Rusted pipes, leaks, patched flooring; in some ways, visiting St Mary’s Hospital in Paddington was exactly what you would expect.
The Central London site, home to the capital’s busiest major trauma centre and half of which is older than the NHS, has faced much-publicised battles with estate failures and a growing maintenance backlog.
In the last year alone, it has had to manage floods, power outages and a fire, with the Chief Executive of Imperial College Healthcare NHS Trust, Professor Tim Orchard, describing the period as “particularly challenging”.
With substantial Government funding not expected until the mid-to-late 2030s, Professor Orchard gave a stark warning on the risk of inactivity.
“Our concern is St Mary’s doesn’t quite have that long to go, without the risk of significant estates failures becoming very significant.”
On a tour of the site earlier this week, the Local Democracy Reporting Service (LDRS) was shown first-hand some of the issues the team at St Mary’s are having to grapple with.
While the more recently refurbished areas were in decent nick, if a little small, the older buildings were showing clear signs of wear and tear.
The sprawling nature of the hospital also meant navigating without staff was almost impossible, with more than one instance when visitors approached the team to ask for directions.
Imperial, which also runs Hammersmith and Charing Cross hospitals, has grand plans to fix up its facilities. Central to this is a redevelopment of St Mary’s, with a new 800 to 840-bed hospital and life sciences campus envisaged.
This was dealt a serious blow in January when the Government revealed St Mary’s, Charing Cross and Hammersmith were shunted to the final tranche of its New Hospital Programme (NHP), meaning much-needed works are not expected to start for another decade, and wouldn’t end until the 2040s.
The announcement constituted a serious headache for the Trust, with Professor Orchard at the time warning St Mary’s was at risk of serious decline, with every six-month delay expected to cost an additional £63-£73 million.
“We understand that the Government’s New Hospital Programme must be affordable but the simple truth is that St Mary’s Hospital, in particular, will not last until the 2040s,” he said. “We run London’s busiest major trauma centre and care for more than a million patients a year.”
Since then, the Trust has been granted millions of pounds in funding towards detailed designs and planning for the St Mary’s redevelopment, with the hope planning consent for the project can be secured in 2027/28.
Essentially this means getting prepared in advance to hit the ground running when the final round of NHP projects gets going. Professor Orchard has said the new campus could contribute well in excess of £1 billion to the economy and 10,000 jobs.
Short-term fixes
Earlier this month the Trust was also awarded £25.25m by the Government as part of its Estates Safety Fund, which is intended to keep the existing hospital functioning while it awaits the much-needed redesign.
Together with other sources of money this bumps Imperial’s capital spend on reducing risks and improving patient experience across its five sites for 2025/26 to £115 million.
In an interview with the LDRS in his canalside office, Professor Orchard said the funding is necessary simply to keep things ticking along and does little to address more long-standing challenges.
“The £115m is essentially the money we need to keep the lights on and keep the hospitals as somewhere which are safe for patients to come and will provide as good an experience as we can for them given the estate’s constraints.”
The breakdown of the funding shows Charing Cross is to receive the most in capital spend for the year ahead, with just under £50m earmarked, followed by Hammersmith/Queen Charlotte’s and Chelsea.
St Mary’s meanwhile is allocated £18.2m, the largest item of which, at £4.8m, is a refurbishment of the angio suite.
Asked why, given the much-publicised problems St Mary’s is facing, it is allocated less than half of Hammersmith and Charing Cross, Professor Orchard said this “snapshot” of funding for the hospital does not reflect the package it has received in recent years.
On the NHP, Professor Orchard said the concern is that St Mary’s cannot wait until 2035 for work to begin without the risk of estate failure becoming “very significant”.
He said the focus for the spending at the moment is largely on ensuring patients get the best experience possible, “albeit from sub-optimal estates”.
Professor Orchard however added there have been some developments in identifying alternative sources of funding for St Mary’s ahead of the NHP’s 2035 date.
This has included positive noises from the Government regarding the use of private finance. A taskforce was also recently established to progress plans and look into other funding models.
“I think clearly the period between now and getting a full planning consent is a period where we will be really trying to work through what funding models could look like, what sources of funding might be with a view to getting started in terms of actual construction as soon as possible after getting planning consent,” he said.
Asked whether this could mean a return to a Private Finance Initiative-type scheme, a controversial model particularly favoured under New Labour, Professor Orchard said: “Nobody is envisaging a return to old fashioned Private Finance Initiatives because they saddled NHS organisations with very substantial maintenance costs, apart from anything else, and I don’t think anyone is envisaging a return to that sort of arrangement.
“I think however there are probably models that we can look at to try and get alternative sources of funding utilised to build. The issue as always will be around how do you make sure that you’re getting good value for money for the public, how do you make sure the costs are not going to be exorbitant in terms of the revenue situation, and I think probably overall we have to have a sensible solution to how we are going to account for that capital.”
The Fleming Centre
Another key area of change on the St Mary’s site is the proposed new Fleming Centre.
Envisaged as a research and public engagement hub, the centre will form part of the wider Fleming Initiative, established to tackle the threat of antimicrobial resistance (AMR).
A joint project by Imperial College Healthcare and Imperial College London and led by Professor the Lord Darzi of Denham, it will bring together researchers, policymakers and other experts.
While separate to the NHS funding for St Mary’s, it is intended to work alongside the redevelopment and contribute to the local Paddington Life Sciences cluster. The plan is to open the centre in 2028 to coincide with 100 years since penicillin was discovered at St Mary’s by Sir Alexander Fleming.
Professor Orchard told the LDRS: “Probably something over a million people die every year from antimicrobial resistance and that could be in excess of 10 million if you fast-forward another 25 years or so. So it is a significant global health issue and it’s an issue we face every day.”
An on-site exhibition is to run until June 28 and an online public consultation until July 18, with more information on the Trust’s website.
The centre, which will incorporate heritage buildings including that in which Professor Orchard’s office is located, is a reflection of the opportunities St Mary’s and Imperial more widely can rightly point to, alongside the clear challenges ahead.
“It will be an amazing resource,” Professor Orchard said. “Not simply for us, but for the nation and the world.”
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