In 1819 my ancestors, fleeing a bankrupt Britain after the Napoleonic wars, boarded the HMS Chapman for South Africa. There was a long delay due to shipping congestion in the Thames. While waiting they were horrified to learn that a neighbouring vessel had sunk without warning, drowning the entire crew. The rotten bottom timbers had just fallen out. This was an example of a coffin ship.
The settlers from inland Staffordshire learned that shipwrecks occurred almost on a daily basis just around the coast of Britain. Most frequently they broke up or fell apart for the simple reason that they were wormeaten and worn out. Money was skimped on repair and maintenance, especially by the shipowners (not the Navy), though sailors who refused to sign up for dodgy vessels were fined.
To add to these dangers the vessels were often overloaded, making them helpless in storms, too heavy and cumbersome to manoeuvre.
UK’s hospital coffin ships
Are you paying attention, Chancellor Reeves? For ships, substitute NHS hospitals. Are you, by your refusal to finance urgent maintenance catch-up, allowing our older hospitals to become coffin ships? Here is a brief list as a wake-up call:
- Green algae growth in a hydrotherapy pool
- Power lost in an operating theatre
- Sewage leaking into a waiting area for ophthalmology
- Parts of a ceiling collapsed in a clinical area
This is negligence, not management. In a wealthy G7 country it amounts to a complete and utter disgrace.
Staff in the NHS and social care sector are demoralised. They are overworked, over-governed and exhausted from trying to make the ridiculous integrated care system work, while enduring conditions in buildings that are deteriorating rapidly. Integrated care boards should be held to account for their achievements in growing primary and community health and care services, rather than for the performance management of the hospital system.
500% more high-risk problems
But if, as head of the Treasury, you need an economic argument, how about this? The backlog of repairs that began under the Tories has continued its steady increase and the cost now stands at £13.8bn – which means that to eradicate problems in just the hospital system will cost more than the entire maintenance budget of £11.8bn for the financial year.
That £13.8bn includes a scale of risk, the repairs categorised in terms of urgency and impact, with a 15% increase in the ‘high-risk’ backlog in the past year – ie, where failure to address urgent remedial work could lead to serious injury for both staff and patients, as well as major disruption to services.
To understand the scale of the dereliction, especially under former Health Secretary Jeremy Hunt, here are some figures (taken from the Kings Fund Review in December 2024): under Labour, 2004–2010, the backlog cost grew by 29%. Under the Tories, 2011–2024, a period dominated by Hunt, the backlog costs grew by 245%! The high-risk costs grew from 10% under Labour to 500% under the Tories.
Healthy NHS or bigger Heathrow?
This is the background story of the NHS’s fleet of coffin ship/hospitals. If the NHS were the Navy, Hunt would be court-martialled. Instead, he is made the Patient Watch Safety Chair. You could not make it up!
In summary, if by some miracle the backlog of work was accomplished this year, the total cost would be £15.6bn – roughly the same as your proposed third runway at Heathrow.
Politically, if the maintenance list were to be tackled boldly right now by Labour, starting with resuming the upgrade at Jimmy’s (St James’s Hospital) in Leeds, where the site is shovel-ready, then the dwindling confidence in this Labour government would begin to be restored. And just to add an economic argument, consider the multiplier effect.
It has been shown in study after study that investing in the health system yields a minimum of £4 for every £1 spent. You only need to change the frame and call it what it is – an investment, not just a cost. The work is labour-intensive and the financial return for the areas where the work is carried out would be, using the example above, £15.6bn x 4 – so that’s £62.4bn circulating in the catchment communities.
UK health is its wealth
So Chancellor, what are your priorities? The wellbeing of British people or a controversial airport project that will provide about 10% of the employment that the recovery and maintenance of NHS buildings and equipment would provide. I wonder if you are aware that in the NHS and social care you are investing in an institution that has more employees than the whole of the US civil service.
As things stand you are not only endangering the health of the nation but also its solvency. If the NHS goes down, as looks at the moment all too likely, our economy will probably collapse with it. Investing in the National Health Service and Social Care sector could actually save Britain.
To understand more about what this kind of disruption looks like, the Epsom and St Helier University Hospitals, are waiting for the review into the New Hospital Programme to confirm whether their new specialist emergency care hospital will be built, alongside the much-needed investment to make their existing buildings fit for purpose. Their current buildings are deteriorating faster than the Trust can fix them. Due to a key corridor flooding, ambulances have had to transport patients the short distance from one part of the hospital to another this year…
