New Hospitals: A major component of the UK’s future industrial strategy

Let's use NHS capital to promote excellence and growth, alongside renewal

Healthcare capital needn't just be about infrastructural repair. It can play a strategic role in future UK industrial strategy. The Cambridge Biomedical Campus contributes hugely to the local and national economy, showcasing the potential for the UK to replicate the economic impact from major US health systems. To reach world-class standards, we must invest capital. The good news is that these investments could become self-sustaining through innovations and industry partnerships. There would be additional benefits, too: improved patient outcomes, specialist recruitment, staff satisfaction, and enhanced international competitiveness. Let's collect the rigorous evidence needed to support strategic investment in NHS.

The case for new hospitals can be about growth as well as repair

Investing in healthcare infrastructure as part of the UK’s future industrial strategy can catalyse economic growth and improve healthcare outcomes, not just “fix the plumbing”.

Across the UK, many hospitals, including those with the responsibility of serving as major national research and tertiary facilities, face infrastructural decay and operational challenges. These issues range from outdated buildings and overused equipment to cramped facilities unable to accommodate the demands of both patients and modern clinical practice. This has consequences for patient care, staff morale, and the training of future healthcare professionals.

Recent media reports have highlighted rat infestations, disruptions to care, fires and flooding (including of sewage) at NHS hospitals. This doesn’t only raise concerns about patient safety and care quality but also underscores the missed opportunities for economic growth and innovation.? For example, the Guardian, using data gathered by the Liberal Democrats, reports that “Imperial College Healthcare NHS Trust in London spent the most on pest control in the last three years, ￡383,597, with 2,157 incidents.”? Imperial ought to be one of the UK’s most prestigious and advanced academic health institutions.? It’s a genuine contender as a hub for major developments in life sciences.? And it’s having to struggle with badly outdated estate, to the point of serious pest infestations.

Investing in healthcare infrastructure is more than a matter of patching up old buildings; it's about strategically enhancing our capacity for medical excellence and economic growth. Centres of excellence, through a combination of high-quality healthcare services and cutting-edge research, can act as significant economic engines, much like their American counterparts.

Cambridge gives us a taste of the potential

Cambridge Biomedical Campus is a great example of how combining industry, academia, and clinical practice can create a dynamic and economically potent environment, comparable to major American health science centres. It has successfully attracted major industry players like AstraZeneca and GSK, contributing significantly to both local and national economies. The campus's economic contributions include ￡1.91 billion in operating income and funding and ￡1.09 billion in Gross Value Added (GVA), along with supporting thousands of jobs and stimulating further economic activity through its extensive network of collaborations.

And yet, its main hospital building is very much in need of replacement.? Fortunately, it is on the New Hospital Programme list.? This means it will likely be replaced, as with all programmes on that scheme, with the Minimum Viable Product (MVP).? To be fair, we don’t know exactly what MVP means and we can certainly expect that the quality will be well ahead of the current building.? However, I think we can also ask, in the context of all that this campus has achieved and its future potential, whether MVP is the right standard for this facility.? Either way, it will be interesting to see how much more Cambridge can achieve with a properly modern hospital infrastructure.

Cambridge vs US health systems

Set out below is a summary of the information I could find online about the relative economic contributions of three major US healthcare systems, vs Cambridge.

(Johns Hopkins source? Mayo Clinic Source Cleveland Clinic source Cambridge source)

These estimates come from various sources using various techniques.? I doubt they are strictly comparable.? (Incidentally, if anyone has better data, I’d love to see it.)? Either way, the table does give a flavour for the potential which could be achieved by expanding the impact of Cambridge even further.??

And that’s just for starters.? Cambridge is leading the way, but there is ambition and potential around the UK,? I’ve mentioned Imperial.? Manchester, Edinburgh and Cardiff have also been working to develop major capability.

We have a number of candidates for major centres, if we will only invest

I thought about coming up with a list of possible centres that Government could prioritise.? That seemed like I’d be on a hiding to nothing since:

• I don't have the time or resources to do a proper analysis (but wouldn’t it be good for Government/the NHS to do this?); and
• I’d invariably miss people out that I like.??

So I asked ChatGPT to take the hit for me.? Here’s what it said:

To identify UK healthcare centres with the potential to develop into centres of excellence comparable to the Mayo Clinic, Cleveland Clinic, and Johns Hopkins, we should consider institutions that already have a strong foundation in medical research, advanced patient care, and education. Here are some leading candidates:

1. Oxford University Hospitals NHS Foundation Trust - Affiliated with the University of Oxford, one of the world's leading universities for medical research, this trust includes hospitals like the John Radcliffe and Churchill Hospital. It has a strong emphasis on integrating medical research and teaching, making it a prime candidate.

2. Cambridge University Hospitals NHS Foundation Trust - This trust encompasses Addenbrooke's Hospital and is linked with the University of Cambridge. It is renowned for its advanced biomedical research campus and partnerships with major biomedical companies, positioning it well to become a centre of excellence.

3. Imperial College Healthcare NHS Trust - Associated with Imperial College London, this trust operates several major hospitals in London, including St Mary’s and Hammersmith Hospitals. Imperial's cutting-edge research in medicine and technology makes it a strong contender.

4. King’s Health Partners - An academic health sciences centre that combines King's College London with three NHS Foundation Trusts: Guy's and St Thomas', King's College Hospital, and South London and Maudsley. Known for its comprehensive health services and research capabilities, it is strategically positioned to be a leader.

5. Manchester University NHS Foundation Trust - One of the largest NHS trusts in the UK, affiliated with the University of Manchester. It has a significant focus on research and development, which is crucial for developing into a centre of excellence.

6. University College London Hospitals NHS Foundation Trust (UCLH) - UCLH works closely with University College London, one of the top universities globally for clinical medicine and research. Its central London location and focus on specialised services like cancer and cardiovascular treatment make it a notable candidate.

These centres are characterised by their strong links with prestigious universities, high levels of funding for research, and a solid track record of innovation in medical treatment and education. To reach the level of the aforementioned American centres, significant investment in facilities, staffing, technology, and research capabilities would be essential, along with a strategic vision that aligns with economic and healthcare goals.

OK. I know it has more or less stuck to the existing list of AHSCs (leaving out Bristol and Newcastle - NB not my idea!).? But perhaps the fuller list of AHSCs is a good place to start for England? Perhaps not unexpectedly for AI, it’s also left out the devolved nations, but that would need to be dealt with under a separate policy regime in any event.? I can certainly see a rationale for Edinburgh and Cardiff, from my own discussions there… and I suspect there are others that I’ve not been exposed to.

The investment needed is significant - but could become self-sustaining

Looking again at Cambridge vs the three selected US systems showed that the US appears to significantly outspend the UK on capital for their premier health hubs.? Again, the data is just what I could find online and likely lacks comparability.? However, it does seem clear that the NHS is spending much less than you’d expect for a major biomedical centre.

In reality, the required cost could be even more than this suggests, since our centres will need investment to get them up to a world class standard / configuration - and will then need significant ongoing investment to (a) maintain them at this level and (b) expand them to meet the increasing economic potential of the site.

That might all sound expensive - but perhaps it’s only expensive initially:

• There’s a history in the US of industry contributing to the development of medical facilities where they are working together.? For example, the Cleveland Clinic has a commercialisation arm that works closely with industry partners to develop new medical technologies. These partnerships often result in enhancements to hospital facilities and the funding of research labs, demonstrating a direct contribution from the biomedical industry to hospital costs.
• There may be a case for private funding (e.g. PPP) for the additional capital beyond MVP.? The objective could be to fund this additional longer term healthcare cost through returns from future commercialisation and innovation.?
• Even failing that, we can have a high degree of confidence that world class facilities on a properly integrated academic, clinical and business campus will accelerate the UK’s international competitiveness in biomedical research and increase GDP.? That’s going to increase taxes, hopefully well beyond the expenditure needed.

There will be other benefits beyond an expanded biomedical sector too:

• Better outcomes for patients
• Better access to cutting edge treatments
• Better recruitment of leading specialists and researchers
• Better staff satisfaction and retention
• Knock-on benefits for the university sector and for its international standing

Healthcare deserves investment and the right investment will also repay itself in economic growth

As I’ve said before in other forums, healthcare represents 10% of the UK economy and the NHS is 78% of that. This is larger than transport, energy or telecommunications. The sector underpins key, government-targeted growth sectors like life sciences, research and education. It's a knowledge industry, with highly qualified people developing new products and innovations every day. Not to mention, healthcare is a fundamental ingredient and enabler of economic productivity. Put simply, you can’t work if you're ill. Healthcare therefore drives growth, employment and productivity in the broader economy.

But I’m arguing for more than a fair-shares approach to investing in healthcare.? What we need is significant strategic investment in leading academic research centres to help them to play their part in the development of a bigger, better and thriving biomedical economy.? The potential is huge.

Next steps

• A more rigorous review of the evidence on economic impacts of biomedical campuses around the world (including outside the US) would be helpful to make the case.? It would also be helpful to understand how national differences and differences in research areas impacts the figures and affects comparability.
• Similarly, policy makers would benefit from more rigorous evidence around the necessary level of capital needed to sustain the campus.
• A future industrial strategy would need to make some decisions about where best to target additional strategic investment in NHS and academic facilities.? Which centres hold the most immediate promise and how does this play into government regional priorities?