The government is likely to miss its target to build 40 new hospitals by 2030, the spending watchdog has said.
The National Audit Office (NAO) said in a report that the project had been beset by delays. It also warned that cost-cutting and inaccurate modelling of future demand could mean new hospitals are too small.
The health department remained "firmly committed" to delivering the England building pledge, a spokesperson said.
But Labour called the report "damning".
The hospitals plan was a Conservative manifesto commitment during the December 2019 election campaign, and it was made policy the following year.
When the health department officially set out the plan in October 2020, eight hospital construction projects already under way were not included in the target. But recent government statements about building 40 new hospitals include these eight projects, referred to as "legacy hospitals".
And in May, the government changed the scope of the scheme to include hospitals in urgent need of repairs, including five judged to be at risk of collapse because of crumbling concrete infrastructure.
Now the National Audit Office has analysed the plans and found that, by the definition set out in 2020, the target will be missed, and only 32 will be built in time. The NAO said the government has used a "broad" definition of "new", which includes refurbishment of existing buildings as well as completely new hospitals.
The 32 that will be built in time include 24 from the original new hospitals programme, five that were added in May, and three new mental health hospitals.
It said a further eight do not count towards the original definition of "new" because they were already under way when the commitment was made.
Questions have been asked for some time about whether the programme is on track and it is significant that the watchdog has now ruled that, judged by the original template, it is not.
In May, a BBC News investigation found that building work had not started on 33 of the projects.
The NAO said staff shortages mean a planned design for a standardised hospital has been delayed until May 2024.
It also warned that a push to meet the target at the lowest possible cost - combined with optimistic forecasts about how much care will be outside hospitals in the future - could result in new hospitals that are too small.
The government had failed to achieve good value for money, the NAO said, as it called for a review of the underlying assumptions behind the plans to make sure the new hospitals are fit for purpose.
Health Secretary Steve Barclay had already told MPs in May that some of the original group included in the new hospitals programme might not be completed by 2030.
He made the admission as he updated the department's building plans to deal with hospitals built with a lightweight concrete that was used in the 1980s and is now judged to be unsafe.
But he restated the commitment to deliver 40 new hospitals by the end of the decade.
Gareth Davies, head of the NAO, said the programme included "innovative plans" to improve efficiency and quality. But there are important lessons to ensure future major projects were affordable, transparent and delivered on time, he said.
Sir Julian Hartley, chief executive of NHS Providers, urged the government to "shift gears" to get the hospitals built and warned that costs had "spiralled due to high inflation".
He said many NHS trusts were "deeply disappointed" by delays and said the government "could have better managed expectations about the funding available, given the uncertainty involved and the impact of inflation".
Liberal Democrat deputy leader Daisy Cooper said the "utterly damning report demolishes the government's claims to be building 40 'new hospitals'".
She called on the health secretary to make an urgent statement in Parliament addressing its findings, saying "the public deserves answers".
Labour's shadow health secretary Wes Streeting said: "The Conservatives have overpromised, under-delivered, and they've been found out.
"Meanwhile patients are being treated in outdated, crumbling hospitals."
A health department spokesperson said: "The NAO's report acknowledges that despite changes to the original programme, 40 new hospitals are still expected to be delivered by 2030 and praises the programme's innovative plans to standardise hospital construction, deliver efficiencies and improve quality.
"We remain firmly committed to delivering these hospitals, which are now expected to be backed by over £20 billion of investment, helping to cut waiting lists so people can get the treatment they need quicker.
"Three new hospitals have already opened and more will open this year so patients and staff can benefit from major new hospital buildings, equipped with the latest technology."
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2023-07-16 23:29:11Z
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