It was the penultimate evening of 2024, the last of our guests had departed, and I had just settled down to start reading a very welcome Christmas present – Michael Sandel’s Democracy’s Discontent – when an SMS popped up on my iPhone:
Hi Paul. This is Sukh from the LBC.
Then that little message that says, Sender is typing. I waited pensively but that was it. Nothing came through.
Sukhmani Sethi is the producer who manages the Andrew Marr evening show on media outlet LBC tv weekdays, and Matthew Wright’s morning radio slot on weekends. She is incredibly sharp and always on the cusp of breaking stories. So what was up?
Five minutes ticked by. Still no follow-up.
Then my mobile rang, and it was Sukh wanting to know if I would do an interview with Matthew at 07.45 the following morning. Topic: the previous day’s Guardian leader about ‘England’s run-down hospitals’, an issue which the paper has been highlighting consistently. Here’s a sample few of its headlines during 2024:
26 Jan: Crumbling hospitals cause over 100 care disruptions a week, NHS figures show – 27,545 incidents in five years because of fires, leaks and infra-structure problems
15 April: More than 2,000 buildings in England older than NHS, figures show
8 May: Chronic underfunding, broken equipment and asbestos in the ceilings: this is the NHS
17 October: Repair bill for crumbling NHS buildings in England soars to almost £14 billion
Then, one to wrap up the year.
30 December: Matthew Taylor, chief executive of the NHS Confederation, said parts of the health estate (are) ‘so run-down that some patients are being treated in. . . outright dangerous facilities’
Taylor pinned the blame on ‘decades of underinvestment’ in the health service capital budget, which meant the NHS received ‘woefully’ less funding than comparable countries.
With this invitation came a 283-page set of minutes from a board meeting of the Stockport NHS Trust: Sukh’s briefings are nothing if not thorough! Pushing my book aside, I began to ponder. How should I play this interview? How could I make a positive impact in this dire situation? More noise? Endorse the findings? Amplify the complaints? Sooth the troubled waters?
The next morning, 07.42: Refreshed after a good night’s sleep I waited courtesy, of an online video connection, as Matthew Wright rounded off his previous interview and began a summary of the Guardian’s latest findings. Of particular note to him, among a long list of crumbling buildings, was the Bobby Moore cancer unit at Stepping Hill Hospital. Opened in 2000, he had helped raise the funds: how could a building so new have deteriorated so badly and so quickly?
Intro completed, and clearly incredulous, Matthew turned to me and asked: ‘How bad is it?’ Some 1.7 million equally incredulous listeners awaited my answer.
As a ‘Blood Biker’, with seven or so years of experience delivering emergency samples and platelets into hospitals, I have seen enough to know that in places it’s very bad. But the story is patchy: within the landscapes of many of our cities there are also plentiful examples of gleaming new hospitals – citadels of excellence that match world’s best standards. Projects that any UK community should be proud of; projects that every UK community should have.
Matthew’s question therefore offered me a generous opportunity to segue into some interesting territory, so I simply endorsed Mr Taylor’s report (after all, he is at the pit face so why would I doubt him?) and moved quickly on.
I pointed to the enormous amount of capital the Private Finance Initiative and PF2 investment injected into the health care estate, from 1998 to 2018, when the then Chancellor of the Exchequer called a halt to any further PFI funding, describing the process as being ‘inflexible, overly complex and a source of significant fiscal risk’.
As of March 2021, there were 694 completed PFI projects, with a capital value of £54.7 billion. Of these, about 140 relate to healthcare buildings and facilities. So, while making it clear that I am certainly no fan of PFI, I suggested that it would be wrong to think that there has been no investment in healthcare infra-structure. The new Royal London hospital alone represents a £1.2 billion spend.
Royal London Hospital
True as the Guardian reports might be in relation to some parts of the NHS estate, the picture for the estate as a whole is very uneven, with many hospitals being maintained to high standards by their respective PFI operators. But, as we know from a multitude of reported cases, there are many ongoing disputes between health authorities and their PFI partners in terms of alleged maintenance failures.
Then there’s the bigger story of which we should all be concerned: the PFI contracts mostly have 25- or 30-year lives (one notable exception has a 52-year life). When the contracts end, PFI buildings/facilities revert to NHS ownership. In most cases, there is a lease obligation that they be returned in the condition equivalent to ‘two years of usage’.
Two huge questions arise here. First, will those facilities be returned in that prescribed condition and what can we do to ensure that this happens? And, as important, who will determine whether those conditions have been met?
Second, how will the NHS organise and fund future repairs and ongoing facilities management? This problem is coming down the tracks like an express train.
The NHS estate is huge. There are 1,148 hospitals, many comprising multiple buildings. And beyond those thousands of buildings, the NHS has a myriad other associated non-healthcare facilities.
Sadly, the UK has a generally appalling record on building maintenance, especially in the state sector. Our schools are too often in a poor condition. One of the major drivers for the Thatcher initiative to sell council housing at a discount to tenants was (say some critics) the resulting unloading of maintenance and repair obligations.
The NHS, with all the other far-reaching challenges that it faces, must get to grips with the financing of repairs and ongoing maintenance of buildings as a discrete matter.
As any competent property manager knows, well planned and ongoing maintenance programmes (clearing and unblocking the rainwater gutters, downpipes and gulleys, replacement of mastics and sealants to modern facades, redecorating older forms of construction), are critical to ensuring that simple neglect does not lead to major building defects.
Twenty years is a very short period in what should be the long lifetime of a building. Bobby Moore’s oncology centre at Stockport is a timely reminder: that a properly funded and executed ‘stitch in time’ is as important as delivering the new; a message that both public and politicians need to acknowledge.
ends