Plans for a new Monklands hospital remain uncertain, with no agreed budget, final design or confirmed opening date despite more than £250 million already being spent on the project.
The Scottish Government has reaffirmed its commitment to replacing University Hospital Monklands in Airdrie, but NHS Lanarkshire has been ordered to draw up a more affordable scheme after ministers rejected the £2.1 billion proposal earlier this year.
The decision has raised questions about the size of the new hospital, the services it will provide and how long patients and staff will have to continue using the ageing existing building.
In its latest published update on 3 November, NHS Lanarkshire confirmed that £250.9 million had been invested in the replacement project between April 2016 and September 2026. This includes buying land at Wester Moffat, preparatory construction work, infrastructure improvements, design fees and professional services.
The health board says the investment will support the revised project. The original plans had already secured planning approval and envisaged one of Scotland’s most technologically advanced hospitals.
However, the Scottish Government announced on 25 June that the full business case could not be approved because of its escalating cost.
The project has since entered a formal redesign process, described as a “reset”, with new proposals due to be presented to ministers by the middle of 2027.
The government wants construction to begin in 2028, but that remains an ambition rather than a confirmed timetable.
Questions over the new hospital
Health Secretary Angela Constance faced renewed questions about the project at Holyrood on 28 October.
Labour MSP Joe Fagan raised reports that the replacement could be smaller and offer fewer services than originally planned. He asked which existing hospital services and specialisms might be withdrawn.
Ms Constance insisted that the government remained committed to building a new district general hospital at Wester Moffat, complete with a Type 1 accident and emergency department.
However, she said ministers had yet to receive the revised proposal and could not determine the next steps until that work was completed.
The Health Secretary said: “In the not-too-distant future, we will have to get clarity on the financial envelope.”
The absence of a confirmed budget leaves NHS Lanarkshire working towards a revised scheme without a publicly agreed final price.
How did the cost reach £2.1 billion?
The replacement project has undergone substantial changes in its estimated cost over the past decade.
A Scottish Government infrastructure report recorded an estimated £1.344 billion cost when the outline business case was approved in July 2023. At that stage, the hospital was expected to become operational in 2031.
By June 2026, ministers said the proposed development would cost upwards of £2.1 billion.
Ms Constance said the design would represent an unprecedented concentration of NHS capital spending on a single project, with an estimated construction and development cost equivalent to £5 million per hospital bed.
Announcing the decision to reject the business case, she said the proposal was significantly more expensive than comparable developments and could not be justified within the government’s financial position.
NHS Lanarkshire expressed disappointment that years of work on the original design could not proceed.
The replacement programme is now being reconsidered alongside plans for hospital and community healthcare services across Lanarkshire and the wider west of Scotland.
That could affect how services are organised between the new hospital, other acute hospitals and facilities closer to patients’ homes.
What happens to the existing Monklands hospital?
The uncertainty comes as NHS Lanarkshire faces growing maintenance pressures at University Hospital Monklands.
The health board has confirmed that the existing hospital had an estimated maintenance backlog of £47.9 million at 31 March 2026.
This covers work on mechanical and electrical systems, heating, water supplies, fire safety, equipment and clinical areas.
The board is working with cost advisers on improvements needed to extend the hospital’s operational life until its replacement is ready.
The Scottish Government has promised targeted additional investment to address infrastructure problems, although a final funding package and detailed timetable for that work have not been set out in the project’s published updates.
NHS Lanarkshire says the existing hospital will continue to provide acute services while the replacement is redesigned. Patients should attend appointments as normal.
The rejected design for the new hospital
Work continues at Wester Moffat
Despite the rejection of the original design, work has not stopped at the proposed new hospital site.
NHS Lanarkshire says preparatory activity at Wester Moffat is continuing, including power and drainage infrastructure and access arrangements for construction teams.
There has also been progress on a major road scheme intended to improve access to the future hospital.
In October, North Lanarkshire Council granted planning permission for the 2.3km Towers Road Link, which will form part of the wider East Airdrie Link Road project.
The route will provide a second access to the hospital site, including a new bridge over the North Calder Water.
The Scottish Government has confirmed a funding contribution towards the road, with construction planned to begin in 2028 and completion scheduled for 2030.
NHS Lanarkshire chair Katharina Kasper welcomed the decision as evidence of the continuing commitment to a new hospital.
What happens next?
The government’s Programme for Government, published in September, committed ministers to developing a new affordable design by mid-2027, with the ambition of beginning construction in 2028.
A reset oversight board involving NHS Lanarkshire, the Scottish Government, North Lanarkshire Council and other NHS planning bodies has been established to oversee that process.
The health board has also been holding meetings with staff and local community representatives to explain the changes and gather views.
What remains unclear is how the redesigned hospital will compare with the original proposals, how much it will cost and when patients will be able to use it.
The government has guaranteed that a new hospital will be built at Wester Moffat and will retain an emergency department.
For the people of Airdrie, Coatbridge and the wider Lanarkshire area, the next significant decision is expected when ministers consider the revised plans for a hospital that has already been in development for more than a decade.