Professor Tim Orchard

RUSTED pipes, leaks, patched flooring; in some ways, visiting St Mary’s Hospital was exactly what you might expect.

The Paddington site, home to the capital’s busiest major trauma centre and half of which is older than the National Health Service, 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”.

On a tour of the site earlier this week, the Local Democracy Reporting Service was shown first-hand some of the issues the team at St Mary’s are having to grapple with and learned about potential plans to raise funds from the private sector to complete long-awaited renovations.

Imperial, which also runs Hammersmith and Charing Cross hospitals, has grand plans to fix up its facilities.

Impression of a proposed canalside ‘Fleming Centre’

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.

Imperial’s capital spend on reducing risks and improving patient experience across its five sites for 2025/26 is £115million.

Professor Orchard said: “The £115million 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.”

St Mary’s has allocated £18.2million, the largest item of which, at £4.8million, is a refurbishment of the angio suite.

Prof 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”.

He added, however, that 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.

Prof Orchard said: “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.
Asked whether this could mean a return to a PFI, private finance initiative-type scheme, a controversial model particularly favoured under New Labour, Prof 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.”

Another key area of change on the St Mary’s site is the proposed new Fleming Centre, a joint project bringing together researchers, policymakers and other experts.

While separate from 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.

Prof Orchard said: “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.