The case for building a British hospital ship

Feb 24, 2014   //   by NavyLookout   //   blog  //  6 Comments

RAF Nightingale - British hospital ship

Many in Britain may feel proud that the UK government is giving away £11.2 Bn per year in overseas aid, leading the world in ‘international development’. While growing poverty in the UK leaves increasing numbers dependent on food banks, the armed forces suffer cut after cut and national debt rises by £1Bn per week, for others this generosity is hard to stomach. There is a case for overseas aid both on a pragmatic and moral level – we should do the right thing and besides, lifting people out of poverty should make us all richer. The old adage that “charity begins at home” has lost much of its meaning in the context of the globalised inter-connected 21st century world where what happens in far off nations can have immediate impact at home. The principle that governments of rich nations should be helping the poorest and the most vulnerable in the world is sound and should not just be left to charities or benevolent billionaires.

What is not in doubt is that UK overseas development has been mismanaged in some areas to the point of lunacy. Not only is much of the money wasted by corruption, absorbed by expensive ‘aid professionals’ or put into schemes with no accountability but we have been giving money to growing economic powerhouses such as India and even China. We are sending cash to relieve grinding poverty in India while their government has the resources to run a space programme and build aircraft carriers. We don’t necessarily need to cut our overseas aid budget but we certainly should start spending it far more intelligently. Building and operating a hospital ship is a good example of how we could spend this money better.

With apparent climate change bringing more extreme weather, regular earthquakes and tsunamis, it is sad but safe to say that the services of hospital ships will be needed many times in the coming decades. With 95 of the 100 largest cities in the world port cities and the 90% of the world’s population living within 200 miles of the sea, aid and assistance from ships will often be the most appropriate way to deliver large scale relief.

By diverting a very small part of the Department for International Development’s (DFID) very generous budget into building and running a hospital ship, the MoD would be spared further pressure on its already under-size budget. The taxpayer would be getting a highly visible ambassador for Britain and a force for good in the world. A hospital ship can deliver medical aid direct to those who need it most while avoiding potential corruption and the middle-men that plague so many aid projects.

Ideally we would have 2 vessels. One ‘forward-deployed’ mainly around Africa or Asia making scheduled visits to provide a programme of free medical care but ready to respond to natural disasters. The second vessel would be at home either refitting or in reserve but at a few days notice to respond to emergencies. In their secondary roles, the ships would give the armed forces of the UK and its allies the assurance of a dedicated hospital ship able to cope with large numbers combat casualties. They would also provide a useful back up to the NHS in the event of a major incident or disaster in the UK. It is notable with the closure of Royal Naval Hospital Haslar in 2009, the UK is now the only country in the Western world not to have a dedicated Military hospital.

English: The Royal Fleet Auxiliary vessel RFA ...

RFA Argus (Photo credit: Wikipedia)

RFA Argus is the nearest we currently have to a hospital ship. Designated a “Primary Casualty Receiving Ship” (PCRS), she carries a fully equipped 100-bed hospital. However she is painted grey and does not conform to the requirements of the Geneva Convention on hospital ships because she carries weapons and embarks operational units. She is also the Navy’s helicopter training vessel and in wartime she would be a very useful extra helicopter carrier. Originally converted from a container ship for the Falklands War and then significantly re-built, few vessels have provided the taxpayer with better value for money. Argus is due for retirement in 2020 and like so many “gaps” in MoD equipment, there is no active plan or funding to replace her. We would advocate her replacement as soon as possible this should be treated a seperate issue to the hospital ships which would be white-painted non-combatants with a much larger capacity.

Design & build

To have sufficient capacity to cope with large numbers of casualties or medical cases the ship would need to be fully equipped to a standard similar to a large general NHS hospital with at least 500 medical beds. Procurement of these ship need not be particularly expensive. A new build vessel would provide welcome work for the Portsmouth, Cammel Laird or Appledore shipyards. However a merchant ship conversion would probably be more affordable and could be done faster. Ideally the ship would be able to manage a sustained 25 knots as speed of response could be important, although most merchant ships can manage a maximum of 18 Knots. A flight deck and large hangar would be required to support several helicopters. There would be ramps and a vehicle deck to allow casualties and stores to be driven on and off when in port. A couple of light landing craft (LCVPs) in davits would also be useful for embarking casualties when port facilities are damaged or unavailable and the ship has to lie at anchor.If the ship had an RFA crew and was based in Portsmouth or Devonport it would utilise existing training and support infrastructure keeping costs down. The medical staff would come from across the armed forces and it would provide valuable experience for them, especially as the superb work of the battlefield medical teams in Afghanistan winds down.

Existing examples

This video showcases the amazing work of the Mercy Ships charity - a great example of what can be done with a hospital ship. With an annual budget that is probably less than what DFID spends on paperclips, their ship MV Africa Mercy spends several months in ports of the world’s poorest nations providing free medical care ranging from simple medical checks to major operations.

USNS Comfort

The US operates the 2 largest hospital ships in the world, USNS Mercy and Comfort. Pictured above is USNS Comfort arriving to assist in the wake of the earthquake in Haiti in 2010. Both are merchant ship conversions operated by the Military Sealift Command – a civilian organisation similar to the Royal Fleet Auxiliary. (US Navy Photo)

Chinese Hospital ship - Peace Ark

Launched in 2007, the Chinese Navy have a dedicated purpose-built hospital ship called the “Peace Ark”. This shows how China understands the value of  investing in ‘soft power’ while rapidly expanding its naval and military capabilities. (Image via Wikipedia)


The humanitarian aid mission is often forgotten in political discussions around the size and shape of the navy. We should perhaps consider allocating further DFID funds to support  branches of the forces which can and do contribute significantly to humanitarian aid operations. If we purchased additional naval auxiliaries, helicopters and heavy lift transport aircraft we would be better equipped to respond to crises and have more badly needed assets without increasing the defence budget. Indeed there are already signs the government is thinking this way. With public opinion increasingly hardening against involvement in armed interventions, it is likely that humanitarian missions will occupy a growing proportion of our forces work. A British hospital ship is an ‘everyone wins scenario’ and would be a popular first step to reshaping the aid budget and would avoid the howls of criticism that aid money is being diverted to weapons spending.


The Type 26 Frigate – Key to the RN’s future surface fleet

Aug 21, 2012   //   by NavyLookout   //   Articles, blog  //  10 Comments

The latest design for the Type 26 Frigate, key to the future of the RN’s surface fleet was revealed by the MoD yesterday. Although this design was shown off by BAE back in March, this now looks likely to be the basic arrangement for the ship. In general terms it is: 148 metres long, 5,400 tonnes, is armed with a new medium calibre gun, has vertical launch missile silos, carrys the Sea Ceptor self defence missile, mounts 2 Phalanx CIWS and 2 x 30 or 40mm guns. It will have a large flight deck and hangar and a ‘mission bay’ to carry unmanned vehicles. It is primarily an anti-submarine ship but with a diverse range of other capabilities. It will have diesel / gas turbine /electric propulsion (similar to the Type 23) with a top speed of over 28 knots and an exceptionally good range of up to 11,000 nm.

Officially it’s called the “Global Combat Ship” – an indication perhaps of the controversies around the concept of a frigate. In laying down the specification for this ship the Naval Staff have been navigating through very choppy seas. In a climate of cuts and austerity, somehow the RN has to balance cost and capability with competing arguments about future needs. There are several ‘schools of thought’ on modern frigates; some say they should be simpler, cheaper maritime security-orientated ships built in large numbers for the low-intensity operations that is the RN’s main occupation today. Or there is the ‘gold plated’ school that demands a warship survivable in the most high-intensity naval conflicts with the most modern (and therefore expensive) weapons and sensors possible. Then there are the radical fringe who argue the concept of the surface escort is fundamentally obsolete and because submarine hunting is mostly done by helicopter, the RN should just convert cheap merchant ships to carry lots of helicopters. Against this background the latest design appears to offer something of a ‘middle way’ – ship that is ‘relatively affordable’ while offering some high-end capabilities.


  • At approx 5,000 tonnes it is smaller than the previous 7,000 tonne ugly duckling initially proposed. This offers a little hope it should be affordable in decent numbers.
  • The ‘middle way’ design has real export potential which could help keep costs down.
  • The design includes MK41 silos for vertically launched Tomahawk Land attack missile (TLAM) tubes, amongst the most useful and relevant weapons possessed by the UK. This also provides an option to carry a variety of missile types in future.
  • Increase in accommodation to allow for 190 offers more flexible manning in future. ‘Lean manning’ keeps running costs down but Falklands war veterans will tell you exhaustion is a becomes a big factor for crews on prolonged operations. Numbers of sailors are needed for damage control and automation is not a substitute.
  • Has adaptable mission bay and large hangar providing flexibility and allowing for operation of Unmanned aircraft and submersibles in the future.
  • Use of proven technology that may have already been to sea on the Type 23 will help reduce costs and technical problems.
  • Aesthetically pleasing!  Possibly the best looking RN warship or auxiliary design to emerge for sometime.


  • Although maybe a choice dictated by circumstance, it is not a very radical design, the mission bay is really the only major innovation for an RN vessel and foreign warships with these features are already at sea.
  • Slow pace of design and building means design could it be partially obsolete soon after it enters service. As the power of anti-ship missiles continues to increase, directed energy weapons (Lasers) maybe the only credible defence and this design does not have provision for this.
  • It’s still quite large design for a frigate and although an attempt to keep costs under control, it’s difficult to be optimistic, given the dismal history of cost inflation and export failure. Whether costs can be controlled and export orders or international collaboration can be achieved remains to be seen.

We want 13, preferably more but certainly nothing less

Slick computer animations and designs on a computer are one thing but now the RN has to get the ships built and funded. Phil “the spreadsheet” Hammond says the MoD has £11Billion earmarked for purchase of new warships (but that is not just for the Type 26s). The Type 26 must be steered through the 2015 defence review after which we will probably see an order for a first batch of 3 or 4 ships. The RN expects the first order in 2015 and then delivery of approximately one ship per year from 2020. Beyond that it becomes difficult to predict when funding for the next batches more will arrive. A bold move would be to simply order 13 together, providing much-needed security to industry and reducing costs by economy of scale, but of course this is probably wishful thinking.

Like many of the UK’s major defence programmes, the Type 26 is really running around 5-10 years behind when it will be needed. This is the result of a combination of factors, lack of funding, prevarication and delays by successive governments and the aircraft carrier effort. The result of this is that some of the 13 Type 23 frigates currently in service may have to be kept patched-up and running for around 30 years until the last Type 26 is delivered around 2033. The Type 23s have proven to be excellent ships and have adapted well beyond their origins as ASW specialists, however their original hull design was supposed to last 18 years although thoroughly refitted and upgraded they will be very tired an obsolete by the 2030s.

In the last decade the RN has effectively been forced to trade its frigate force against the promise of the new aircraft carriers. With just 13 frigates left this is already far to few but there is a now determination across the navy not to let numbers fall below this ‘rock bottom’. Indeed more than 13 frigates would be highly desirable. A repeat of the Type 45 program which was initially for 12 ships, then cut to 8 and finally only 6 delivered, must not be repeated. Junior Defence Minster, Peter Luff has rightly stated the “The Type 26 will be the backbone of the Royal Navy for decades to come.” We will hold his government and its successors to that and the campaign to “draw a line in the sand” & make it politically unacceptable for RN to receive less than 13 starts here!