Sir Keir Starmer has accused Boris Johnson of claiming new hospitals are being built when they are just being refurbished after a document advising NHS trusts on wording was leaked.

The Labour leader held up the report, entitled New Hospitals Programme Communications Playbook, as he said the government was being loose with its definition of “new”.

A major part of the Conservative Party’s 2019 manifesto was that it would build 40 new hospitals by 2030 to help alleviate pressure on the NHS.

The document advises trusts they can call hospitals new if they include an additional wing or involve a major refurbishment of an existing hospital building.

“The more we look at this promise, the murkier it gets,” Sir Keir told the Commons at Prime Minister’s Questions.

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“I’ve got a document here sent by the Department of Health to the NHS. It’s called the New Hospital Programme Communications Playbook – I kid you not. It offers advice to make it easier to talk about the programme.

“This guide instructs everybody to describe refurbishments and alterations on existing hospitals as new hospitals. We can all agree that refurbishments are a very good thing, but they’re not new hospitals.

“How many of the 40 are fix-up jobs on existing hospitals and how many are actually the new hospitals he promised?”

Mr Johnson said it would be irresponsible to always build on greenfield sites and said: “You rebuild hospitals and that’s what we’ve said for the last two-and-a-half years.”

Sir Keir Starmer says Boris Johnson is "taking the British public for fools" and asks about the PM's promise to build more hospitals.

The PM insists the government is putting "record investment" into the NHS.

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Sky News has seen the leaked document, which was an internal memo sent to NHS trusts.

It contains three definitions of a “new hospital”:

• A whole new hospital site on a new site or current NHS land, either a single service of consolidation of services on a new site

• A major new clinical building on an existing site or a new wing of an existing hospital, provided it contains a whole clinical service, such as maternity or children’s services

• A major refurbishment and alteration of all but building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure.

Mr Johnson was also forced to deny his hospital building programme is unachievable after Sir Keir referenced a report from the Heatlh Service Journal that said a government infrastructure watchdog has raised concerns about the lack of progress.

Sir Keir said: “The Cabinet Office and the Treasury have checked on the progress and it’s reported that they have reached a damning conclusion.

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“They have concluded that the project needs a red flag because it is unachievable. Prime minister, is that true?”

Mr Johnson replied: “No. He plays politics and asks frivolous questions, we are getting on with the people’s priorities.

“We are helping to build another 40 new hospitals with an injection of £36bn of investments which that party voted against.”

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