St Mary’s Hospital in Paddington has been a site of globally important healthcare breakthroughs since 1845. But when Alexander Fleming discovered penicillin here in 1928, in the then relatively modern Cambridge Wing, he might have struggled to believe the same facilities would still be used to provide some of the world’s best healthcare almost a century later.
Yet this is exactly the situation. With our sprawling estate, built piecemeal primarily before the NHS existed, we continue to offer excellent care and innovation. For example, during the Covid-19 pandemic, a joint Imperial College London and NHS team at St Mary’s led the influential clinical trial that identified new treatments now in widespread use.
Our staff have found ingenious workarounds for the collapsed ceilings, the flooding and sewage leaks, and the lifts that are well past their planned lifespans. But it comes at a cost. Not only in terms of the £7m we spend annually on repairs at St Mary’s just to stay operational. Patients regularly arrive hours early for fear of getting lost in our warren of buildings and missing their appointments, and our staff estimate they waste 10 to 15 per cent of their time due to estates problems. The wider impact on patients and staff of providing care in airless, crumbling facilities is immeasurable.
St Mary’s is a particularly grave example of what happens when strategic infrastructure decisions are continually left for another day. I started work at St Mary’s as a consultant in 2001, looking forward to the Paddington Health Campus scheme that was set to provide new facilities for St Mary’s and the Royal Brompton. The plan was shelved in 2005.
But many hospitals across the NHS are stuck in a similar cycle. We invest the capital we do have as strategically as possible. For example, the expansion of our same-day emergency care unit helps hundreds of people a year avoid a hospital admission. We also implemented an electronic patient record system ten years ago that has removed the need for paper records and allows us to develop digital applications such as our sepsis alert, which draws on routine patient data to automatically prompt clinicians to start early treatment for at-risk patients.
Imagine what we could achieve if our whole infrastructure was upgraded in line with a clear and shared vision of 21st-century healthcare. At St Mary’s, not having this investment is now becoming more of an existential threat rather than just a missed opportunity. Expert advice has made it clear that if we don’t rebuild within the next seven years or so, it will become impossible to continue to patch up our oldest facilities. But even for the many other hospitals that aren’t at such immediate risk of major estates failures – like our Charing Cross and Hammersmith sites – it’s still a huge problem. Without modern facilities and a genuinely user-focused digital architecture, we will not be able to deliver the improvements that are vitally needed.
More capital funding would clearly help, but it won’t solve the problem. The lack of a strategic investment programme is a long-standing issue. When extra capital is made available, it is often part of a national directive and at short notice. This makes it hard to use as effectively as possible and even harder to explore additional funding sources, as we need to know what we can bring to the table. If we are clear about our goals and what we can contribute, it will help us harness support from the private sector and others while avoiding the mistakes of the – now discredited – private finance initiatives.
Major NHS hospitals are key players in local ecosystems, offering opportunities for beneficial collaboration. We need much longer funding cycles and more freedom so that we can plan and invest for the long term, and be a true partner to our local stakeholders.
This piece first appeared in a Spotlight special print edition on the NHS’s 75th anniversary. Read it here.