Poor NHS buildings mean poor NHS care

I’ve been writing about the poor condition of some NHS buildings and equipment for nearly a decade. Over this time the cost of tackling the problems with NHS buildings and equipment has more than doubled from £4 billion in 2011/12 to over £10 billion in 2021/22. And nearly one-fifth of the repair bill is now for equipment and buildings that are in such a sorry state they present potentially catastrophic risks to patient care.

But after all these years, the numbers are starting to lose their meaning to me. Of course, £10 billion is a large number. But is it really much bigger than the £6.5 billion in 2018/19? How much worse does an extra £3.5 billion really feel? Well, this summer I spent some time visiting the paediatric ward of one of the older hospitals in England. The problems felt real enough.

'Roughly 40 per cent of buildings at this site pre-dated the creation of the NHS but there are still a large number of NHS sites where all the facilities and buildings date back to before the NHS.'

The entry doors to this hospital’s paediatric ward did not close properly, so anyone could wander in at any time of day or night without being ‘buzzed through’. The corridors were so narrow that hospital gurneys from A&E could not be moved through easily – so toddlers with broken limbs were being carried to their beds instead of being slide-board transferred. Roughly one in three blood pressure machines worked, which meant vital signs had to be taken again and again in the middle of the night. The metal casing for electrical sockets was broken and jagged – exposing the wiring underneath and leaving heavy lamps wobbling above children’s heads. And a nurse briefing included the terrifying words ‘we are still not fire compliant’.

This ward may not be typical of all NHS estate. But it is not unusual either. And it isn’t even in the worst shape. Roughly 40 per cent of buildings at this site pre-dated the creation of the NHS but there are still a large number of NHS sites where all the facilities and buildings date back to before the NHS. The postcode lottery in health care clearly extends to the varying quality of buildings, as well as the varying range and quality of services.

The problem of run-down NHS buildings and equipment has been well known and well described for a decade. What then is the solution? In the past decade I have seen capital strategies written and refreshed. I have read health infrastructure plans and national reviews. And I have come to the reductionist conclusion that the solutions are ‘money’ and ‘time’. We are simply not spending nearly enough on the upkeep and development of our health care facilities and equipment. And although this government was elected on a promise to build 40 new ‘hospitals’, its decision to set hospital building budgets for only the next three years looks more like short-termism than stewardship: as an NHS England board paper earlier this month noted ‘The [New Hospitals] Programme has not, to date, had a budget for the full programme agreed by HMG [His Majesty’s Government], a programme scope or timeline.’

No doubt ‘more money and a longer funding period’ misses some of the nuance of modern estate maintenance and development. If you want to build a health care facility now you have options of alliance contracting and modular methods of construction. You will have to consider how pandemic respiratory viruses and climate change affect the design of hospitals. You will need to plan for surges in the cost of building materials because of global supply shortages and a plunging pound. And you will have to navigate spending rules that sometimes mean local NHS bodies are not allowed to upgrade their buildings and equipment even if they have the cash to do so.

'When I visited that paediatric ward the state of the building left me scared about the quality of care that could be delivered there and it made me ashamed that staff and patients had to stay in a place like that.'

But sometimes it is easy to overthink the problem and to use that as an excuse for inaction. When I visited that paediatric ward the state of the building left me scared about the quality of care that could be delivered there and it made me ashamed that staff and patients had to stay in a place like that.

Political leaders come and our political leaders go – but their decisions have a lasting impact on the future path of the NHS and their names live on in the plaques that sit on mental health wards, ambulance stations and hospital wards up and down the country. Current health ministers have already said that cutting NHS capital funding would be ‘short-termist’. I would like to see them go further and either commit to a funded longer-term capital investment programme or explain to the public why that paediatric ward I visited may be a harbinger of the future rather than a relic of the past.