CEO: Staff suffering ‘moral injury’ from poor estates

Thom Lafferty said Princess Alexandra Hospital Trust needed around £120m to fix its basic infrastructure – far outstripping normal capital allocations.

The CEO, who joined in November, said: “Our staff cannot provide the level of care that they wish to because of the deteriorating estate which causes moral injury.” 

He said: “If something is mission critical safety, then we would have access to other resources to fix it. What we don’t have is the ability to guard against that level of operational disruption, which ends up providing a poor service for our patients and also causes moral injury to staff.”

Mr Lafferty said an example of this was the forced closure of two theatres for weeks last summer due to air handling unit failures. HSJ revealed last year that 36 operations were cancelled as a result. 

Moral injury is persistent psychological distress from acting against your ethical code, according to NHS Confederation.

PAHT was once a front-runner in the Conservative plan to build 40 “new hospitals” by 2030, which ended up beset by delays and rising costs.

The rebuild of Princess Alexandra Hospital in Harlow is now around 10 years away after the Labour government pushed timelines further back. Ministers claimed the original timescales were unrealistic and unfunded. 

Mr Lafferty said there was now a greater degree of certainty that the scheme will happen. The government has insisted all will be built despite delays – although sources from various trusts told HSJ they feared timelines were too far in the future to be sure. 

Before joining PAHT, he was deputy chief executive and strategy director across two London trusts: Kingston Hospital Foundation Trust and Hounslow and Richmond Community Healthcare Trust.

Fixing the ‘fundamental basis infrastructure’

The chief executive said the trust has reassessed the inherent estates risk at Princess Alexandra Hospital after the government announced its rebuild would only start building between 2032 and 2034.

He said ageing water and electrical systems, inadequate airflow, fire safety works, and resilience to power failures were areas that needed to be addressed. “They’re about fixing the fundamental basic infrastructure that you’re required to run a hospital.”

The necessary work has been estimated at around £120m. By contrast, the trust said recent annual capital allocations have left around £5m for the estates repair backlog.

Mr Lafferty said the trust will be “doing everything humanly possible” to access emergency NHS capital through various routes, as some risks cannot wait for the hospital rebuild to be completed. 

He said: “Anything that would put safety at risk, we would deal with straight away. But from an overall experience perspective, an operational disruption perspective, [and] staff welfare perspective, we know we could be doing better.”

Earlier this month, Barts Health Trust said it would need at least £200m to “bridge the gap” to the new Whipps Cross Hospital in north London, whose rebuild has also been delayed. 

PAHT said a priority investment plan was being developed.

A Department of Health and Social Care spokesman said: “This government has confirmed a funding plan and realistic timetable to put us on track to deliver the rebuild of the Princess Alexandra Hospital, and we will work closely with trusts to accelerate progress where possible.”

He also mentioned investment to address estates safety works next year, which totals £750m nationally.