Ugly Hospitals Are a Clinical Crisis - But Can We Afford to Be Picky…

Must we accept a country full of crumbling hospitals in a time of fiscal constraints?

Ask any NHS doctor about their workplace, and you will likely receive a mixed set of responses. Often, variation can be seen across corridors as some wards look like they were made thirty years apart. There is no way to escape the conclusion that many NHS trusts look like they haven’t seen a paintbrush in decades and are aesthetically soul-destroying.

When the media want to show how dire certain NHS trusts look, they often end up at St Helier’s Hospital in Surrey. A walk through St Helier’s will make it clear why the hospital, built in 1938, is older than the NHS itself. Flaking paintwork, single-glazed windows that no longer serve any function of keeping the cold out, and lifts permanently out of service as the parts needed to repair them are no longer manufactured are just some ways this hospital can be described as a relic from the past.

Competing Demands

But how can we possibly spend money on infrastructure and interior design when every aspect of the NHS needs more funding? For every two pounds the taxpayer spends on the NHS, one pound goes on staffing, with resident doctors still in a dispute over pay to increase their share of the pie. The NHS also has a shortfall in many training and consultant posts that it needs to fund, alongside having less medical equipment (such as scanners) and fewer beds than comparable countries.

So the NHS funding pie is being pulled in every direction.

We have an interesting statistic called the NHS maintenance backlog. This is the estimated cost of bringing all NHS buildings back to what would be considered a minimum acceptable standard, where the walls are not falling in on themselves, and nothing is leaking from the ceiling. This number sat at £13.8 billion in 2023/24. For comparison, the NHS’s entire 2023/24 budget was £241.8 billion.

When the choice is between adequate patient care and painting a flaking wall, or relaying a floor, then it is no surprise that many NHS trusts look the way they do. Take that 1938 lift at St Helier’s. When it fails, we lose theatre time. We lose patient flow. We lose the dignity of a patient being wheeled through a back-service corridor because the primary route is blocked. Crumbling hospitals also push staff towards the exit.

So here we create a false economy, where decisions may save money in the short term, but ultimately lead to greater overall costs.

The difficulty is the upfront cost of capital investment. The NHS repeatedly raids the budget of long-term capital investment projects for short-term operational demands (e.g. a department that rents a mobile MRI scanner). This is what economists call the deferred maintenance trap, and the NHS absolutely suffers from this, leading to our trusts becoming physically degraded and bare boned. We need to find a way to revitalise capital investment culture, but this can only be made possible if the financial demands that face both the country and the NHS allow for it.

How Will Labour Handle BMA Negotiations During a Leadership Crisis?

“Emergency" is a word that is overused in politics, but this is an existential crisis for Keir Starmer and his government. With 1,200 lost council seats, including key losses in traditional Labour heartlands, and a growing list of MPs demanding a departure date, rival camps within the party are already circling.

Around Westminster, all eyes are on our former Health Secretary Wes Streeting. His resignation as health secretary was quickly followed by a charge towards number 10, but if he were to run, he certainly wouldn’t receive a coronation from the party (and its members who find themselves more ideologically polarised than the average voter in the electorate).

Reports suggest Angela Rayner, despite her recent stamp duty scandal and £40k bill to HMRC, might stand specifically to "Stop Streeting," leveraging her union ties and soft-left brand of politics with party members. Streeting has never hidden his ambition, but a failed coup against Starmer, who is likely to retain some loyalty amongst Labour members, could be career-ending politically.

For the medical profession, the timing is interesting…

Streeting was (supposedly) in the midst of negotiations with the BMA to avert further industrial action. Now that he’s been replaced by James Murray, do these talks risk stalling? We wonder how far Streeting got in his negotiations with the BMA and whether Murray can deliver a deal that will appease the BMA, or will pay and conditions become collateral in a Labour civil war?

Politician’s Orders? The NHS Obsession with Restructuring

How close should politicians get to the NHS?

We are often our own biggest enemy when it comes to getting things done. Rather than focusing on where the issues are and taking the necessary steps to tackle them, we pursue grandiose ideas on how the real issue concerns our organisation’s structure or the models it operates on.

Here is an interesting statistic from The King’s Fund: When NHS leaders were asked what factors often get in the way of delivering local improvements, the most common response was “NHS reorganisation”. This was a more common response than the government’s financial position, lack of social care funding or operational demands.

Wes Streeting is the latest to get involved in restructuring our health service. He believes that the two large organisations of NHS England and the Department of Health and Social Care duplicate inefficient bureaucracy.

In restructuring, the key question becomes: How close do you want politicians sitting to the running of the health service?

Take NICE, which was set up about 20 years ago to oversee the approval of medicines. It was said that NICE could reduce some of the political havoc that plagues the day-to-day running of the NHS. In an unstable political climate, where David Cameron was the last prime minister to finish a full term in office, actions to depoliticise matters pertaining to the NHS are seen by many as a wise option. How on earth is the government meant to focus on governing and doing the serious stuff when you have events such as the current power struggle that is ongoing in the Labour Party?

But it’s not as simple as this, and many would disagree with the above sentiment. Politicians may not be popular, but what you can do in a democracy is hold them accountable. The media loves nothing more than to tear into a rival politician, which they know will sell headlines. So in an organisation that carries a £200 billion budget and employs over one million members of staff, it is quite important to pay close attention to how money is spent and how the organisation is run. There is perhaps no greater way to keep affairs in the public eye than to ensure politicians are the ones making decisions and not unelected officials.

Politicians may also have other reasons to want to sit closer to NHS proceedings. They know that when something goes wrong with the NHS, the public is going to blame them anyway, even if the decisions were made by non-governmental organisations. To which a politician may conclude that they may as well have more of a say in how budgets are allocated and decisions are made.

“Overheard two doctors talking about their weekend at a members club and how it’s worth it for the networking opportunities… Interested to know if anyone has ever made a “valuable” business connection through a members’ club.”

“Was asked by a consultant what my take was on a return to the firm system, and honestly, I just replied by saying I have no idea. I think far too many people believe that they need to have an opinion on everything, when instead they should be comfortable in admitting that they don’t know or don’t have a well-thought-out answer.”

‘Having a long debrief with my supervisor following a difficult stretch of nights, he told me, “There always comes a CST night shift when most people begin questioning their life choices. Don’t be surprised when it happens to you.”’

“Do any general surgery colleagues feel the speciality has become a bit of a dumping ground for non-specific abdominal pain that is more often than not, non-surgical?”

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Some things to review when you’re off the ward…

Are you ready to see a list of the trusts that have grown their private activity the most relative to their NHS activity? The list is as follows: Wrightington, Wigan and Leigh, Oxford University Hospitals, Royal Papworth Hospital, University College London Hospitals, Somerset, and the Royal Marsden. Coming top of the list, however, is Great Ormond Street Hospital, where private income accounted for 12.7% of its overall income. These trusts claim profits from private procedures are reinvested back into their general services.

The average age of a first-time home buyer in England has jumped from 29 in the mid-1990s to 34 in 2026.

Streeting has left his ministerial post as Health Secretary, brandishing the achievement of meeting the government’s interim target of 65% of patients being treated by 18 weeks.

Weekly Poll

Last week’s poll:

In general, do your non-medic friends enjoy hearing about your medic stories, or would they rather you left them at the door?

…and whilst you’re here, can we please take a quick history from you?

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“This Part of My Life, This Little Part, is Called Medic Happiness”

Being a doctor always means looking forward to the next seniority jump, nodal pay increase and a new flashy title. Awaiting the change in the colour and text of one’s lanyard is enough to entertain our senses. That is, until these things actually arrive.

Join any hospital canteen discussion or enter any online forum discussion, and you will find doctors proclaiming that happiness will be found once they have gotten through training, finished their fellowship exam or entered the next nodal pay point. Is this really the case? Every stage of life will bring its own medical and non-medical challenges.

This is, effectively, describing the well-known phenomenon of the hedonic treadmill, where humans quickly return to a relative state of happiness or sadness despite major positive or negative events in their lives. As we make more money, our expectations and wants rise equally, meaning we make no permanent gain in happiness.

As Dr Michael Plant of the Happier Lives Institute says, there is likely good evolutionary data surrounding this adaptation. Does Mother Nature really want us to be happy? Mother nature wants us to survive and reproduce, and getting used to things that used to give us pleasure is a neat trick to motivate us to gather and acquire more.