the government’s proposals go far enough to meet future hospital care needs.” Saffron Cordery, the deputy chief executive of NHS Providers, said: “Trusts need clarity and commitment from the government about the much-delayed New Hospitals Programme (NHP). Shovels and picks at the ready, trusts in the NHP are poised to get to work but are still waiting for confirmation of funding. Those forced to delay for many months now face spiralling, inflation-driven cost increases far above initial forecasts. The NHP can transform healthcare by providing badly needed renewal for acute, mental health, community and ambulance services. But we need to get a move on.” A Department of Health and Social Care spokesperson said: “We are investing £3.7bn for the first four years of the New Hospital Programme and remain committed to all schemes that have been announced as part of it. Requirements for planning permission are dependent on construction timelines over the decade and we continue to work closely with trusts on their plans. We are developing a national approach to constructing new hospitals so schemes can be built more rapidly and ensure value for money.”