The ticking time bomb inside the NHS is not the queues of ambulances outside A&E departments, or patients waiting months for operations, or even the nurses’ strikes but the ‘dire’ condition of many hospitals and GPs’ surgeries and the threat to patient safety.
New reports from the British Medical Association (BMA), the NHS Confederation and the Institute for Fiscal Studies (IFS) make alarming reading.
The BMA states that many buildings are, “crumbling, outdated and poorly laid out, and in dire need of repair and modernisation” – a situation threatening patients’ safety and healthcare, and hampering doctors’ efforts to provide safe and quality care to patients.
The NHS Confederation, which represents healthcare commissioners, is equally blunt. “Leaking roofs, rundown buildings and outdated equipment will make it harder to reduce waiting times and patients at risk.”
A damning indictment of government
The reports are a damning indictment of successive governments’ failure to invest in the bricks and mortar of the NHS and the impact on the safety and wellbeing of patients and staff.
A survey of BMA members showed that 38% of doctors said the overall physical condition of their workplaces is poor or very poor, while 43% stated that the condition of their workplace has a negative impact on patient care.
Alongside concerns about disrepair, the BMA claims that old, cramped and poorly designed hospitals and GP practice buildings are “incompatible with running a 21st century health service.”
They said the layout and size of buildings prevented adequate infection prevention control (IPC) measures during the height of the pandemic because their place of work would not allow for appropriate ventilation and IPC measures to cope with a future wave of COVID-19 or another pandemic.
Urgent funding needed
The BMA report calls for:
- independently audited national review of the condition of the primary and secondary care healthcare estates.
- doctors empowered to immediately raise concerns where building conditions present a risk to patient safety.
- government funding to urgently clear existing maintenance backlogs, or rebuild sites no longer appropriate for repair.
- an urgent review of IPC and ventilation across the primary and secondary healthcare estate, with dedicated funding for improvements and retrofitting.
A national scandal
Dr Latifa Patel, BMA representative body chair, said:
“It is a national scandal that a continued failure to invest properly in the bricks and mortar of our hospitals and GP practices, is threatening safe patient care. While the Government claims there will be ‘40 new hospitals’ it cannot even get right the basics of keeping roofs water-tight.
“The scenes described by our members are not what we would expect to see in a 21st century health service in one of the world’s richest countries. The shocking accounts of leaking ceilings, peeling walls and faulty electrics, will come as no surprise to doctors as the state of disrepair is so endemic across the NHS.
“Going to work every day amid these conditions grinds doctors down when morale is already at rock bottom. Doctors are feeling undervalued, underpaid and overworked, and the fact that their working environment is stopping them from looking after their patients safely is rubbing salt in the wound.”
Maintenance backlog up by 355%
The IFS says: “The maintenance backlog has been growing for a number of years. This represents a failure to invest adequately in hospital infrastructure, as well as a tendency to use capital funding to cover shortfalls in day-to-day funding in the 2010s.
“The total cost of the backlog has continued to rise during the pandemic, and the estimated cost to eradicate it fully stood at £10.2 billion in 2021–22. This is 7% higher in real terms than in 2019–20, and double the 2010–11 level.
“Most concerning is the rise in the high-risk maintenance backlog (‘where repairs/replacement must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution’), which is 13% higher in real terms than in 2019–20 and 355% higher than in 2010–11.”
NHS leaders “alarmed”
The NHS Confederation – which represents healthcare commissioners – agrees that “leaking roofs, rundown buildings and outdated equipment will hinder efforts to reduce waiting lists and patients at risk.”
It says that the National Audit Office found, in 2020, that 14 per cent of the estate pre-dated the formation of the NHS in1948, yet capital spending on NHS infrastructure, estates and maintenance remains behind other developed countries.
Nine out of ten Confederation members said their efforts to reduce the size of the waiting list are being hindered by a decade-long lack of investment in buildings and estate.
“NHS leaders have also sounded alarm over the dire state of many rundown buildings and the spiralling maintenance backlog. All of this is putting patients at risk. Newer facilities and modern diagnostic equipment would enable patients to be diagnosed and treated faster.
One example is the ageing roof of The Queen Elizabeth Hospital Kings Lynn NHS Trust. It is at risk of collapsing and being held up by over 1000 props. Last year, the intensive care unit had to be evacuated and closed for three weeks because of fears the roof would collapse.
“The failure to invest in capital for decades is making the NHS less efficient than it could be. Any efforts to reduce the allocated capital budget will be felt for decades to come with less efficient services and patient outcomes.”
Outdated IT systems
A second BMA report reveals doctors’ frustration with “out-of-date, slow and incompatible IT systems and hardware” which are costing valuable staff time and putting patient safety at risk.
The BMA estimates that more than 13.5 million working hours are lost yearly due to delays as a result of inadequate or malfunctioning IT systems and equipment in the NHS in England alone. This is the equivalent of almost 8,000 full time doctors or nearly £1 billion.
Dr Patel added: “Alongside physical buildings, digital infrastructure is way behind where it should be for a modern health service that can meet the needs of patients and staff.
“Doctors face daily battles with outdated systems that do not talk to one another, unreliable connections and crashing computers – if they can find a computer at all. This takes them away from what they should be doing – providing direct care to patients. Each delay is potentially putting someone at greater risk of harm.
“Funding reliable, safe and secure technology is vital, and this goes hand-in-hand with the need to invest in robust and well-designed healthcare buildings. By doing neither, the Government risks further endangering patients and plunging staff further into despair.”
