Written evidence submitted by Mr Leonard Bartholomew (CBP0060)


It has been over a year since we forwarded to your Committee a hard copy of our brochure* on 29th May 2020.  In our brochure, we attempted to paint a picture of what a new smaller, 2020 hospital might look like as a more affordable and quicker alternative to the kind of large scale provision being proposed for Sutton Surrey and elsewhere.  We anticipated that lessons learnt from the pandemic would expose the inadequacy of the tortuous planning processes, traditional ward and hospital layouts and highlight an urgent need to invest in new, smaller, more efficient facilities initially for trauma and elective services.

All over the country, there is a mismatch between the quality of care skilled staff are expected to achieve using the latest equipment in the worst kind of facilities.  Surgical teams urgently need an opportunity to carry out complex surgical procedures and the processes for recovery in facilities designed to reflect lessons learnt from the pandemic.

Prior to the pandemic, efforts were being made in numerous localities to save, recover, maintain and grow existing hospitals.  Large teams were planning for change to radically update or replace failing hospitals.  They often produced five year plans to implement – but here lies the problem.  The pandemic has rendered such long term plans invalid, unaffordable and unfit for purpose.

Surely now gone are the days of long term planning cycles and public consultations leading to gradual and begrudging ways to improve redundant hospitals or to the provision of monolithic, inflexible new hospitals.  These are guaranteed to remain or become a burden for decades.  Covid-19 demands that we urgently change this mind set.

We believe we are approaching a time when realistically the provision of new hospitals has to be limited by capping capital allocations for all local NHS projects.  This should be seen as a positive policy.  A way to achieve this would be to inform local NHS’s that they can bid to build a new smaller 2020s trauma or elective hospital of up to 10,000 sq.m. if they can demonstrate that this would foster a radical new approach to their service provision, including if possible at an alternative location to the existing hospital.  Existing hospitals were probably built in the right place for the 1900s but are most likely to be in the wrong place for the 2020s.  A strategy providing a network of smaller hospitals would make land acquisition easier.

There is just not enough capacity in the NHS to deal with the current backlog in the short and medium term, so a rapid construction programme should always be a condition of funding.  We are imagining the production of brand new, smaller hospitals to kick start a revitalised hospital construction programme.  Stock piles of data and guidance exist to inform how new, smaller hospitals might be planned, designed and commissioned in the 2020s.  Example solutions used in our brochure were based on this wealth of information and which suggest how (A) a trauma centre and (B) an elective centre might be planned to create a new, smaller 2020s hospital within a 10,000 sq.m allocation.  What is needed now is some-one to sanction the construction of new, smaller hospital prototypes.  An enthusiastic NHS team could be commissioned to plan, design, help arrange manufacture and, when fully operational, monitor and compare performance.

The pandemic has shown that we can learn to move quickly to provide the NHS with equipment and temporary facilities staff demanded for their own hospitals (they did not want to use those over-sized, wasteful and nightmarish Nightingale hospitals).  It has also shown that new and better facilities are urgently required to tackle the waiting lists that are a consequence of the pandemic and that these should build in measures to contain Covid-19 surges.

To summarise, a new smaller hospital in the right location should probably be sited away from, but used in conjunction with, an existing hospital, be assembled quickly, be affordable within a fixed capital cost (up to 10,000 sq.m in size) and have more relevance to the way surgical teams will have to work in the future.  It should also be uncomplicated, patient friendly, therapeutic, flexible and intensively used.

Now is the time to showcase how adaptable, new, smaller hospitals can be provided quickly to replace our many failing hospitals.  These would lift morale, renew confidence and house and promote even better services throughout the NHS.  The primary aim should be to demonstrate that the NHS will require less beds, not more, through improved performances in the right kind of facilities in the aftermath of this life changing pandemic.

If your Committee really is interested in recognising how much the NHS estate and existing hospital buildings are straight jacketing innovation as services need to evolve to meet emerging challenges, here is a tentative road map:

  1. DHSC to appoint a control team to set up parameters for a network of new, smaller 2020s hospitals and project manage the provision and evaluation of the first wave.
  2. Organise an open invitation to local NHSs with a 5 year plan, asking them to put their plans on the back burner and instead, apply to be selected to build a new, smaller 2020s trauma or elective hospital.
  3. Set up a selection process for a first wave network focussing on the following: the applicant’s surgical team’s performance and their proposals to deal with waiting lists; management and staff cohesion; an ability to show how they might operate the new facility; their ways and means of demonstrating a better performance from new facilities; availability of a potential site and its location; how each local NHS is ready to move quickly to provide a new facility and, on completion, how the evacuation of existing hospital accommodation might be used to improve other priority services including long-covid.
  4. Completion, commissioning and a fully operational service should be documented as a case study for a second wave.
  5. Each new smaller hospital should be evaluated to report on performance.

We are looking for no more than an indication that some of our suggestions might be relevant to a rebuilt NHS taking account of Covid-19 and the need for an increased capacity to deal with the backlog.  Also, we are looking for signs that your Committee is taking seriously a need to build the right kind of hospitals to support the future work of the NHS and care services.  Buildings cannot put more staff in place to deal with the backlog but they can give staff within the NHS better facilities to help improve and increase performances.

Len Bartholomew and Rosemary Gorvin


3rd September 2021


*Our brochure “New, Easy, Fast, Smart, Smaller 2020 Hospitals to improve the NHS – after Covid-19”

Sent in hard copy to HSSC on 29th May 2020.  It was subsequently circulated by your office in a digital format on 4th July 2020.

This brochure was compiled during the first Corona virus lockdown by two former employees of the Department of Health, having had access to much of the policy and health building documentation produced over many years to guide the NHS.

It was thought that following Covid-19 there would be less money to invest in the replacement of the existing stock of NHS out of date, inflexible buildings that are no longer suitable for treating patients to modern healthcare standards.


Sept 2021