With £6bn of backlog maintenance pressing down on NHS hospital buildings across the country, this morning’s formal announcement of funds to help tackle hospital maintenance and upgrade 20 hospitals will – rightly – be warmly welcomed. The annual ‘ERIC’ data return detailing the capital needed to modernise these complex but creaking estates makes for sobering reading, and that’s just the numbers: the human stories of the impact of struggling hospital buildings on patients and families are a stark reminder that the environments in which we receive our care can do so much to improve the way we feel during our experiences of illness and injury.
But if the Government takes the NHS Long Term Plan as the compass to guide this capital investment, we must think far beyond hospitals. Of the 20 schemes announced today, a small number focus on primary care. Yet GP surgery and primary care buildings are the workplaces of hundreds of thousands of NHS staff. They are the gateway to wider NHS services, and are often held up as the locations where most patient contact in the NHS takes place. It is there that the NHS Long Term Plan’s vision of care closer to home will be delivered. But many of these buildings are unfit for purpose, without the space, layout, design or digital capability needed to deliver primary care to growing patient lists, to embed new technologies for remote consultations and diagnostics, and to expand the range of health services being delivered in the community. In the latest survey by the British Medical Association, 50% of practices said their premises are not fit for purpose, and 80% said their premises would not be able to cope with expected future growth in demand.
We estimate that around one third of GP buildings are converted homes or former office units – and respondents to a recent Patients Association survey raised issues around space and privacy in waiting areas, the accessibility of surgery buildings for people with disabilities and limited mobility and the impact of poor environments on feelings of stress and anxiety.
The NHS Long Term Plan itself owns that: “Much of our estate consists of world-leading facilities that enable the NHS to deliver outstanding care for patients. But some of our estate is old, in parts significantly older than the NHS itself, and would not meet the demands of a modern health service even if upgraded.”
The plan’s emphasis on prevention, primary and community health services and access to mental health support relies upon significant capital investment to create the capacity and facilities for tens of thousands of additional professionals to move into primary care, and for the delivery of services, tests and treatments which the NHS wants to offer away from hospital. In turn, this will allow hospitals to plan the complex schemes to upgrade and improve their buildings for managing the most serious healthcare needs.
So today’s funding is an important step, but is only the first of many. In planning the next, we cannot forget the sometimes forgotten infrastructure in primary care which underpins the Long Term Plan – infrastructure which could be truly transformational for the NHS.