My visit started with a tour of the busy emergency department at St Helier where I spoke to dedicated consultant and nursing colleagues about their daily challenges. Despite best efforts, staff provide care to a growing number of patients in a restricted and poorly designed space. With demand for care rising, clinicians increasingly contend with corridor care, rising patient acuity and a worrying rise in violence and aggression against staff. Despite these challenges, the clinical team's 'can-do' attitude is remarkable.
The trust's chief executive Jacqueline Totterdell and chief operating officer Alex Ward spoke about the multiple challenges of trying to deliver 21st century healthcare in an 85-year-old building. Installing air conditioning, managing oxygen and concerns about electrical overload are just some of the trust’s recent difficulties.
The differences between the brand new ITU and a cramped older unit are stark. Clinical director Dr Sarkar and other estates colleagues told me about the scale of the task. Driven by a need to improve facilities and expand capacity, the trust carried out extensive clinical engagement and planning before starting the build. The hard work paid off: the new ITU has three side rooms allowing better isolation and infection prevention and control, better floor space, hoists and air flow to maintain pressure.
I saw first-hand how difficulties faced by maternity services at St Helier reflect those experienced by many other trusts, but with the added complexity of a significantly ageing estate. The reality of this hit home when divisional director of operations Kathryn and Bennie, director of midwifery, told me that when it rains, it rains inside. With limited waiting spaces for families and visitors, we discussed a recent and challenging CQC inspection, which highlighted issues including dignity and privacy. Bennie and Kathryn told me about the impact of several hard-hitting national maternity reviews on nursing and midwifery colleagues, telling me: "we do the best with what we have".
Built in 1935, much of the St Helier Hospital estate is older than the NHS itself. The infrastructure challenges facing Queen Mary Hospital for Children tops the trust's risk register. It was alarming to hear of the disruption to children's care and services when the hospital's one and only lift breaks down, and deeply concerning that replacement lift parts must be specially manufactured; Potential delays to vital infrastructure functionality in the hospital are significant.
A visit to a new and innovative reablement unit and a conversation with two of the leads there, Sara and Joanna was a real highlight of the visit and a great example of the innovative work the team at St Helier's does to improve patient care. Staffed by occupational therapists, physiotherapists, pharmacists and nursing staff, the unit’s supported 226 medically optimised patients since November 2023, saving 450 bed days. Sara and Joanna’s enthusiasm was infectious; they told me about the great work being done by the hospital team and those in the community, where home-based rehabilitation allows for continuity of care.
From leaking roofs and cramped wards to broken lifts, it’s clear that the hard working and dedicated staff at St Helier is being asked to provide patient care in facilities in desperate need of renewal.
The trust has the green light to build a brand-new hospital in Sutton as part of the New Hospital Programme. But progress is painfully slow and the effect of these delays and the impact on staff and patient care was plain to see.
This reinforced, once again, why capital investment in the NHS is so critical for transforming facilities, improving the quality of care the NHS provides to patients, and creating better working conditions for our staff.
About the author
