Two new hospitals are set to be built and another refurbished in Cambridge. At the other end of the A10, the roof of a crumbling building has to be held up by props to stop it falling in on patients. Chris Bishop asks why.
Punctuated by the occasional scream of ambulance sirens, the rumble of construction equipment drifts across the fields south of Cambridge from Addenbrooke's Hospital.
A children's hospital, a cancer hospital and a rebuild of the main site are all in the pipeline. The Cambridge University Hospitals Trust says the new builds will have "really positive impacts for patients across the region as a whole".
The children's hospital will care for young people across the east when it opens in 2025. A new children's ambulance service is being launched across Norfolk, Suffolk and Cambridgeshire to transport patients.
The cancer hospital, which the trust says will change the way cancers are detected and treated, was one of 40 new hospitals announced by the government in October 2020 as part of a £3.7bn health infrastructure plan.
Also included were rebuilds of the James Paget Hospital, at Gorleston and the West Suffolk Hospital, at Bury St Edmunds.
Of the West Suffolk, the Department of Health and Social Care's press release said the West Suffolk rebuild would "replace poor estate and provide a better patient environment".
Both it and the James Paget were so-called Best Buy hospitals, built from prefabricated sections in the late 1970s and early '80s.
The Queen Elizabeth Hospital at King's Lynn was built under the same regime. The construction of all three included concrete planks to support the roof.
As well as being light, the planks offered excellent insulation. Cutting hospitals' energy costs was part of the Best Buy brief.
But all three buildings are now working more than a decade over their originally-anticipated 30-year lifespan. And the planks that kept the heat in are starting to fail.
A few weeks ago, it was reported that the West Suffolk had 27 props supporting areas of its roof, while the James Paget had 18.
The QEH, which was not included on the government's list of new hospitals, has more than 200. Its risk register warns the roof poses a grave risk to the safety of patients and staff.
Yet for some reason, the hospital did not make the cut. Some believed it was because it was in special measures after being branded "inadequate" by the Care Quality Commission two years earlier.
A new management team has since made great strides in turning things around - despite also having Covid to contend with.
So could there be another reason? When talking about the state of our hospitals, there can be few that are in a worse condition than the QEH, said by staff to be "Britain's most-propped".
Yet it is currently languishing on a list of 120 applications to be one of eight further rebuilds, with a decision expected in the Spring.
Two submissions
The QEH has made two submissions - one for a brand new hospital at an as-yet undisclosed site. A landowner has offered what is currently farmland near the Hardwick Roundabout as a potential location.
The second submission is for a phased rebuild, with parts of the hospital rebuilt in stages.
Senior managers say it has a compelling case despite the odds, with the first option being their preferred outcome.
The population of the area of west Norfolk, north east Cambridgeshire and south Lincolnshire which the hospital serves has increased significantly since it opened in 1980.
Back then, the emergency department was designed to treat up to 30,000 patients a year. Attendances are now more than twice that.
At the QEH's December board meeting, chief executive Caroline Shaw said an increase in the overall footprint of more than 60pc was needed across the hospital to sustain current services and meet future demand.
Ms Shaw said the QEH had presented "a robust case for change", while an "end of life date" for the current hospital was now expected to be 2030. So the clock's well and truly ticking.
Ms Shaw added continued investment in the existing hospital was "vitally important" because even if it was included in the new hospital programme, the earliest a new hospital could be expected to open its doors would be 2029.
Continued investment
So far, so good on that score. The QEH was awarded £20m in emergency funding earlier this year. Some £12m of it will be spent on a new endoscopy unit.
The unit will offer space to "decant" patients from areas where repairs to the aging building are needed, such as a structure to support the roof.
Hospital chairman Steve Barnett warned board members significant amounts of money would be needed every year to enable it to continue operating.
Most recent estimates put the cost of a new hospital at £650m, while maintaining the current estate will cost £550m.
By the time you have spent £550m, the hospital will be at its end of life date so a new one will be needed at whatever a new build will cost nearly 10 years down the line.
It seems a no-brainer. Just spend the money now, because it will end up costing almost twice as much if you wait.
But perhaps there is another reason why the hospital has not made it onto the list of new builds. Because perhaps it may not be rebuilt to deliver the same services.
Will it need to provide the same full range of services to young people after a brand new children's hospital opens in Cambridge complete with its own ambulance fleet, for example?
Or might its work with cancer be scaled back when a new specialist cancer hospital opens at Addenbrooke's?
Will some acute services evolve to be delivered at regional centres of excellence such as Cambridge, where millions and millions are being ploughed into medicine and life sciences?
Cambridge University Hospitals Trust has not yet revealed how much the new cancer hospital or the Addenbrooke's rebuild over the next 10-15 years will cost, but you can safely think hundreds of millions. The government has committed £100m towards the children's hospital leaving the trust to raise £100m.
Poor relation?
When people complain services in Norfolk are a poor relation, they might just have a point.
Back at the QEH, you might wonder if a phased rebuild is already under way. The new endoscopy unit comes after the purchase of the former BMI Sandringham private hospital which stands on part of the site.
A new £3m eye care unit and an outpatient's unit are also in the pipeline.
Investment on this kind of scale each year, replacing the areas which most urgently need it, might well prove more attractive to Whitehall bean counters than writing a cheque for £650m.
But however the government tries to sell it as part of the levelling up, building back better agenda, it will almost certainly not deliver what the community needs or wants if it leads to a smaller QEH, delivering fewer services.
People with poorly children want to be near them - not two hours' drive away.
One thing the health planners of the 1960s and 70s did get right was the vision of the district general hospital, delivering just about everything its catchment area needed under one roof apart from complex specialities such as cardiac or cancer surgery.
West Norfolk, north east Cambridgeshire and south Lincolnshire need a fully-featured general hospital, not a smaller one built in stages. And they need it now.
Almost 10,000 people have signed the EDP's petition calling for a rebuild at https://tinyurl.com/2w6mdv66.
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