The need for affordable housing for key NHS workers has never been greater. Some trusts are trying to address the problem. Lynn Eaton reports

The housing czar may talk of modern homes with state-ofthe-art facilities - en suite bathrooms, all mod cons, Internet access and so on. But for nurses and doctors in London and Birmingham facing eviction from their NHS accommodation because it is not fit to live in or worth mending, it sounds like another world.

The contrast underlines a key dilemma for the NHS: it needs to provide affordable housing to recruit and keep staff who are not well paid, but is unable to finance the repairs needed to bring existing accommodation up to scratch.

Many hospitals, faced with this problem, are either selling off their leaseholds to housing associations or closing what facilities they have.

City Hospital in Birmingham, for instance, has just told 44 doctors and nurses that they will have to move out because the homes they live in do not meet new building regulations. The building is due to close in August, although it will remain empty after that. Repairs to the 1950s building would have cost at least£1. 6m, according to the trust, and attempts to sell the property to a private housing association have come to nothing.

But Clive Walsh, the trust's director of operations, points out that alternative accommodation is available two miles away, costing only£225 per month, with free transport to and from the hospital. 'We felt it was not the right thing to expect our staff to live in sub-standard accommodation, or to reduce the money spent on patient care, when there was a viable alternative available, ' he said.

Similar problems with on-site accommodation have recently dogged other hospitals. In Newham, student nurses slept outside the Department of Health headquarters last November in protest after the trust announced it was going to close their nurses' home in 2003.

Eighty-seven students were living in the home at St Andrew's Hospital in Bromley-by-Bow.

Newham Heath Care trust leases the home to the local education consortium which in turn rents it to the nurses. The nurses faced eviction by the trust last month, but, at the last minute, London regional office stepped in with a cash advance of£60,000 to bring the£150-a-month units up to building standards. However, the home is still set to close in 2003.

'There is a plan to close the site where the nursing home is, ' said a trust spokesperson. 'But the new hospital site would not have any similar accommodation.

'It was whether we wanted to be in the landlord business any more, ' she said. 'We are in the health business, not property. '

A similar row developed in Greenwich in February 2000, following the proposed closure of the Woodlands nurses' home on the old Queen Elizabeth military hospital site. The home was due to be sold to the developers as part of the deal for the new hospital in Greenwich. Although the trust now admits that the letter warning residents that they would have to move out by the summer was badly worded, it adds that they knew they were on short lets. Accommodation is available on the new hospital site, although, because it is a private finance initiative, there is no question about the trust being landlord: the whole hospital is, effectively, rented.

Meanwhile, at University College London Hospitals trust in London, student nurses are furious at changes in their rent which has left some of them facing eviction because they can no longer afford to pay it.

A rent review of the accommodation, some of it in Gower Street where a hotel room for the night can cost£100, came up with a standardised rent of£260 a month. The new flat rate was a cut for some nurses but an increase for others, who were less happy. The move comes as the trust is trying to transfer the accommodation into housing association hands under long lease arrangements.

Housing czar John Yates, appointed by London regional office in September 2000, welcomes an increased distance between trusts and their roles as landlords.

'What we are undertaking is transferring the stock to registered social landlords who have the skills and resources to improve the properties. The staff will get better accommodation but the NHS will reserve nomination rights for the use of it. We are not losing it. But there may be instances where accommodation just can't be converted. '

The NHS will usually be transferring just the leasehold to housing associations, not the freehold, he added.

Mr Yates has already agreed reasonable rates for renting in London following discussions with the Royal College of Nursing. Through the block purchasing power of the NHS, he has just managed to rent 250 flats close to the prestigious Barbican centre in London which NHS staff can rent for about£90 a week. Similar deals have been struck in Greenwich and Kilburn.

'What we are about is recognising the importance of affordable accommodation to NHS staff, ' he insists.