Not many estates and facilities directors will admit that their hospital fell into the 'bright red' category in the first round of PEAT inspections, but Bob Pepper, of Pembury Hospital in Kent, is that rare exception.

Pembury has since been named one of the handful of hospitals facing the hardest struggle to improve. Mr Pepper's willingness to talk about the problems is a sign that they are actually being tackled.

Pembury's problems have been overshadowed by the drive to get approval for a replacement single-site hospital that would combine its facilities with those of the nearby Kent and Sussex. Its parent trust merged with another last year.

As a result of the uncertainty about the future, improvements to Pembury were put on the back-burner: Mr Pepper describes his task as 'starting from rock bottom'.

He says: 'We inherited a very complex situation of a large amount of backlog maintenance, an enormous amount of fire safety non-compliance and run-down buildings. '

His board took the view that something had to be done, even if it was only five to six years before the hospital was replaced. 'We thought that if we invested in years one and two, then we would get the benefits in years three, four, five and six, ' he explains.

In addition to the£150,000 of government funds, he was given£500,000 of trust funds. He was also able to get access to other funds - for example, Action for Cataracts money helped refurbish buildings to house the ophthalmic department.

The site is now undergoing a complete change of signage; the car park is being resurfaced, re-marked and re-lit (the downside is this will mean charging is introduced); and public areas are being redecorated.

The two-and-a-half year programme should make a significant difference to patients - but it will take time.