Image copyright Reuters Image caption Boris Johnson visited Whipps Cross in September

The Conservatives have repeatedly pledged to build 40 new NHS hospitals.

The party's manifesto says they are proud "to have begun work on building 40 new hospitals across the country".

"We will build and fund" them, it adds, "over the next 10 years."

The pledge has been questioned throughout the election campaign. Is it certain that all 40 will be built? Will they be creating new beds and additional capacity or just replacing existing facilities?

There will be a £2.7bn investment over five years for the first six hospitals of the 40 pledged.

All are existing NHS hospitals and they all have one thing in common - there is no building work happening as yet.

For the remainder of the pledge 21 trusts will initially share just £100m to develop the business cases necessary to secure funding for 34 projects.

Conservative leader Boris Johnson recently told LBC radio that he would think of an existing hospital being knocked down and rebuilt - even if it is in the same place - as a "new hospital".

Siva Anandaciva, chief policy analyst at health think tank the King's Fund, says: "The phrase 'six new hospitals' might suggest the NHS will see its stock of hospitals grow with six brand new, fully staffed hospitals that offer a full range of services.

"But - in reality - the promised investment is likely to pay for new facilities on existing hospital sites and the redeployment of existing staff."

So, looking at the first six hospitals, how far along are they and how much is new?

More or Less examines election pledges

Leeds General Infirmary

Leeds Teaching Hospitals Trust is being given funding towards a major building project. The £650m development will sit on the current site of Leeds General Infirmary.

It is planning to move out of the older buildings and to keep one modern building. Then the plan is to construct "two state-of-the-art new hospital buildings" - one for adult services and one for children's care. The outline planning documents say this would "consolidate and centralise" their services.

Image copyright Leeds Teaching Hospitals Trust Image caption How the proposed redevelopment at Leeds General Infirmary might look

A previous bid of £410m was declined in early 2019 under an existing NHS scheme, according to an analysis by the Health Service Journal (HSJ).

Whipps Cross Hospital, London

Barts Health NHS Trust, which runs the hospital, is also proposing a major building project, described as "a new hospital with a full range of acute health services... built on a fraction of the land now occupied".

Image copyright Barts Health NHS Trust Image caption An artist's impression of what the Whipps Cross redevelopment could look like, from a September 2019 consultation document

The trust has told the BBC that it does not know the final amount it is getting from the government. A previous bid of £343m was declined in early 2019 under an existing NHS scheme, according to an analysis by the HSJ.

The current plan for Whipps Cross, says that "using the site for homes could release funding to support the building of a new hospital, but the money raised would be nowhere near enough to pay for a new hospital."

Princess Alexandra Hospital, Harlow

Image copyright Google

The trust says it is going "to rebuild a new hospital", so is that rebuilding or a new hospital?

The trust says the plan is for a new hospital as that is what the government has told them. It says, however, it does not know whether this is a whole new hospital to house all its current services, or a new facility for some of its services.

"The details around the funding and the timeframe are being finalised and we are completing our full business case," according to the hospital's chief executive.

Epsom and St Helier Universities Trust

The trust describes its plans as both a facility and a hospital. It is in line for "hundreds of millions of pounds" to consolidate acute care in a new £500m project on one of its current sites, merging the two A&E services which it is currently struggling to staff.

The BBC was told 85% of the existing services would remain in the same place. The new building will be located at one of the three current sites - in Epsom, Sutton or St Helier.

University Hospitals of Leicester

The trust says it has been allocated £450m to fund a refurbishment with possible extensions of existing buildings. It will upgrade facilities at its three sites, including: maternity and children's services at Leicester Royal Infirmary; and a "treatment centre" for planned operations at the Glenfield site.

West Hertfordshire Hospitals

The trust says it is being given £400m by the government to "redevelop its buildings and facilities," - this means refurbishment although 30% of the buildings at its Watford General site will be new.

But there's been a big row about the fact that this is not a new hospital. Local campaign groups have been fighting for a new hospital for years, claiming that proposals don't meet the future needs of the wider West Hertfordshire area.

One of them, the New Hospital Campaign, has recently taken the trust to court to challenge its plans for refurbishment of existing buildings. It has crowdfunded enough to take the matter to a judicial review, for which it has been granted permission.

New hospitals or not?

We contacted the Conservatives for more detail about the status of these six hospitals. A party spokesman told us: "Some will be whole new hospitals and some will be whole new rebuilds."

The overall plan to deliver 40 new hospitals is actually part of a 10- to 15-year project to overhaul health infrastructure, he added.

Health Secretary Matt Hancock said: "We've made a manifesto commitment to build and fund 40 hospitals over the next decade, and a Conservative majority government will deliver on that commitment."

What about the other 34 hospitals?

Six of the trusts are developing cases for multiple hospitals. In the case of Dorset Healthcare NHS Foundation Trust, that means "potentially 12 community hospitals".

Some of the hospitals sharing the £100m seed funding to develop their business case have been exploring proposals for a number of years, or have previously made bids for capital funding through previous schemes.

In the prime minister's own constituency, a master plan for the Hillingdon Hospital site began in October 2015.

Stage one was completed in June 2016 and the preferred option identified as a new facility on a new site at Brunel University.

University Hospitals of Morecombe Bay Trust - in its Five Year Strategic Plan 2015-20 - outlines a scheme for Royal Lancaster Infirmary that "will allow all clinical activity to be located for the first time into a single modern building on the site, with peripheral buildings vacated and demolished or sold". This has yet to be undertaken.

Update 13 December: This piece has been updated to include new information provided by West Hertfordshire Hospitals NHS Trust.