Health secretary Angela Constance told the Scottish Parliament that ministers could not approve NHS Lanarkshire’s full business case “in its current form,” citing serious affordability concerns.

The estimated cost works out to around £5 million per bed, a figure the government says is out of step with comparable hospital projects and even exceeds the price of building Glasgow’s Queen Elizabeth University Hospital and the new HMP Glasgow prison.

Ms Constance was careful to frame the move as a pause rather than a cancellation, describing it as “a reset and not a stop.” The government says it remains committed to building the hospital, which is planned for a site at Wester Moffat, near Airdrie, and had been billed as Scotland’s first fully digital, net zero hospital.

The £2.1bn estimate is roughly 56% higher than the £1.344bn figure approved as part of the outline business case back in July 2023, and far above the original £700m projection. NHS Lanarkshire had approved its full business case in December, expecting government sign-off to allow construction to start in 2026.

By the end of the 2024/25 financial year, £92.4m had already been spent on the programme, though it’s unclear how much of that work can be carried over into a redesigned project.

The decision lands just weeks after the SNP’s Holyrood election manifesto told voters that work on the Monklands replacement was “already well underway.” Ministers had the £2.1bn business case in hand throughout the campaign before rejecting it.

A joint redesign process involving the Scottish Government, NHS Lanarkshire, and other west of Scotland health bodies is due to begin immediately and report back with revised options by mid-2027. Construction is now only described as an “ambition” for 2028, subject to further ministerial approval, meaning the 2031 opening date originally promised is no longer guaranteed.

Ms Constance said the new approach would fold the hospital into a wider system spanning acute care, community services, diagnostics, and digital healthcare, rather than concentrating investment in one large acute building. She insisted this “is not about downgrading services” but about delivering care “in the right place” — though the government has stopped short of guaranteeing every service currently offered at Monklands will carry over to the new site. It also hasn’t confirmed whether Wester Moffat remains the chosen location.

In the meantime, the government has pledged unspecified “targeted” investment to address urgent infrastructure problems at the existing, ageing Monklands Hospital while the redesign is under way.

Laing O’Rourke, the contractor selected in 2023 for preconstruction work, said it is continuing to work with NHS Lanarkshire on the project’s design and is progressing with enabling works already under way on site.