Decaying hospitals highlight government failure to invest in the NHS

The writer is chief executive of NHS Providers

Vital parts of the National Health Service are falling to bits. Literally. When I was in charge of a big NHS trust in Leeds, on my desk I kept a lump of Raac, the now notorious reinforced autoclaved aerated concrete, given to me by the chief executive of another hospital where it had fallen from the ceiling.

That chunk of crumbling Raac reminded me every day of the poor state of the fabric of England’s NHS, another daily challenge on top of the growing demand and relentless pressures that the UK’s health services are under.

Unsafe Raac is a symptom of a far bigger and long-running problem facing the ageing NHS estate. Safety of patients and staff is paramount but this is threatened by an eye-watering £11.6bn backlog of essential repairs, up by more than 13 per cent since 2021-22. Alarmingly, more than half of those on the “to do” list are classed as high or significant risk.

That is why the government’s New Hospital Programme (NHP), unveiled in late 2020 pledging £3.7bn for the construction and refurbishment of 40 hospitals by 2030 with a further eight schemes invited to bid for future funding, was welcomed. Since then, the government promised that five hospitals built mostly with Raac would also be rebuilt by 2030 as part of the NHP.

Last year, however, MPs warned they were “extremely concerned” by the plan’s “lack of progress”; the government’s own spending watchdog said that the NHP had not been good value for money so far.

Almost a year to the day since the government reconfirmed its commitment to the programme, NHS trusts’ confidence in its delivery is on increasingly shaky ground. Some trust leaders told us that delays to their NHP schemes were costing them — and the taxpayer — upwards of about £1mn a month due to spiralling costs, with plans constantly being reworked in order to make them more affordable. That means potential benefits for patients have been delayed or scrapped in a bid to balance the books.

Many trusts in the NHP were disappointed to learn last year that their building plans won’t become a reality before 2030. Many more were left demoralised after getting no funding at all. Deteriorating mental health facilities and the fact that more than 100 trusts applied to join the scheme show the scale of under-investment in the fabric of the NHS. 

For years, the NHS has been forced to use money earmarked for transformative capital projects to pay for essential day-to-day work. Now we are living with the consequences of the national under-investment that made these trade-offs necessary.

The NHP will help some trusts tackle serious safety risks but the big picture is still uncertain. Trust leaders want to know that they will be able to afford to build facilities of the size and quality that patients, staff and communities were promised. They need buildings that reflect the health requirements of their communities now, not from when the plans were first drawn up.

NHS trusts have called long and loud for greater, planned, long-term capital investment from government to transform their estates. Without it the NHS will struggle to improve productivity and ensure safe, high-quality care in modern facilities. Ministers have also been warned too that proposed hospitals in the current plan may be too small for future health and care needs.

Ahead of a UK general election, trust leaders have called on politicians to work with them to build a new infrastructure programme for the NHS. To meet the challenges of the future, an incoming government must commit to equipping the NHS with the resources it needs, not just in hospitals but in mental health, community health and ambulance services too. We need to get a move on. Time and money are being squandered.