Crumbling, outdated and poorly laid out buildings, in dire need of repair and modernisation, are hampering the efforts of doctors to provide safe and quality care to patients,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 report – 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 survey 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 second report 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.”