In my first year as a doctor, I witnessed the fetid reality of crumbling NHS real estate. Arriving at work one morning on the emergency assessment unit – the frenetic hub through which most of the hospital’s acutely unwell patients passed – I discovered it had ground to a malodorous halt. Men in hard hats were shouting orders to nurses, porters were evacuating patients on trolleys. I was told a main waste pipe on the floor above had ruptured, with predictably rancid and unhygienic consequences. So much for being an NHS teaching hospital of global renown: we were literally awash with slurry. I was reminded of these unsavoury events by Sajid Javid, who tweeted last week: “Looking forward to opening one of new 48 hospitals [sic] later today.” Imagine bragging about building all those new hospitals when the existing ones are so rundown and dilapidated, they can’t even contain their human excrement. Javid’s tweet met with a chorus of derision. The fact was, the health secretary was not en route to a “new” hospital at all, but rather to a new cancer unit, built within the existing Cumberland Infirmary in Cumbria, which was itself opened in 2000 – by the then prime minister, Tony Blair. As Siva Anandaciva, chief policy analyst at health think tank the King’s Fund, puts it, the phrase new hospital “might suggest the NHS will see its stock of hospitals grow with … brand new, fully staffed hospitals that offer a full range of services. But – in reality – the promised investment is likely to pay for new facilities on existing hospital sites and the redeployment of existing staff.” I shared the public fury. For what, precisely, is wrong with simply telling the truth and saying you are delighted to be opening a new cancer unit? Why devalue all the effort, hard work and rightful pride among its staff by pretending it is an actual hospital? I don’t lie to my patients. So why does the health secretary think he is exempt from the NHS’s duty of candour, lying to NHS staff, patients and voters alike? Needless to say, these questions are rhetorical. From the moment Boris Johnson became prime minister, he has sought to convince voters of his compassion and decency through outlandish promises to build scores of shiny new NHS hospitals. First, in August 2019, he pledged an “extra” £1.8bn to help rebuild the NHS’s tattered real estate, although £1bn of that was immediately exposed as not being new money at all. Moreover, as experts were quick to point out, the figure was a drop in the ocean after the havoc wreaked on NHS infrastructure by a decade of austerity underfunding. Johnson learned from the criticism. Size, he realised, was everything. By the 2019 Conservative party conference, the “new” money had ballooned to £3bn, and, by the end of the year, he fought the general election on a manifesto pledge to build and fund “40 new hospitals” over the next decade. Journalists swiftly observed that in fact only six upgrades of existing hospitals had actual funds committed, and the number of funded “new” hospitals amounted to precisely zero. Instead, various NHS trusts would share a mere £100m of “seed money” to help them draw up plans – paper plans – for 34 future projects. No matter that the numbers didn’t add up. Like “Get Brexit done”, “40 new hospitals” was another headline-grabbing, three-word soundbite. Johnson has duly repeated it ad nauseum. By October last year, like Pinocchio’s nose, the numbers had grown again. This time a staggering 48 new hospitals were promised, or, as Johnson put it: “the biggest hospital building programme in a generation”. You can unravel that claim on the back of an envelope. With a new-build hospital costing around £500m, 48 of them would clearly require £24bn and not the £3.7bn promised by Johnson. The numbers simply don’t add up. Why does this matter so much? Well, in case the new health secretary hasn’t noticed, NHS staff are feeling pretty battered after 18 months of Covid. In pretending he was opening a “new” hospital, Javid diminished the efforts of staff locally who broke their backs to get a new cancer centre commissioned and operational against the backdrop of a global pandemic. That is disrespectful as well as dishonest. It treats NHS staff as fools. Even more importantly for patients, there is the direct impact on patient safety of neglected, decaying NHS infrastructure. In the same week that Javid faked his “new” hospital visit, several NHS hospitals in England warned of being at risk of catastrophic roof collapse, with building materials having reached the end of their lifespan more than a decade ago. The government’s failure adequately to maintain our hospitals means operating theatres that have to be closed when it rains too hard. Downpours that trigger electrical faults in vital machinery keeping patients alive. MRI scanners that end up unused because inadequate servicing has led to avoidable malfunctions. Most fundamental of all, when a government insists, effectively, that two plus two equals five, it trashes public trust in politics. The hallmark of Johnson’s approach to the NHS – ever more grandiose promises, ever more unhinged from reality – are, for this doctor, soul-destroying. Rachel Clarke is a palliative care doctor and the author of Breathtaking: Inside the NHS in a Time of Pandemic