NHS trusts need hundreds of millions to stop hospitals’ roofs collapsing

A series of freedom of information (FoI) submitted by NCE has revealed that five of the worst affected trusts have applied for £331.9M of additional funding to be spent on fixing RAAC planks during the next three years.

Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust has applied for the most funding, asking NHS England & Improvement (NHSE&I) for £110M to cover remediation costs up until 2025 at the Queen Elizabeth hospital.

The other four trusts are North West Anglia NHS Foundation Trust, which has applied for £89.9M; West Suffolk NHS Trust, which has applied for £64.7M; Mid Cheshire Hospitals NHS Foundation Trust, which has applied for £51.1M; and Frimley Health NHS Foundation Trust, which has applied for £15.6M.

RAAC is "borrowed" technology from other industrial processes that speeds up the manufacturing turnaround of precast concrete units and was used in schools and hospitals between the 1960s and 1990s. However, there is a high volume of air within RAAC, making it vulnerable to moisture ingress and it is now known to lose tensile strength in situ. As these buildings are now surpassing their 30-year lifespans, recent years have seen structural failures occurring as commonplace.

A sudden roof collapse at a primary school in Essex in 2018 brought the issue to light, and a total of 20 hospitals at 18 different NHS trusts around the UK have been identified as suffering from the blight. It has seen the NHS implement emergency supports and monitoring systems on seven badly affected hospitals around the country that have been built with RAAC.

RAAC panels are usually (but not always) 600mm wide and 2.4m long. They typically have a slight chamfer to each edge and often have arc-shaped stripes across the face.

RAAC panels were used mostly on flat roofs, but can also be found on pitched or sloping roofs. They typically span between steel beams, but can also span onto masonry walls. They can be hidden behind suspended ceilings.

At the Queen Elizabeth Hospital in King’s Lynn, which sits within the constituency of prime minister Liz Truss, there are already 1,500 steel props holding up the roof in 56 different areas. There is also a team of 12 maintenance staff checking the safety of the building 24 hours a day, seven days a week.

The trust which runs the hospital has applied for £90M between 2022-23 and 2024-25 for a rolling programme of “failsafes” to be installed across the entire first floor of the hospital – six wards and its theatres. NHSE&I has agreed to pay £80.6M over the three years, starting with £30.6M paid this financial year.

This comes in addition to £20.6M emergency capital funding the Queen Elizabeth Hospital received from NHSE&I in 2021-22 which was partly used to refurbish two wards, install failsafes to reduce risk from RAAC failures and provide the necessary ward and decant space for the forthcoming rolling programme of failsafes.

Despite plans for remediation being drawn up, the trust ideally wants to tear down the current hospital and build a new one. It has submitted a separate bid for £862M to the Department of Health and Social Care (DHSC) for the new hospital proposal.

A spokesperson for the trust told NCE: “A new QEH is the only long-term sustainable solution to solving the well-documented and significant challenges the Trust faces.”

Meanwhile, North West Anglia NHS Foundation Trust looks after three hospitals, with Hinchingbrooke and Stamford & Rutland Hospitals both affected by RAAC issues. In June 2021 it released a report saying that it could not treat heavier patients in part of Hinchingbrooke Hospital due to RAAC concerns. It has applied for £89.9M to deal with the issues, including £52M in the current financial year. NHSE&I has initially only agreed to release £39.9M of the £52M for 2022-23, but the trust has made a further application to request the £12.1M shortfall and is awaiting a response.

West Suffolk Hospital in Bury St. Edmunds has at least two known RAAC roofs. The West Suffolk NHS Trust has applied to NHSE&I for £64.7M between 2020-21 and 2022-23, including £30M in the current financial year, to help mitigate the issue.

Leighton Hospital in Crewe is looked after by the Mid Cheshire Hospitals NHS Foundation Trust, which has estimated that it will take a decade and £660M to replace the 34,000 RAAC planks in the building. It has applied to the DHSC for funding to completely rebuild the hospital, as it believes it would be quicker and cheaper. In the meantime, it has applied for £51.1M emergency funding over two years to mitigate the RAAC issues.

Frimley Health NHS Foundation Trust has made the relatively small appeal for £15.6M over two years to deal with RAAC concerns in Frimley Park Hospital. However, the RAAC situation in the hospital is so severe that it is separately bidding for a £1.26bn revamp of the entire building.

An FoI response from University Hospital Southampton NHS Trust revealed that it is dealing with RAAC but has not applied for funds from NHSE&I as it is a relatively small amount and the building is to be refurbished in the next few years.

In response to NCE’s FoI investigation, Liberal Democrat deputy leader and health spokesperson Daisy Cooper said that “patients are paying the price for years of neglect” by successive governments.

“All of these hospitals are in constituencies held by Conservative MPs, including Michael Gove and none other than the ex-health minister himself, Matt Hancock,” Cooper said.

“It is truly shocking that patients are being treated in crumbling buildings that could be at risk of collapse. The NHS is crying out for the funds to fix creaking roofs so that patients can be treated safely. The public needs to know that the funds to fix this are on the way as soon as possible.”

There are 13 more hospitals in 12 NHS Foundation Trusts dealing with RAAC issues, although the DHSC has admitted this number could rise as trusts identify more sites that are affected.

NHSE&I does not expect to eradicate RAAC from NHS hospitals until 2035. The NHS has started carrying out simulations of evacuations should a roof collapse occur. In that event, a national incident would be declared, forcing patients and services to be moved to other parts of the country.

The DHSC provided £110M of ring-fenced cash to deal with the immediate RAAC issues in 2021-22 and has committed to providing another £575M to trusts during the current spending review period, which runs to the end of the 2024-25 financial year.

A spokesperson for structural safety body Cross – which raised an alert on the problem in 2019 – said that it was pleased that the issue was finally being addressed.

“The scale of the problem has become clear with many buildings been found to contain RAAC roof planks. There are echoes of other systemic faults that have caused major disruption to buildings in the past including High Alumina cement in the 1970s,” the spokesperson said.

“Where systemic faults occur they can affect very many buildings and in the case of the hospitals this means that very large numbers of roofs are having to be investigated and in many cases repaired or replaced.  Hospitals are particularly difficult to deal with because of the disruption to patients and staff, and the consequential difficulties with services and complex equipment.

“Cross is pleased that a problem brought to light with their alert is resulting in an increase in safety in such an important area as hospitals and schools where RAAC has also been found.”

A DHSC spokesperson added: “The government is publicly committed to eradicating RAAC from the NHS estate by 2035 and protecting patient and staff safety in the interim period, with the NHS approaching this on a risk basis prioritising NHS Trusts of concern.

“We are providing more than £4bn for trusts to support local priorities, including to maintain and refurbish their premises, as well as over £685M to directly address urgent risks relating to the use of Reinforced Autoclaved Aerated Concrete (RAAC) in the NHS estate.”

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