one NHS hospital’s long wait to fix crumbling facilities

In the flooded basement of Queen’s Medical Centre in Nottingham, a wooden plank is the only means of moving between dingy rooms where patients once received specialist care for pain. 

Exposed ceilings have collapsed and water damage has left swaths of paint peeling off the walls of the hospital, which Queen Elizabeth II opened in 1977.  

“It is incredibly embarrassing showing people around areas like this, and frustrating,” said Mike Soroka, QMC’s head of estates, when the Financial Times visited the clinic that closed six years ago because it was deemed unsafe. “We want to provide a nice, clean and safe hospital environment, but without the investment, we struggle.”

QMC, part of Nottingham University Hospitals NHS Trust (NUH) in the East Midlands, is one of the most dire examples of how a long-standing lack of capital spending is being felt across the health service.

The NHS in England had an accumulated maintenance backlog of £13.8bn in 2023-24, the highest on record. QMC has a backlog maintenance bill of £439mn, the third-highest in the NHS and the biggest outside London. 

NUH was selected for refurbishment under former Conservative prime minister Boris Johnson’s flagship New Hospital Programme, which promised to build or expand 40 hospitals in England by 2030.

Last month, the trust found itself at the back of the queue after health secretary Wes Streeting set out a new timetable, in which hospital bosses were told that building work would take place in four “waves”.

Construction at nine projects under the programme, including NUH, will now not start before 2035, and could begin as late as 2039. Streeting did not set a deadline for when the entire programme would be delivered, stressing the Department of Health and Social Care would put it “on a firm footing with sustainable funding”.

“We were expecting to start our builds in 2030, so to hear it was pushed back by at least seven years was really disappointing,” said Philip Britt, director of major capital programmes at NUH.

“Quite frankly, our patients and staff deserve better facilities and we can’t wait that long to make the much-needed improvements in our hospitals.” 

One reason for the NHS’s enormous maintenance backlog was identified last year in a landmark government-commissioned study into the NHS by Lord Ara Darzi. The surgeon and former Labour health minister found England had spent almost £37bn less than peer countries on health assets and infrastructure since the 2010s.

The shortfall — labelled the “missing billions” by Darzi — has forced the NHS to raid capital budgets in order to manage day-to-day spending amid a surge in demand for treatment. It has also hit productivity and left parts of the service with buildings that are falling apart. 

Twenty per cent of the NHS estate predates the founding of the service more than 75 years ago, and some of NUH’s facilities date back to the Victorian era.

“Increasingly, more things are going wrong in our hospitals,” said Britt, citing the one unit on which QMC relies to provide clean air for four operating theatres. It “can quite often fail”, he said, leading to operations being cancelled.

“More and more frequently our facilities are failing and the risk is increasing as the equipment gets older,” Britt said, noting that multiple critical incidents had been declared owing to power cuts and leaks.

“Over time, if we don’t get significant investment, the frequency will increase,” he added.

In the autumn Budget last year, chancellor Rachel Reeves announced a £3.1bn increase in NHS capital spending over two years, alongside a £22.6bn rise in the service’s day-to-day budget over the same period.

But inflation is one of the biggest threats to NUH’s annual capital spending budget. With a maintenance backlog of more than £400mn and rising costs, any boost to the trust’s capital budget typically “just about keeps us standing still”, said Britt.  

The main New Hospital Programme project for NUH, which included plans for new centres for women’s, children’s and family care and critical care, was originally projected to cost about £1.3bn in 2020. But the government now estimates the project at above £2bn. 

Staff at QMC stressed that when given proper funding, they made “excellent” use of it, pointing to a state of the art neonatal unit that opened in December last year and is the largest in the East Midlands.

Rory Deighton, acute director at the NHS Confederation, which represents health managers in England, said the group’s members “tell us time and again that there are still too many NHS buildings in a state of disrepair and not fit to treat patients in a 21st-century healthcare system”.

He added: “Higher capital investment in estate, digital and equipment is crucial to shoring up and improving the quality of NHS services and its long-term financial sustainability.”

Back in the wet basement of QMC, Soroka praised the efforts of his colleagues to deliver care despite the hospital’s old infrastructure. “The team we have got here does an incredibly good job of keeping, on the face of it, the hospital running, seemingly as if there are no issues,” he said.

NHS England did not comment.

The Department of Health and Social Care said: “The New Hospital Programme we inherited would not have been delivered because it was completely unrealistic and unfunded.   

“This government has confirmed a realistic timetable, expected to be backed by investment of £15bn, to put us on track to deliver the rebuild of Queen’s Medical Centre and all other projects.”

Data visualisation by Amy Borrett