Hospitals: Maintenance

Lord Markham Excerpts

Thursday 9th February 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the NHS’s Estate Returns Information Collection data, which show that the cost of maintenance work on hospitals in England exceeded £1 billion in 2021–22.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Patient and staff safety is our top priority: that is why the Government are providing £12 billion in operational capital to the NHS over the next three years for trusts to maintain and improve the estate. We support the increasing levels of investment by trusts to ensure that facilities are safe and maintained to a high standard.

[Baroness Merron (Lab)]

My Lords, while the cost of replacing crumbling wards and operating theatres soars, only 10 of the 40 proposed hospital construction projects have full planning permission and the National Audit Office is investigating the programme. Can the Minister confirm how many of the 40 promised new hospitals will actually have been built by 2030? Can he also confirm that they really will be hospitals and not extensions or refurbishments?

[Lord Markham (Con)]

Twenty-one outline or full planning permissions have been given, which is totally on track with the target. Clearly, if some of those hospitals are not being built until, say, 2027, there would be no detailed planning permission yet. So those statistics are not representative of the situation, which shows that the programme of planning applications is on track. I am committed, as are my colleagues, to ensuring that we deliver the 40 by 2030.

[Lord Scriven (LD)]

My Lords, what are the Government going to do to end the ludicrous situation whereby even if NHS trusts have cash in the bank or access to the proceeds of asset disposals, they can be barred from improving major equipment on their estate because of arbitrary departmental capital expenditure limits imposed by the Treasury?

[Lord Markham (Con)]

Clearly, we want to give each trust the freedom to spend where it needs to. Obviously, there are overall Treasury rules but the main thing is the increased allocation we have made available in this space. We have spent £1.4 billion in the past year, which is a 57% increase, recognising that it is a good thing to put preventive maintenance in place to get on top of the backlog.

[Lord Davies of Brixton (Lab)]

My Lords, I may not be doing the Minister much justice but I admire his ability to give straight answers. I also admire his ability to maintain the fiction of 40 new hospitals. Does he accept that the Nuffield Trust puts the number of hospitals that any person in the street would recognise as new at three?

[Lord Markham (Con)]

I know that it is a lot more than that. The number of cohort 1 and cohort 2 hospitals being built at the moment is substantially more. This is a real programme; in fact, I invite all my colleagues here to a parliamentary open day, which I think will happen in the next month or so, when we plan to exhibit exactly what we are doing. We will have virtual reality glasses so that noble Lords can see the hospital of the future. Please come along and see for yourselves how real this programme is.

[Baroness Wheatcroft (CB)]

My Lords, the old joke about how many men it takes to change a light bulb tends not to go down well in PFI hospitals, where the answer can be “Several—and a lot of money”. In November, the Minister said to me that he was re-examining all these ruinous PFI contracts. Can he tell the House what progress he has made?

[Lord Markham (Con)]

We are actually making a lot of progress on them. A number of them, dare I say it, were introduced by Governments of a different colour and we are now working through and correcting those. At the same time, private capital can do a lot of good things. Many in the House will have heard me say just yesterday that if we put LED lightbulbs in every hospital, it would cost £400 million and save £100 million a year. That is the sort of thing private capital will fund every day of the week, probably at a 5% yield, giving us £95 million of savings a year. That is a good use of private capital, and the sort of thing I am looking at.

[Lord Allan of Hallam (LD)]

My Lords, I am surprised that more noble Lords have not dived into this report. It is fascinating, especially sheet 7 of the spreadsheet, which tells us that NHS England is spending £234 million a year on storing medical records. So while some parts of the NHS are working towards all-singing, all-dancing federated data platforms, in other places the height of modern technology is a new shopping trolley to move mouldering files in and out of a dingy basement. Will the Minister share with the House the Government’s plans to digitise or securely dispose of those paper records so that in future editions of this ERIC report, we will see that that £234 million has fallen close to zero?

[Lord Markham (Con)]

The noble Lord makes an excellent point. As he knows, we are investing heavily in a federated data platform, which is precisely about stopping storing paper and making such savings. Even more importantly, it is about improving patient care so that we can ensure that records are transferred instantaneously and really build on the knowledge that will bring.

[Lord Harris of Haringey (Lab)]

My Lords, I am not sure that the Minister really addressed the question my noble friend raised about the number of hospitals. He said that it was substantially more than three, then tailed off without giving us a number. He promised us a virtual reality opportunity to look at “the hospital of the future”, but I do not know whether that exhibition will show exactly which hospitals the 40 in question are, what is going to happen and how many of them a normal person in the street would regard as new. While he is on his feet, can he tell us what feedback Ministers have had from NHS staff working in hospitals about the physical state of those buildings and the extent to which that impedes their daily activities supporting patients?

[Lord Markham (Con)]

We have eight cohort 1 hospitals, which all have full planning permission and are in various stages of construction. We have 10 cohort 2 hospitals, of which two have full planning permission, seven have outline planning permission and one is awaiting approval of outline permission. All have had the preparation works done. So that is 17 where massive progress is being made. We then have cohort 3 schemes: the new hospital 2.0 projects, which are introducing modern methods of construction to standardise production and get cheaper and more efficient hospitals at a quicker rate of output. That is what I invite noble Lords to come and see for themselves over the coming weeks. This programme is very real and I will happily take people through whatever detail they want because, believe me, it is all there.

[Lord Foulkes of Cumnock (Lab Co-op)]

Is the Minister aware that, from time to time I have asked his predecessors to discuss with Scottish Ministers how they can help each other? However, in this area I am not going to do that because in Scotland, the children’s hospital in Edinburgh was delayed by a year and the Queen Elizabeth University Hospital in Glasgow has had enormous problems. Is there a competition between the English Tories and the SNP to see who can bring the NHS to its knees first?

[Lord Markham (Con)]

I can speak clearly on the subject of the new hospital programme, which I think the noble Lord will find is world-class. I will happily demonstrate that to him; indeed, people will see how ground-breaking this project actually is. We will see standardised designs with improved clinical standards, and more efficient productivity and costs as a result. It will be world-class, and we will export it around the world.

[Baroness Finlay of Llandaff (CB)]

My Lords, if the Government are saying that these are to be world-class hospitals, what is the comparison? Is it hospitals such as those in the Netherlands, which are extremely well designed and function very well, versus the many hospitals here which do not function well and have appalling design features? As soon as the staff move into them, they deteriorate rapidly.

--- Later in debate ---

[Lord Markham (Con)]

We are assessing best practice around the world in order to design them. That is exactly the point: we are taking on board things from the Netherlands and all round the world to make them state of the art and world class.

[Baroness Foster of Oxton (Con)]

I do not know how many hospitals have been completed, and I accept that there is a huge programme. But what I do know is that, since we came into power, in Liverpool we have had the brand new, state-of-the-art Liverpool University Hospital, a multi-billion pound hospital that has opened recently; Alder Hey Children’s Hospital, a first-class, world-renowned children’s hospital which has been opened in the last few years; and a huge cancer research centre—all within three miles of each other. I am sure there must be many others around the country. Does my noble friend the Minister agree with me on this?

[Lord Markham (Con)]

Yes. Now I am no longer holding anyone up in terms of time, I welcome noble Lords to visit places like Liverpool hospital and Chase Farm Hospital, where they will see brilliant examples of state-of-the-art hospitals. There will be many more—in fact, 40—going forward.