Capital investment delays leave England’s hospitals crumbling
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“When it rains, we often have to stop surgery because theatres have flooded,” one senior NHS chief executive laments. “Critical cancer operations are cancelled minutes before surgery because of leaks.”
The hospital in the south of England is just one example of how a long-standing lack of capital spending is being felt across the NHS. The service is struggling with an accumulated maintenance backlog worth more than £11.6bn, the highest since records began.
More than half of the outstanding repairs relate to buildings classed as posing either a “high” or “significant” risk to patients and staff, according to NHS England data.
The “high risk” list is estimated to be about £2.36bn, defined as repairs and replacements that “must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety”.
The problem of unsafe hospitals has been seized upon by opposition political parties ahead of the general election on July 4, which cite crumbling buildings as a symbol of the Conservative government’s unwillingness to invest in public services over its 14 years in power.
Sally Warren, director of policy at The King’s Fund, a health and social care charity, said that sustained under-investment in capital over the austerity decade of the 2010s, has forced the NHS to “raid capital budgets each year to manage day-to-day spending”.
That model is “OK if it’s for a year or two, but if it’s year after year there is a real challenge in terms of ensuring our buildings are safe and effective”, she added.
The backlog is partly a function of short-term decision-making when funding is tight but it is also symptomatic of an “endemic problem” in the way the government funds the NHS, said Anita Charlesworth, director of research at the Health Foundation think-tank.
“We prioritise the here and now over the investment that will build capacity and modernise services, so that they are more productive . . . it will require at least a decade of higher investment to put things right,” she said.
The UK health service has been underinvested in capital compared with other health systems around the world, such as France and Germany, for decades, Charlesworth added.
“That has meant that not only are our facilities crumbling but also we aren’t as far as advanced as we would want to be on digital and IT,” she said.
On Tuesday, four NHS hospitals in London were affected by a cyber attack on a lab services provider, resulting in operations and other procedures being cancelled.
The government’s “new hospital programme” set up in 2020, a legacy of former prime minister Boris Johnson’s time in office, aims to construct or expand 40 hospitals by 2030, backed by about £20bn of capital funding.
Saffron Cordery, deputy chief executive at NHS Providers, which represents senior managers at health organisations across England, said progress on delivering the scheme has so far been “alarmingly slow”.
As a result “trusts are met with delays costing millions of pounds a month that directly impact patient care and productivity”, she added.
“After years of under-investment in NHS infrastructure, trusts urgently need a comprehensive, long-term capital investment strategy from the next government,” she said.
The National Audit Office, the UK public spending watchdog, warned last July that funding cuts, combined with planning and staffing problems, meant that only 32 of the 40 hospitals would be completed by the 2030 deadline.
The NHS chief executive, who asked to remain anonymous, said they were promised a new hospital eight years ago. “By now, the build should be complete but we still have not received the money to start the enabling works,” they said. “I am left wondering whether the money will ever come.
“I hope an incoming government [will] provide stability and recognise the need for rapid investment into healthcare. They certainly cannot be any worse.”
Buildings containing reinforced autoclaved aerated concrete, also known as Raac, has been a serious cause of public concern in recent months.
Identification of the lightweight and potentially dangerous concrete across the NHS estate last year prompted health bosses to order urgent checks on hospital sites in England and ensure evacuation plans were in place.
Of the 42 hospitals where Raac is present, seven are constructed almost entirely of the material, according to the health department.
“We have emptied wards because of the Raac but in other areas of the same building, with the same roof and the same problems and risks, we are still providing patient care because we do not have any other space to decant to,” the chief executive said.
“Providing patient care versus stopping services because of an unsafe environment is a difficult decision to take and I worry most days we have not correctly calculated the risk.”
Additional reporting by Amy Borrett
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