‘High risk’ estates maintenance cost continues to spiral

As of April 2019, the NHS’ estimated bill to carry out urgently-needed repairs to “high-risk” estate had risen in a year by nearly £60m – from £1.038m to 1.095m, according to data from the Estates Returns Information Collection.

The increase is smaller than in previous years. However, the rapid rise (in 2014-15 the estimated cost was £458m) has prompted strong concerns from trust chief executives.

Tracy Taylor, chief executive of Nottingham University Hospitals Trust, said in a release from NHS Providers “our hospitals will continue to deteriorate and our ambition for better healthcare may never be realised” without both short-term and long-term capital investment.

A spokeswoman for the Department of Health and Social Care (DHSC) said it had “supported the NHS with £3.9bn to upgrade facilities” and “recently injected an extra £1.8bn to tackle the most urgent infrastructure projects”.

High-risk estate is defined as areas where repairs must be addressed with urgent priority in order to prevent “catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution”.

Nearly a third of the NHS’ total high-risk cost is carried by Imperial College Healthcare Trust (£334m). Other trusts with the highest costs in this category include Hillingdon Hospitals Foundation Trust (£48.5m), Medway FT (£37.5m), and University Hospitals of Morecambe Bay FT (£34.5m).

Hillingdon was this week forced to close three children’s wards because of subsidence.

The NHS’ overall backlog maintenance cost now stands at £6.5bn (£5.9bn in 2017-18), of which more than half (£3.4bn) is categorised as “high or significant risk”.

But the figures show trusts only spent £433m on reducing backlog maintenance in 2018-19.

Josh Kraindler, an economics analyst with the Health Foundation, told HSJ the maintenance backlog has grown to such a level that it is larger in trusts than their annual capital budgets.

“A fair bit of the overall backlog’s increase is in the high and significant risk categories, and it looks like the increase is split across quite a few trusts,” he added.

HSJ has previously reported how capital budgets have been repeatedly raided to prop up revenue budgets.

Since 2017, the government has allocated more than £3bn to the NHS, but the majority of this cash has not yet been distributed to the recipient trusts.

Last month, the government announced funding for the rebuilding of six hospitals and outlined plans for dozens more schemes between 2025-30.

The DHSC spokeswoman added: “We want patients to receive safe, world-class care in world-class facilities and have launched the largest hospital building programme in a generation, as part of a long term programme of investment to modernise the NHS estate and eradicate critical safety issues.”

Meanwhile, the ERIC data also shows a 25 per cent rise from 2017-18 (3,835) to 2018-19 (4,810) in the number of incidents caused by estates failures resulting in delays or cancellations to clinical services – such as power failures. 

However, the definition for this metric was broadened slightly for 2018-19, which could be a factor in the rise.

Saffron Cordery, deputy chief executive of NHS Providers, said: “We are not in a good place when patients are forced to wait longer for treatment because of faulty scanners and theatre equipment or wards are closed because of leaks.

“It also directly impacts staff wellbeing with some working day in and day out in Victorian facilities at heightened risk of fires.

“The recent investment we have seen from the prime minister, and funding for six new hospitals, has been very welcome, but these figures make it clear we need much more to rebuild our NHS. We need to start making real progress in tackling the NHS backlog maintenance, or we continue storing up problems for the future.”

A multiyear capital settlement for the NHS is expected in the next comprehensive spending review.

Story updated at 10.10am on 18 October to include comment from DHSC.