"We operate 21st century healthcare from 19th century buildings – increasingly unsustainable."
So said one NHS leader responding to our survey of trusts included in the government's flagship New Hospital Programme (NHP), underpinned by its manifesto commitment to build 40 new hospitals by 2030.
What was billed as the biggest hospital building programme in a generation is on shaky ground.Interim Chief Executive
Against a backdrop of ongoing political drama and turbulence that has seen a change of health and social secretary, and just days after the National Audit Office said that it will launch a review into the NHP, it's vital that the pressing problems of capital investment in the NHS are addressed urgently. Delays and growing concerns about the lack of progress and funding, however, mean that what was billed as the biggest hospital building programme in a generation is on shaky ground.
Our survey findings paint a picture of doubt and frustration. Half of trusts said that their building projects are underfunded and around two in five said their schemes were behind schedule – by up to four years in some cases. Some don't even have a starting date yet. These delays also raise concerns about the ability of the government to uphold its commitment to deliver a further eight hospitals before 2030.
Trust leaders are anxious that the benefits they expected to be able to deliver for patients and their communities are increasingly at risk, in some cases getting further beyond reach every passing day. Many trusts say public confidence that plans will get beyond the drawing board is eroding fast. In October 2020 the prime minister announced £3.7bn for trusts to make headway on the 40 NHP schemes. That's just not enough for every trust in the programme to deliver their preferred option during the current spending review period.
The NHP shows just how complex it can be to deliver a national programme for which the government is responsible but for which local parts of the NHS are accountable to their communities.Interim Chief Executive
Trusts are ready to start construction but are still waiting for confirmation of funding. Those forced to delay now face inflation-driven rises in the cost of building materials and supply-side issues including labour shortages. The NHP shows just how complex it can be to deliver a national programme for which the government is responsible but for which local parts of the NHS are accountable to their communities. When having to announce delays, trusts need government support to manage important relationships with staff, partners, the public and MPs and to explain why we are where we are.
Much of the NHS estate is in a bad way. So much so that in some cases bulldozing and rebuilding is the only feasible option. Without proper investment, leaking roofs, broken boilers and outdated technology – more Blockbuster than Netflix, to use a recent analogy – don't get fixed or replaced, with damaging knock-on effects on the quality of care and patients' safety. The maintenance backlog is a huge problem right across the NHS.
The NHP is a fantastic opportunity to transform the very fabric of the NHS and the delivery of healthcare by providing badly needed renewal for acute, mental health, community and ambulance services. If delivered properly, it could also support the 'levelling up' agenda by reducing health inequalities and driving long-overdue improvements to patient safety, service capacity and the recruitment and retention of valued, professional staff.
Trusts in the NHP agree that with the right amount of government support their schemes will mean better care, experiences and outcomes for patients and help them to boost productivity. It is vital, therefore, that government properly funds these schemes and gives trusts the freedom to get on with it as soon as possible.
The NHS turned 74 this week but it shouldn't be stuck with old buildings and facilities well past their sell-by date. If we don't build modern, safe settings now where staff can give patients first-class care it will cost the NHS dear for a long time to come.
This blog was first published by the BMJ.