We need politicians to give the NHS estate their full attention, then perhaps they can use the construction industry more effectively to ease the pain

chloe mcculloch black

The NHS estate is burdened with a £6.5bn maintenance backlog – that’s half a billion pounds more than last year. The austerity years have clearly taken their toll. While revenue spending has kept in line with inflation in the past decade, capital expenditure has not – in fact building and maintenance budgets have been raided for the sake of those politically sensitive frontline services.

All this has led to more than half the backlog of maintenance issues being categorised as posing a high or significant risk. That sounds serious, and it is. Poor maintenance is not just a case of sprucing up wards in need of a lick of paint; we are talking about buildings malfunctioning to the point where there are power cuts, sewage blockages and fire risks. The very places that are supposed to help people get better are endangering their safety. This is clearly intolerable. 

One particular concern is that no mental health facilities are in line for any of the extra capital funding. This is a shocking oversight

Prime minister Boris Johnson – known for being partial to a ward round with the media in tow – seemed to grasp the urgency of the situation, with one of his first announcements in Number 10 being a £1.8bn cash injection for NHS building repairs. This has been swiftly followed by a further pledge from health secretary Matt Hancock of £2.7bn for six new hospitals and plans for improvements at a further 21 trusts.

The new money has been welcomed by hospital executives, but the crucial question is: is it enough? The short answer is no, not by a long chalk. At the moment, annual capital investment in the NHS trusts is roughly £3bn, according to the Health Foundation, and most experts reckon that should have another £2bn added to it.

One particular concern is that no mental health facilities are in line for any of the extra capital funding. This is a shocking oversight. Earlier this month the Quality Care Commission reported that 10% of inpatient services for those with learning difficulties and autism were rated inadequate, while psychiatric units have deteriorated. The reasons for this often come down to staffing issues, but inadequate buildings undoubtedly pose specific risks. One NHS insider told us about units where dormitories are still in use, which increases the distress of patients forced to share communal areas. Even worse is that the rabbit-warren layouts of Victorian asylum buildings makes it hard for staff to monitor patients who may be suicidal.  

The more general problem with the most recent pledges is that they are one-offs, and the government has only capital commitments for the one-year spending review period. If you are an NHS estates director, what you really want is to be able to plan for the long term, hence calls from campaigners for five-year rolling capital programmes. Given political attention is focused elsewhere, this very much appears an aspiration rather than an achievable goal, for now at least.

It’s not all doom and gloom from a construction perspective. True, the government’s 27-hospital programme is small compared with the heydays of PFI in the late 1990s and early 2000s. But the sums that have been pledged are significant and the move away from risk-laden PFI contracts may tempt contractors back to the sector – many of which were spooked after Carillion’s well publicised problems on the Midland Met and Liverpool hospitals.

One thing is certain, there is a huge unmet need to improve the NHS estate. What we need now is for politicians to give it their full attention, then perhaps they can use the construction industry more effectively to ease the pain. 

Follow the leaders

And now for a more cheerful topic. Here you’ll find our shortlist for the Building Awards Female Leadership category, where there are six contenders from a range of professional backgrounds and at different stages in their careers. Some have taken on big roles on megaprojects or become experts in a particular field, while others have founded their own businesses or focused on turning their companies in a new direction. What unites them is not just that they have reached senior positions within a very male-dominated industry, but that they are actively using their positions of influence to help others enter the industry and move up the career ladder. 

So on top of high-pressure day jobs where they have more than proved their worth to their companies, they have carved out time to raise the profile of women in the wider construction sector, with the laudable aim of encouraging others to take up, or indeed stick with, construction careers.

It’s a tall order given how stubbornly the number of women in the industry has stayed at around 13%. Last week, the BRE Group’s chief executive Gillian Charlesworth said in the pages of Building that progress for women in construction has been “glacially slow”. She talked of the power of these types of peer-to-peer support initiatives and how they can make a real difference to women’s careers.

And let’s not forget there is a wider diversity agenda here. Women, after all, are not the only underrepresented demographic in this sector – and our female leaders are acutely aware that construction needs to improve its inclusivity across the board. With leaders like this, the rest should follow. 

Chloë McCulloch, editor, Building