SITTING IN the Midland Metropolitan University Hospital (MMUH) in Smethwick, near Birmingham, Francis Gallagher, one of its architects, explains its novel features: its compact design, with car parks, clinics and wards stacked on top of one another; its distinctive roof, a giant pillow of plastic, under which walkways glow with a soothing natural light; its winter garden, full of cherry trees, and a restaurant where locals come to enjoy affordable meals. “It’s a new model for hospitals,” says Mr Gallagher of the £850m ($1.1bn) project.
Five years ago this was true. In 2020 the MMUH topped a list of 40 “new” hospitals promised by the then prime minister, Boris Johnson, by 2030. The aim was to help the National Health Service (NHS) “build back better” after the covid-19 pandemic. Not all the proposed hospitals were actually new. The state had already rescued the MMUH project after Carillion, the private contractor responsible for financing and building it, went bust in 2018. Some were extensions or refurbishments. Still, the vision was clear. Standardised designs would help cut costs and reduce health inequalities in poorer areas like Smethwick. It would be the largest state hospital-building programme in a generation.
That vision has proved illusory. In January Wes Streeting, the health secretary, said the plan had been unfunded and undeliverable, and would be delayed: some contractors would not break ground until 2039. The Labour government has shifted not only timelines, but priorities. It is pledging to move billions out of hospitals and into the community; far from fighting a pandemic, this government is now preparing to fight a war in Europe. The future of hospitals looks uncertain.
There is a logic to investing in hospitals, which treat the sickest and offer scale for specialists and kit. Long thought of as the vertebrae of the health-care system, this crucial backbone is aged and arthritic. A maintenance backlog of £14bn ($18bn) includes hospital buildings propped up with scaffolding. City Hospital, which the MMUH replaced, opened in 1889. Its wards, based on designs by Florence Nightingale, were often ravaged by infection.
New buildings enable hospitals to modernise. MMu’s grid structure is intended to make it easier to adapt to new technologies. Whereas the old Nightingale wards were designed so that a matron could see her patients at all times, at the MMUH most patients have side rooms for privacy.
Yet hospitals also seem anachronistic. Between 2006 and 2022 the share of the NHS budget spent on them rose from 47% to 58%, squeezing funding for primary and social care. In a system starved of capital, many argue that cash should go towards refurbishing existing buildings and crumbling general practices. “The new-hospital programme should be scrapped,” says Rosie Beacon of Reform, a think-tank.
Hospitals are doing more beyond their physical walls. Wards are increasingly virtual. When the trust moved patients from City hospital to the MMUH, it was able to discharge dozens of frail patients to be monitored at home. When done well, virtual wards can be safer for patients, relying on wearables to transmit data about vital signs rather than the usual manual checks.
Hub and bespoke
Some 100 miles east of the MMUH at Addenbrooke’s Hospital in Cambridge, a team of five nurses, a pharmacist and two doctors can care for 75 patients at a time out of a back office. Their virtual wards saved 7,900 bed days for the hospital last year, across 32 specialties. Dr Iain Goodhart, the scheme’s clinical director, reckons at least three-quarters of inpatients could benefit from such care, by delaying admission to hospital or shortening stays.
Partnerships beyond the hospital matter more and more. Dr Goodhart is trying to strengthen links with general practitioners. The MMUH has been working with nursing homes to create proactive care plans for residents. Ideally, “you should only be in hospital if you need surgery, specialist or intensive care,” says Dr Sarb Clare, one of the trust’s senior consultants.
As hospitals begin to act differently, they will probably start to look different, too. Some may contain command centres to co-ordinate care; others will function more as campuses, including primary care and clinical-research labs. Staff will rotate more between hospital networks or spend time in satellite hubs: at odds with the new-hospital programme’s aims of standardisation. “We’re no longer thinking that a hospital in Manchester should look and feel like one in Frimley [a small town south of London],” says Siva Anandaciva of the King’s Fund, another think-tank.
None of this means that shiny new buildings are irrelevant. Older, sicker populations mean there will be a growing demand for acute care. The evidence for virtual wards remains mixed; cost pressures mean some are likely to be closed. Hospitals play important roles as anchor institutions: a learning campus soon to open opposite the MMUH will strengthen links with local colleges, and provide 750 new homes. An independent study found that the project would offer a return on the investment of around four to one.
The government must decide what it wants from the hospitals of the future. Then it will have to work out how to pay for them. One suggestion mooted by the outgoing chief executive of the NHS, Amanda Pritchard, is to bring back private-finance initiatives for capital projects. Here, too, the MMUH offers a lesson. Mr Johnson could not build the hospitals of the future, but neither could Carillion. ■
For more expert analysis of the biggest stories in Britain, sign up to Blighty, our weekly subscriber-only newsletter.