Strikes by nurses and ambulance workers have laid bare the effect on many NHS staff of longstanding, severe pressures right across our health and care system.
Trust leaders were already geared up for a tough winter, always the most difficult time of year, and many feared it could be the worst they've ever seen. So it is proving.
And while they and their staff pull out all the stops to ensure patient safety amid industrial action and soaring demand for overstretched services they have to contend with underlying issues that have been causing concern for years.
Capital is one of those fundamental problems.
The very fabric of the NHS, its estate, is coming apart at the seams leaving trusts ill-equipped to do everything that NHS England and the government ask of them.
Major operational and strategic capital investment is needed, not least to tackle the £10.2bn maintenance backlog across the NHS. Far too many buildings and facilities are in a bad state and the latest figures show that things are getting worse as the costs of trying to patch up creaking infrastructure mount. The maintenance backlog has grown by 11% in a year and more than half of it poses a 'high and significant risk'.
"We operate 21st century healthcare from 19th century buildings – increasingly unsustainable." That's what one NHS leader said responding to an NHS Providers survey of trusts included in the government's New Hospitals Programme (NHP).
The safety of patients and staff is at stake. Without proper funding, leaky roofs and ceilings, obsolete equipment and ageing IT don't get fixed or replaced, compromising quality of care.
Take mental health services, for example. A £677m maintenance backlog across mental health trusts is an unwelcome extra burden on overstretched services struggling with a record 1.8 million people in contact with them.
It's vital that the pressing problems of capital investment in the NHS are addressed urgently.Deputy Chief Executive
Mental health trusts need more capital funding so that patients receive care in the right environment. Another recent NHS Providers survey found that almost three in four mental health and learning disability trusts have had trouble getting capital funding this financial year, and trusts reported a lack of prioritisation of mental health services in the bidding process.
It's vital that the pressing problems of capital investment in the NHS are addressed urgently. Trusts which need to replace unsafe, decades-old reinforced lightweight concrete blocks in ceilings and walls are still waiting to hear from the government if they will get the necessary funding.
They need an urgent capital investment boost as well as clarity and commitment from the government about the much-delayed NHP.
Shovels and picks at the ready, trusts in the NHP are poised to start construction but are still waiting for confirmation of funding. Those forced to delay for months have faced spiralling, inflation-driven increases in the cost of building materials far above initial forecasts.
The NHP can transform a sizeable chunk of the NHS estate and the delivery of healthcare by providing badly needed renewal for acute, mental health, community and ambulance services. But throughout the NHS there just isn't enough capital funding available to invest in anything beyond business-as-usual needs.
The NHS, its staff and patients need safe, efficient, reliable buildings and equipment, not wards where crumbling ceilings have to be propped up.Deputy Chief Executive
Major strategic capital investment has the potential to radically improve the NHS. Trust sites designed to support new models of care, digital transformation and clinical research can deliver measurable improvements in key health outcomes. And with the right level of investment, the NHS could play an even bigger role in turning the government's ambitions for net zero and 'levelling up' from ambition to reality.
The NHS, its staff and patients need safe, efficient, reliable buildings and equipment, not wards where crumbling ceilings have to be propped up. If we don't build modern, safe settings now where staff can give patients first-class care it will cost the NHS and the public purse dear for years to come.
This blog was first published by Public Finance's print magazine.