They were the flagship success in the government’s coronavirus response: 12 brand new hospitals built across the UK in a matter of weeks to ensure the pandemic did not overwhelm the NHS.
But an investigation by HuffPost UK has found a veil of secrecy surrounds the costs to build these trailblazing hospitals, who built them and even who pays for them.
The government and the NHS repeatedly failed to answer questions about which private companies worked on the Nightingales or what multi-million pound contracts were handed out.
Basic information about these contracts has also not been published on public databases where information should appear within 30 days.
When HuffPost UK first approached NHS England we were told information relating to the costs and contractors for the Nightingales would be issued.
But the organisation made an apparent U-turn, backtracking once the information had been sent to its legal team.
Only today at the eleventh hour, faced with the threat of imminent publication of this story, did NHS England concede to release some limited, basic information confirming the list of contractors.
Procurement experts told HuffPost UK the government may still be in breach of the law if contracts are not published within the statutory timeframes.
The apparent secrecy has led to accusations of a lack of transparency over government spending on one of the most significant health infrastructure projects in a generation.
“Failing to open these details up to scrutiny – especially during times of crisis – raises the risk that public money is wasted on overpriced services or awarded to companies with political connections, rather than those best suited to the job,” said Rachel Davies Teka, head of advocacy at Transparency International UK.
Another procurement expert, Dr Mihaly Fazekas of the University of Cambridge, told HuffPost UK: “The government shouldn’t be suppressing this.”
Work on the Nightingale hospitals was carried out in a matter of weeks in March and April this year by companies working alongside the NHS and the military.
The hospitals were put up within existing buildings, such as the ExCeL centre in London and the Manchester Central Convention Complex, and the speed of their construction was unprecedented in the UK.
The extra capacity offered by these pop-up hospitals was also vital in ensuring the NHS did not become overwhelmed by the deadly coronavirus pandemic.
But procurement specialists told HuffPost UK that even in a pandemic the government had a duty to be open and transparent about public spending.
Dr Fazekas, who has a PhD in public procurement and corruption risks from Cambridge, where he is a research associate, said it was “surprising” that the government had been unable or unwilling to issue the information.
“I mean, 'unable' – they’re not unable to do it, they just don’t want to, right?” he said. “Because it exists.”
He said the national emergency due to coronavirus may explain a delay in publication of contract information but not withholding it altogether.
“Of course, if you’re busy saving lives, it’s fine to achieve publication a little later, and by a little later I mean one or two weeks later,” he said. “But these hospitals are up and running for more than a month now.”
He added: “You can do things quickly but the information is public information. They’re not building nuclear submarines here.”
HuffPost UK has checked the main databases where government contracts are expected to be published – Contracts Finder and Tenders Electronic Daily – and has found no record of the Nightingale hospital builds.
The procurement experts we spoke to also said they had seen no public information published about the Nightingales.
“If there is no proper paper trail, then no one can be held accountable. So it’s really important that external scrutiny remains”
- Dr Mihaly Fazekas
Despite persistent attempts, HuffPost UK’s questions about which private firms were involved with the Nightingale builds in England were met with a wall of silence from the government and the NHS.
Not until an hour before this story was due for publication did NHS England concede to release the name of one further contractor who worked on the project.
In stark contrast, health boards and local authorities in Wales, Scotland and Northern Ireland willingly issued detailed information about their temporary Covid-19 hospitals.
In one case, Neath Port Talbot Council in Wales was able to provide responses to our questions about the building works while the government and NHS England failed to do so.
Experts say without this information it is hard to gauge what the cost of the Nightingale hospitals was and, crucially, whether they offered value for money.
“We have seen many cases from the US to Italy where the lack of publication of basic information enables, on the one hand, the covering up of low value for money and, on the other hand, favouritism and potential corruption,” said Dr Fazekas.
“If there is no proper paper trail, then no one can be held accountable. So it’s really, really important that at least some external scrutiny remains.”
He said emergency procurement happening under Covid-19 is unusual in that governments globally are competing for the same very small range of resources, meaning the buying power of government in negotiating contracts is diminished.
“The main channel to check these things, and limit potential wrongdoing, is by looking at who are the names, how much money did they win, and being able to scrutinise whether they have political connections, whether they donated to party campaigns or go to the same clubs as key decision makers,” he said.
“Without knowing who the company is and how much money they have been awarded, you cannot check that.”
The figures gathered by HuffPost UK for the five field hospitals in Wales, Scotland and Northern Ireland show they cost an estimated £86million to build.
There is no information in the public domain about the equivalent costs for constructing the seven Nightingale hospitals in England, although they could be substantially higher if number of beds is an indicator.
The five field hospitals in Wales, Scotland and Northern Ireland have a maximum capacity of 4,570 beds.
The seven Nightingales in England are designed to offer up to 9,150 beds.
HuffPost UK asked NHS England and the government what procurement process was used for the Nightingales. They did not respond.
Just before publication, NHS England told HuffPost UK: “All contractors were appointed in line with the government’s COVID-19 procurement policy.”
We also asked who will pick up the bill for building the Nightingales – the NHS or the government – but received no answer.
Procurement experts told HuffPost UK the default position on this type of large public infrastructure project is transparency and that you would expect to see basic contract details made public within 30 days.
A leading procurement lawyer told HuffPost UK the government may be in breach of the law if contract information is not published in those timescales.
“It is a statutory obligation to do so, so – yes – they would be in a breach of statutory obligation,” said the lawyer, who asked not to be named due to potential conflicts of interests in her work.
She said one explanation for why the government has not published the information may be inefficiency, describing government procurement teams as “fairly crap, to be honest”.
“But also from a political angle they may be unwilling to do that because it may reveal the true extent of the contracts that they’ve awarded and they will be asked questions,” she said.
The experts speculated on two routes the government and NHS may have used to issue contracts for the work.
They could have made use of an existing procurement framework and issued what is known as a call-off contract to suppliers already on the framework without re-tendering.
Or the government could have relied on emergency procurement powers granted to all public bodies to deal with the coronavirus pandemic.
Under either scenario, basic contract information for any spending over the value of £10,000 has to be published according to the Public Procurement Act.
“Even if it’s emergency procurement, that’s very important – the publication requirements are there,” said Dr Fazekas.
Meg Hillier MP, chair of the House of Commons Public Accounts Committee, which scrutinises government spending, called for greater government transparency.
“It is understandable that government has bypassed usual contracting and procurement processes in mounting an emergency response, and the incredible, rapid increase in capacity that was delivered in the Nightingale hospitals may have saved our NHS, just as we got nail-bitingly close to capacity in some places,” she said.
“But that key, welcome, success does not mean government can or will escape scrutiny for the decisions it has made.”
Both the Public Accounts Committee and the National Audit Office are working to review government spending related to the Covid-19 pandemic, but have as yet done no specific work on the Nightingales.
The National Audit Office has published a report showing that between January 31 and May 4 the government spent £124.3bn on its response to the pandemic, including £6.6bn on health and social care measures.
Some information about the private companies involved in the Nightingales has entered the public domain via other routes, such as the firms that won contracts issuing statements themselves.
HuffPost UK compiled a list of main contractors for the Nightingales, which was confirmed by NHS England.
This showed construction firm CFES worked on the Nightingale London, Integrated Health Projects on the Nightingale North West, Interserve on the Nightingale Midlands, Kier on the Nightingale Bristol and BAM Construction on the Nightingale Harrogate.
Earlier today, NHS England also confirmed that Tolent Construction was the main contractor for the Nightingale North East.
It is thought at least some of these contracts were awarded through the government’s Procure 22 framework for England, which was extended to accommodate the creation of temporary hospitals during the outbreak.
The total value of work under Procure 22 is listed as £4bn, although this would include other projects outside of the Nightingale hospitals.
The firms listed on Procure 22 include BAM Construct UK Ltd, Integrated Health Projects, Interserve Construction Ltd and Kier Construction Ltd.
The Financial Times has also reported that consultancy firm KPMG was drafted in as project manager, with NHS England hiring a team of about 60 consultants to build the seven Nightingale hospitals working alongside military planners.
There is no suggestion of any wrongdoing on the part of any of these firms.
In fact, the rapid speed with which the hospitals were constructed has been widely praised.
It is the government’s secrecy about the unknown sums paid to contractors that has led to questions about value for money in building the hospitals, the majority of which have taken only small numbers of patients.
One expert said it should not matter who is asking for information – the overriding principle is that it should be publicly available to protect the integrity of the system.
Ian Makgill, founder of procurement analytics company Spend Network, said: “It doesn’t matter who is asking. The requirement of transparency is that you or I get to know what happened and that is the commitment the government has already made and the commitment that they put into law – to publish the details of all of this.
“Now, they have a choice about whether to adhere to the law, but they don’t have a choice about whether to release the information on the basis of who’s asking.”
HuffPost UK first put questions to NHS England and DHSC on April 21 asking for the estimated budget to build the Nightingale hospitals and the principal contractors selected for the programme.
We were told these questions had been passed to NHS England’s estates team and the press office said in an email: “We will have a line and some background over to you as soon as legal have confirmed everything is correct.”
But NHS England later said it was unable to issue the information, claiming it was already in the public domain. Shortly before publication it confirmed the names of contractors who worked on six of the seven Nightingales.
NHS England also claimed that contractual details including costs are commercial in confidence for an initial period.
We put the same questions to the Department of Health and Social Care (DHSC) and were told we should contact NHS England.
DHSC has not provided a statement about why this information is not in the public domain.
NHS England told HuffPost UK, in a statement sent shortly before publication: “The commissioning of contractors for the Nightingale sites in England was a collaborative process involving all relevant parties and all contractors were appointed in line with the government’s Covid-19 procurement policy note to enable work to begin as quickly as possible.”