The must-read stories and debate in health policy and leadership.

NHS England receives attention each year for its ever-rising backlog maintenance figure, which current estimates put at a staggering £11.6bn. 

At the same time, another piece of data is published which looks at the condition of estates through a different lens, but receives less attention. 

This is the percentage of space in NHS sites that is considered “not functionally suitable”. In other words, below a condition considered acceptable for use.

General acute hospitals fared the worst, with 14 per cent saying most of their occupied space – more than 50 per cent – was unsuitable. 

Two hospitals even said 100 per cent of their occupied space was not suitable: Hartlepool and Wycombe. HSJ was told this related to new room size standards that have overtaken the 1970s Hartlepool build, while Wycombe was gradually moving services out.

Some sites considered mostly unsuitable are among the 40 “new hospitals” promised by 2030. But most are not in the programme, nor have any major investment in the works to completely revamp their whole estate.

Are icebergs behind troubled ship?

The Royal College of Surgeons’ review into general surgery at the Royal Sussex County Hospital in Brighton makes grim reading. But what is most surprising is that it makes reading at all. These invited reviews are very often hidden away by trusts and sometimes not even released when the Freedom of Information Act is used.

Seeing one in board papers is unusual: the stories of a “culture of fear” and “disconnect” between clinicians and leaders are not uncommon in the NHS but a trust being told to consider the “suitability, professionalism and effectiveness” of its executive leaders is.

The long list of previous investigations into this troubled area shows how little has been done and some of the criticisms contained within this report are recent, not historic.

But HSJ has been told that senior leaders at the University Hospitals Sussex Foundation Trust – especially chief executive Dr George Findlay – hope publishing the report will mark a fresh start and illustrate a determination to tackle these issues, even as a police investigation into deaths at the trust rumbles on. RSCH has long been a troubled ship but may be a (relatively) new captain can turn it around.

Also on today

In London Eye, Ben Clover explains why his recent assertions on which London Integrated Care Boards had the least integrated set of acute providers have been turned on their heads, and in a Comment piece, Vanessa Apea says cuts to HIV testing put the UK’s HIV elimination ambitions at risk.