The condition of two of Greater Manchester's busiest hospitals has been slammed as 'shocking and dreadful’ by the region's health chief.
During one of his first appearances as incoming NHS boss, the former Manchester City Council leader took aim at our dilapidated facilities.
Stepping Hill Hospital and the Royal Bolton Hospital were both given as examples of the scale of the problem.
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And even the hospital trusts, themselves, admit that their buildings are ‘ageing’ and ‘not fit to last another generation’.
‘Fit for the Victorians, not fit for us’
The pair of hospitals have plans for state-of-the-art units - new builds designed to deliver modern healthcare bosses say they cannot provide in their current setups.
But these developments could be years away from even breaking ground, as the hospitals attempt to secure funding from central government.
In the meantime, serious concerns remain over sites which 'may have worked for the Victorians, but not for the 21st century’.
“It's quite remarkable how underfunded the NHS has been over decades, not just a few years,” Sir Richard told the Manchester City Council’s Health Scrutiny Committee on Wednesday, February 9.
"If you look at the conditions a lot of colleagues are operating under, they're pretty shocking really.
"I was in Stepping Hill on Monday, looking around their site, which is not far behind North Manchester General Hospital in terms of its conditions.
"They have just got Stepping Hill's Emergency Department's up to CQC good, but you have to wonder why given when you look at the circumstances they are operating within, they are pretty dreadful.
"From a climate change point of view, just one example from Stepping Hill, they've got lots of bolted-on corridors on the outside of the building. Miles of them. All of that is just pouring heat out into the atmosphere.
"I was up in Bolton, and again, really badly designed, thrown together, bits added here, bits added there.
"Both very poor from a productivity and utility point of view, but they are certainly not fit for purpose if we're going to tackle climate change.
"And you can't just retrofit buildings like that. They need fundamentally rebuilding if you're going to make them workable."
The CQC for Stepping Hill overall, graded in January 2022, was one of requires improvement.
Plans for ‘entirely new hospital builds’
There are a range of construction projects already underway to regenerate and renew some of the city’s hospitals.
North Manchester General Hospital’s Crumpsall site has seen demolition in ‘once in a generation’ revamp over the next 10 to 15 years.
The ‘radical redesign’ followed independent assessments which concluded that 70 per cent of the site was in ‘desperate need of rebuilding’.
The plans include a new acute hospital, a mental health hospital, and a well-being hub, among a slew of other services.
The project has received approval for almost £70m of government funding for the initial redevelopment plans and the site enabling works. These works include the new HQ, North Manchester House, as well as a Multi-Storey Car Park and Cycle Hub to help address the long-standing car parking pressures at North Manchester General Hospital.
These works are preparing the site for full development, once the detailed plans and final funding for the redevelopment of the hospital site is agreed through the government’s New Hospital Programme.
Salford Royal is also in the midst of a £68m extension, which will result in a centre for 90 percent of the major trauma operations across Greater Manchester, providing support for people involved in serious incidents such as car crashes or life-changing falls.
But questions still hang over whether money will be granted to other vital builds, including at Stepping Hill and Bolton - and the journey to nail down funding can take as long as the building itself.
However, time is of the essence as populations grow, age and change.
Local leaders are asking how the NHS in Greater Manchester can ‘get ahead’ to ensure the cash comes to the North, as being unsure of whether funding will be granted is ‘no way to plan and refresh an NHS estate’.
“There’s some real challenges across Manchester and more broadly in Greater Manchester around the NHS estate,” said Councillor Suzanne Richards.
“We had a report last month which outlined some of the really excellent plans we have in North Manchester, some plans for Wythenshawe.
“But clearly, there’s much broader challenges when we look at primary care provision. We’re building a lot of homes across the city. There’s going to be a need for additional infrastructure.”
In Bolton, the hospital estate is ‘in need of significant repair, modernisation and upgrade’, according to the organisation’s leaders.
A strategic outline case was approved by the hospital trust’s board of directors, before being submitted during the government’s window for bids to its hospital improvement programme in September 2021.
Government officials will now assess each funding bid, with eight trusts throughout the country expected to be successful.
The plans span more than 25,000 square metres and house just shy of 200 beds.
Should Bolton’s bid be successful, it is expected that the new build would be completed by late 2025.
Fiona Noden, Chief Executive at Bolton NHS Foundation Trust, said: “We have a submitted a proposal for an entirely new hospital build on our existing site to help us meet the increasingly complex needs of our community and provide the level of care they require which we are confident would fit what our diverse communities have told us they need and are keen to progress those plans.
“Phase one would see a brand new facility for women, children’s and maternity services built next to our current maternity buildings.
“While we do already provide safe and effective care from our current buildings, they do need bringing up to modern standards.
“Our current hospital isn’t fit to last for another generation. Narrow corridors, cramped spaces and open wards may have worked for the Victorians, but they are not best suited to life in the 21st century, especially as our estate is in need of significant repair, modernisation and upgrade.”
Over at Stepping Hill, bosses say local people ‘deserve a modern healthcare environment’ - where the ‘ageing hospital’, which opened in 1905, is currently falling short.
“We welcomed Sir Richard Leese’s recent visit to our hospital to see the challenges we face with our current site,” said a spokesperson for Stockport NHS Foundation Trust, which operates the hospital.
“Stepping Hill Hospital is an ageing hospital that was not designed to deliver modern acute services, and is expensive to maintain.
“This is why we have submitted a bid to the national New Hospitals Fund to build a state-of-the art hospital that would provide the modern healthcare environment local people deserve, and help us achieve our ambitions set out in our new Green Plan. This includes reducing our greenhouse emissions by 85 per cent by 2032, and achieving a ‘net zero’ carbon footprint by 2040.
“Our recent good CQC rating was in relation to our A&E services, which were found following inspection to be safe, effective, caring and well-led. This inspection was specifically around these services rather than the wider hospital environment.”
The funding needed for Stepping Hill is into the multi-millions, with a bid also being submitted to the government in September for Stockport to have one of the 40 new hospitals which will be built as part of a £3.7 billion government programme.
The New Hospitals Programme aims to build the new hospitals by 2030 and has already announced 32 new build projects. It is now looking for a further eight projects, with Stockport hoping to be among them.
While the final design will influence the cost of any new build, it is estimated the government would need to invest around £500m in the creation of the new hospital.
With no room on the existing site to build a new hospital, the trust and Stockport Council have been identifying possible alternative sites, currently looking at an area of the town centre that incorporates the Heaton Lane multi-storey car park and former Debenhams store.
“We are also facing a £95m maintenance bill,” Karen James, OBE, Chief Executive of Stockport NHS Foundation Trust, has said.
“But even if we had the funds available to carry out all the work needed, it still would not provide the modern hospital environment patients and staff deserve.”
NHS overhaul
The frank analysis of the state of the two hospitals comes as the NHS undergoes a massive reorganisation across the country.
Following the passing of the Health and Care Bill late last year, longstanding Clinical Commissioning Groups are to be axed and replaced by Integrated Care Boards (ICBs).
Sir Richard Leese is now the Chair Designate of Greater Manchester’s Integrated Care Board, which is anticipated to come into power in July once the legislation is formally adopted.
The board will be the budget holder for the NHS in the region, paying for the services patients need across the service - from cancer treatments to A&E beds.
ICBs form larger Integrated Care Systems, designed to bring together all the organisations that influence the health of residents, aiming to address a range of issues that affect health, too.
Greater Manchester will not be part of an Integrated Care System, but will have an ICB. The city-region has already made strides towards this kind of collaborative working within its health and care services in the wake of devolution.
"The number one task for the ICS is improving population health," said Sir Richard. "Over 80 per cent of what will need to be done to improve population health and social determinants of health are nothing to do with the health and care system.
"It's about housing, whether people are in work, how much exercise people get, diet, a whole range of other things.
"Unless we build that into our thinking, we're not going to meet our outcomes.
But the challenges to make the NHS work better for residents, across the country, spread far and wide, says Sir Richard.
"A lot of primary care is also operating from really bad premises. In Manchester, being able to invest in places like the Gorton Hub [is good], but those sorts of facilities are more broadly needed across the system.
"Do we have enough resources? The obvious answer is no, not just in terms of the money available but the number of vacancies within the NHS and our ability to fill them - where there is money but we haven't got the resource, because we haven't got the people."
