Richard Smith visited and wrote about the NHS in Dumfries and Galloway in 1980, 1990, and 1999, and this series of blogs describes what he found in 2016. A feature article provides a summary.

When I first visited Dumfries in 1980, the new hospital was only five years old. I enthused over it, but now a new hospital is being built and is due to be occupied in 2017. As I arrived in Dumfries I was for a while confused about whether the hospital I was seeing was the “old” or the “new” hospital. It was the “old” hospital, but it looks deceptively new because of white cladding.

The need for a new hospital became clear when the health board started on maintenance of the old building. The cost was so high and the disruption so considerable that it made more sense to build a new hospital, which is now happening on a site some four miles from the current hospital. The new hospital is an NPD (Non-Profit Distributing programme) project costing £213 million with 90% of the money coming from the Scottish government. NPD is described as “an alternative to the traditional PFI (Private Finance Initiative)” but several people said to me “It is a PFI.”

Several people bemoaned to me that a new hospital should last only 40 years and told me that a new hospital was being built because money could be found for the new hospital, but not for refurbishing the old one.

The new hospital will have 10 more beds than the old one, which is unusual in that replacement hospitals tend to have fewer beds—as the trend is supposed to be away from hospitals and into the community. But the plan is for the hospital to open with four fewer beds than now with 14 “mothballed” for when the aging population needs them. All of the beds will be in single rooms, a decision of the Scottish government that is controversial.

Chris Isles, a physician who has been at the hospital for many years and is retired but still looks after the education of young doctors and provides emergency cover, believes that it is wrong to make the whole hospital single rooms and has written an article in The BMJ saying so. He points out that many of the patients admitted are demented or delirious and that a single room is even more disorientating than a four bedded ward. He’s also worried about the number of medical beds, producing data showing a steady rise in the number of emergency admissions and the current hospital running at near capacity when 85% is recommended. He fears that “ambulances may be queuing outside the hospital on the day it opens.”

But, as John Knox, the board’s project director for the new hospital, pointed out to me, the board is taking the opportunity to reorganise services to make them more effective and efficient. He drove me to the site of the new hospital, where there are some 600 people working, and I met the project director Roger Frost, who has built some nine hospitals and Terminal Two at Heathrow. His pièce de résistance was the hospital in Birmingham and he enjoys building hospitals because of the good they do. He hasn’t ever built a hospital that is all single rooms, but the Birmingham hospital was half single rooms and half four-bedded wards. He comes up from Bristol every week, and many of the workers have to come long distances because an area like Dumfries doesn’t have workers with all the skills needed. Nevertheless, some two thirds of the workers come from within 50 miles, and such a big project provides local employment. I was surprised that there was a large office with perhaps 100 people, but Frost pointed out that there were many logistic arrangements, not least procuring everything needed for the new hospital.

We stood on the roof of the temporary project office and looked down on the hospital, which is going up remarkably fast. One of the reasons it is going up so fast is that much of it is prefabricated and assembled onsite. This is a specialty of Laing O’Rourke, the company building the hospital. The broad design of the hospital is that it has a main block with clinics, operating theatres, and support services, three ward blocks at the back, a mother and child unit at the front, and separate residences. The building is being built to almost the highest environmental standards and will be flexible in that the insides can be easily rearranged. (Perhaps a future Scottish government will decide against single rooms—and new wards could then be introduced.) The building is on schedule and on budget, and Frost was keen to get the roof on before the Scottish winter bites.

The current hospital will probably be demolished, although the PFI obstetric unit, which was opened in 2000 will be kept. The board would like to be able to sell its grand but large and sprawling offices, which are part of what was once the Crichton psychiatric hospital, but it’s hard to see who would want it. Two universities (University of the West of Scotland and Glasgow University) have taken over much of the rest of the Crichton, which had multiple buildings on a large site, but the building that is left seems unsuitable for a university. Another part of the site has become a hotel, and it’s hard to imagine that there would be the demand for another hotel. What might work, however, is for the current grounds of the hospital to become a golf course, and the board’s offices to become a luxury hotel hosting Americans who want to play golf in Scotland, the home of golf.

Richard Smith was the editor of The BMJ until 2004.