Rishi Sunak’s pledge to cut the NHS waiting list backlog is being threatened by the crumbling concrete crisis as affected hospitals warn they will be forced to shut wards and theatres.
Hospitals were told they had buildings prone to collapse in 2019 but four years later they are still dealing with the issue.
In a report last year, West Suffolk NHS Foundation Trust leaders said that work to replace reinforced autoclaved aerated concrete (Raac) in its hospitals would hit general surgery, urology, gynaecology and orthopaedic care.
Wards have had to close, piling pressure on a crowded A&E as patients can’t be offloaded due to lack of beds, and threatening its ability to hit government targets to reduce waiting lists, it added.
The warning comes as Sir Keir Starmer used Prime Minister’s Questions to attack Mr Sunak over the crisis. He argued that “the cowboys are running the country” and asked the PM if he was “ashamed” of the scandal caused by 13 years of “botched jobs”.
Mr Sunak doubled down on his government's handling of the issue but Downing Street later admitted it could not say how long it would take to resolve the crisis, which is expected to affect thousands of public buildings.
At least 34 NHS buildings have Raac and seven hospitals, including West Suffolk, have the dangerous material “throughout”, prompting fears many more surgeries will be affected while work to fix them is completed. So far, no hospitals have been ordered to close in full.
Saffron Cordery, deputy CEO of NHS providers which represents all hospitals, said trusts had been flagging the issue of Raac for a “significant period” but it “hasn’t topped the priority list”.
She said that “it’s a major issue, but it plays into the bigger issue” of the neglected NHS estate and its impact on care.
“When buildings aren’t fit for purpose, they do undermine productivity and the amount of activity a trust can push through. So when we think about safety checks ... disrupting the use of certain operating theatres or certain sites, what we know is that that slows down progress.
“Raac is a major issue, but it also plays into the bigger concern about capital investment across the NHS, because we see buildings out of commission for all sorts of reasons. Raac is one of them but we also know that the failing estate is another.”
The former chief of Queen Elizabeth Hospital described its Raac roof as an ‘Aero bar’— (Queen Elizabeth Hospital King's Lynn NHS Foundation Trust)
NHS England has asked trusts to carry out an urgent review of their buildings and ensure they have evacuation plans in case any have to shut. An evacuation simulation for hospitals carried out by NHS leaders in the east of England last year found:
- concerns that hospitals and ambulance trusts are not prepared for an emergency move
- lack of bed space at other sites means patients, particularly those needing specialist care, can’t be moved
- trusts do not have enough information about patient needs to safely move them elsewhere
- concerns patients may be moved to other hospitals with Raac problems
- the potential need to move patients to “non-NHS”, temporary or “mothballed” buildings
Earlier this year, the government said it would include seven hospitals most impacted by Raac in its New Hospitals Programme to replace 40 sites. But the funding comes years after trusts were alerted to Raac in 2018 and 2019.
In its annual report for 2022-23, West Suffolk NHS Foundation Trust said it received an alert in 2019 from the Standing Committee on Structural Safety (SCOSS) warning that its hospital in Bury St Edmunds could be affected by “shear failure with very limited warning” – the collapse of concrete beams.
The trust said the work needed to fix Raac would add “constraints in surgical capacity” and fewer available beds. It said the closure of wards would impact its ability to eliminate the number of patients waiting 104 weeks for care in orthopaedics, general surgery, urology and gynaecology.
The Queen Elizabeth Hospital in King’s Lynn, whose former chief described its Raac roof as an “Aero bar”, was forced to close four operating theatres to replace its crumbling concrete. And in its 2022-23 report, Frimley Park Hospital, in Camberley, Surrey, said the temporary reduction of theatre capacity because of Raac repairs will make cutting its waiting list targets “more challenging”.
Ms Cordery said sorting the Raac issue urgently was “critical”. “We’ve got seven trusts who know they’re on the list, but there’s many more will have to wait another 12 years until their Raac is eradicated. That’s going to be an ongoing concern for those organisations,” she said.
Matthew Taylor, chief executive for NHS Confederation which also represents hospitals, said although the government had provided funding for hospitals to fix Raac, the disruption from the work was affecting services.
He said: “Where wards need to be closed, it means patients need to be rehoused elsewhere on-site, when space is already at a premium, meaning that capacity is further reduced at a time when staff are making every effort to tackle the treatment backlogs and stabilise urgent and emergency care.”
Mr Taylor also said Raac was part of a much bigger problem facing the NHS estate and the failure to address it over the past decade was “absolutely hindering its ability to deliver”.
Shadow health secretary Wes Streeting said the government’s failure to act more quickly was putting patients at risk.
“Outdated, crumbling hospitals are still waiting years for urgent repair work,” he said. “This could hamper efforts to get the backlog down. Labour is demanding an urgent, full audit to find out the extent of the failure to replace this dangerous concrete across our public sector. Patients deserve to know if they are at risk.”
A Department of Health and Social Care spokesperson said: “The NHS has a mitigation plan in place for hospital buildings with confirmed Raac, backed with significant additional funding of £698m from 2021 to 2025, for trusts to put in place necessary remediation and failsafe measures. We remain committed to eradicating Raac from the NHS estate entirely by 2035.”
An NHS spokesperson said: “The presence of Raac only affects a minority of trusts ... with a national programme in place to support trusts to mitigate, monitor and eradicate Raac since 2019, local NHS teams have made significant progress in reducing the longest waits for care, with waits of over two years virtually eliminated last summer, and we are working towards doing the same for 65-week waits by March 2024 – treating more than 1.5 million patients in June alone.”
