Crumbling, outdated and poorly laid out buildings, in dire need of repair and modernisation, are hampering the efforts of doctors to provide safe and quality care to patients, according to a damning new report from the BMA.

The report¹ – based on research and analysis from the Association and feedback from its members – lays bare the impact that underinvestment in the bricks and mortar of the health service is now having on the safety and wellbeing of patients and staff.

In a survey² of BMA members, an alarming 38% of doctors said the overall physical condition of their workplaces is poor or very poor, while critically, 43% told the BMA that the condition of their workplace has a negative impact on patient care – illustrating the extent of this crisis.

This comes as new BMA analysis shows that the healthcare services’ maintenance backlog in the UK – the cost of overdue repairs within the healthcare estate – has reached an estimated £13.8bn. This underlines the severe shortfall in funding for health service buildings, with the entire capital budget for the UK (£12.6bn) not even enough to make repairs, let alone build new facilities and update or expand existing premises.

In a series of shocking first-hand testimonies³, doctors revealed worrying safety incidents at their workplaces, and how a long-term lack of investment in buildings impacts them and their patients on a day-to-day basis.

Alongside concerns about disrepair, doctors told the BMA how old, cramped and poorly designed hospitals and GP practice buildings are incompatible with running a 21st century health service.

They said the layout and size of buildings prevented adequate infection prevention control (IPC) measures during the height of the pandemic, with almost 7 in 10 respondents to the BMA survey saying they felt that their place of work would not allow for appropriate ventilation and IPC measures in the event of a future wave of COVID-19 or another pandemic.

Meanwhile a lack of space means doctors do not have suitable rest facilities, room to accommodate additional staff or places where clinicians can discuss sensitive and confidential information with patients and next of kin.

The BMA report makes a number of recommendations, including:

• All UK governments must launch transparent and independently audited national reviews of the condition of the primary and secondary care healthcare estates in England, Northern Ireland, Scotland, and Wales, building on existing work where appropriate.

• Doctors should be empowered to immediately raise concerns where building conditions present a risk to patient safety.

• UK governments should provide the necessary funding to urgently clear existing maintenance backlogs – or decide to rebuild sites that may no longer be appropriate to repair – in order to protect doctors and patients, and to prevent any further growth in the already enormous list of outstanding and costly remedial repairs.

• As part of the independently audited review of their healthcare estate, all UK governments and health systems must carry out an urgent review of IPC and ventilation across the primary and secondary healthcare estate, with dedicated funding for improvements and retrofitting.

Dr Latifa Patel, BMA representative body chair, said:

“It is a national scandal that a continued failure to invest properly in the bricks and mortar of our hospitals and GP practices, is threatening safe patient care.

“While the Government’s claims there will be ‘40 new hospitals’ it cannot even get right the basics of keeping roofs water-tight.

“The scenes described by our members in this report are not what we would expect to see in a 21st century health service in one of the world’s richest countries. Yet for doctors, the shocking accounts of leaking ceilings, peeling walls and faulty electrics, will come as no surprise, as the state of disrepair is so endemic across the NHS.

“Going to work every day amid these conditions grinds doctors down when morale is already at rock bottom. Doctors are feeling undervalued, underpaid and overworked. Knowing that their working environment is stopping them from looking after their patients safely, and even preventing them from having somewhere to take a break, only pours salt into this wound.

“And with waiting lists for hospital treatment standing at 8.9 million in the UK, ensuring that buildings are fit for purpose must be a priority for ensuring that the health service has the capacity to care for such a large number of people.”

A junior doctor working in the East Midlands said:

“During a night shift in early November, rain was pouring through the corridor ceiling. It was so bad that an industrial bin had been placed underneath to collect the water.

“At one point we had more than one bed forced to close in a surgical ward because of leaks. It’s really demoralising for us as staff, so I can’t imagine what it’s like for patients to see things like this. I’m a doctor who knows that clinical necessities are prioritised and we will keep you safe, but it still really doesn’t fill you with confidence when you know critical infrastructure has been affected.

“I don’t blame the hospital management at all, they’re doing the best with what they have. This is what happens when you have an NHS starved of funding for a decade. It’s sadly just a small illustration of the state of the NHS right now.”

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A second report⁴, also published today, reveals doctors’ frustration with another important part of safe healthcare delivery, the health service’s digital infrastructure. Out-of-date, slow and incompatible IT systems and hardware are costing valuable staff time and putting patient safety at risk.

The BMA estimates that more than 13.5 million working hours are lost yearly due to delays as a result of inadequate or malfunctioning IT systems and equipment in the NHS in England alone. This is the equivalent of almost 8,000 full time doctors or nearly £1 billion, and is particularly shocking given how tight staffing, and as a result, capacity to treat patients already are.

Again, first-person accounts, revealed the daily struggles doctors face when it comes to poor quality IT and computer systems⁵.

Dr Patel added:

“Alongside physical buildings, digital infrastructure is way behind where it should be for a modern health service that can meet the needs of patients and staff.

“Doctors face daily battles with outdated systems that do not talk to one another, unreliable connections and crashing computers – that is if they can find a computer at all.

“While this is frustrating for doctors, ultimately it takes them away from what they should be doing – which is providing direct care to patients. Within an understaffed healthcare system each delay is potentially putting someone at greater risk of harm.

“The Government lauds its commitments about digital transformation and data, but without fixing outdated infrastructure, and getting the very basics right, these ambitions cannot be realised.

“Funding reliable, safe and secure technology is vital, and this goes hand-in-hand with the need to invest in robust and well-designed healthcare buildings. By doing neither, the Government risks further endangering patients and plunging staff further into despair.”

 

1. ‘Brick by brick: The case for urgent investment in safe, modern, and sustainable healthcare estates’ is available at this link.

2. 499 doctors across the UK responded to an online survey in February 2022.

3. “Every day I go to work in a ratty, smelly building with peeling paint, loose handles, poorly ventilated and baking hot offices, and loose and pock-marked toilet seats is another day closer to leaving this decaying system for good.” - Doctor working in secondary care
   “The hospitals are disgusting. Paint peeling, ceilings leaking, break spaces revolting. Canteens tiny and gross. Woeful parking. Everyone is MISERABLE as a result and of course that leads to poor patient care.” - Doctor working in secondary care
   “A waste pipe burst in the ceiling covering multiple members of staff in liquid and detritus, exposing them to risks of infection and electrocution.” - Doctor working in secondary care
   “Mites in neonatal units, sewage coming into patient care areas from leaks, fires in the ED resus area etc are all things I've seen.” - Doctor working in secondary care
   “Frequent sewage leaks through ceiling on occasions entire birthing pools full of contaminated fluid.  This often leaks onto computers, notes and staff. Clearing this up and also losing staff due to the environment has caused delays to patient care.” - Doctor working in secondary care

4. ‘Getting IT right: A prescription for safe, modern healthcare’ is available at this link.

5. “So much time is wasted trying to find working computers. As more things are becoming computerised, a solid IT infrastructure is essential and sadly trusts do not seem to be investing in adequate or sufficient equipment.” – Doctor working in secondary care
   “Software should be user friendly, efficient, easy to use, provide flexibility of multi-tasking. The amount of data we are asked to process is horrendous it takes us away from our patients.” – Doctor working in General Practice/ primary care
   “Too many logins and passwords and one software environment not communicating with the other.” – Doctor working in secondary care
   “It has before now taken me half an hour to log into a computer. This is a ridiculous waste of time. Systems are slow and dated, and I worry patient safety is at risk because it isn’t possible to find relevant information.” – Doctor working in secondary care