The poor conditions of properties and infrastructure across the NHS is contributing to poor service delivery, according to a report from the National Audit Office (NAO).
The report, called Maintaining public services facilities, said that on average, 5,400 clinical service incidents happened per year in the NHS between 2019/20 and 2023/24, due to property and infrastructure failures (see box for definition).
It added that maintenance backlogs across public services, including the NHS, schools and prisons are at least £49m. But said the true cost was not known, and could be higher than this figure due to out of date and incomplete government data on the condition of properties.
Clinical service incident definition
Incidents specifically related to critical infrastructure risk backlog maintenance caused by estates and infrastructure failure which resulted in clinical services being delayed, cancelled or otherwise interfered with owing to problems or failures related to the estates and infrastructure failure.
Including:
- Where estates and facilities staff availability is a cause e.g. porters;
- External incidents which estates and infrastructures should have mitigated, e.g. utility power failures where the trust’s backup power system failed to offset;
- Equivalent failures by services contracted out to subsidiaries, PFI, LIFT and NHS Property Services Ltd;
- Both inpatient and outpatient service incidents;
- All levels of incident risk from green to red.
Types of incidents:
- Design of healthcare buildings;
- Engineering of healthcare buildings i.e. medical gas system and lift failure;
- Fires, false alarms and evacuations (exclude where caused by equipment faults or malfunction and/or deliberate/malicious causes);
- Infection control relating to the built environment;
- Resilience of healthcare premises including flooding;
- Heating including overheating;
- Hospital food services;
- Cleaning and cleanliness in healthcare premises;
- Linen and laundry services;
- Pest control;
- Water and/or sewerage supply;
- Decontamination of surgical instruments;
- NHS car parking;
- Healthcare waste management;
- Bedside TVs, telephones and mobile phones;
- Physical security of the NHS estate;
- Portering.
Source: NHS England
It recommended that the government implement measures including mandating a standardised definition of the maintenance backlog and departments producing long-term property plans to set out the capital needs to reduce the backlog.
Gareth Davies, head of the NAO said: ‘Allowing large maintenance backlogs to build up at the buildings used to deliver essential public services is a false economy.
‘Government needs better data on the condition of its operational assets and should use it to plan efficient maintenance programmes to deliver better services and value for money.’
Matthew Taylor, chief executive of the NHS Confederation, said: ‘Our members report that there is a real risk to patient safety if key repairs and developments continue to be delayed due to lack of funding. Not only do crumbling and dilapidated buildings make it more difficult to keep patients safe, but they hamper productivity and impede efforts to improve performance. It is also a waste of scarce public money to have to prop up old buildings.
‘As Lord Darzi pointed out, the NHS has been given insufficient capital, with capital funding pots being raided time and again to prop up deficits which stemmed from a decade of underinvestment.
‘NHS leaders consistently tell us that a lack of capital is limiting their ability to tackle backlogs and boost productivity. So our members welcomed this government’s commitment to boosting capital funding in the October Budget as a welcome first step to putting the NHS on a sustainable footing.’
However, he added that the new funding was still £3.3bn short of what they think is needed.
Saffron Cordery, interim chief executive, NHS Providers, added: ‘Almost £14bn is needed to plug a rocketing NHS repairs build-up. The safety of patients and staff is at risk. This can’t go on.
‘The list of essential repairs across the NHS waiting to be done keeps getting longer and the costs are rocketing. Vital bits of the NHS are literally falling apart after years of underinvestment nationally.’
‘We understand the government’s position on the need for planned and affordable spending and investment but more significant delays to vital improvement plans will affect patient care and hamper efforts to cut waiting lists – a government priority,’ she said.
‘We agree with the NAO that government departments should produce long-term property plans, setting out capital needs and a plan to reduce their backlog.
‘Patients and staff need safe, reliable buildings, facilities and equipment for first-class, 21st century care.’
It comes after the news that the new hospitals programme will be delayed, with 18 of the 40 promised hospitals not starting construction until after 2030.
Nurses revealed last week that patients are dying, miscarrying and suffering cardiac arrest in hospital corridors due to insufficient space and discharge delays.
Recent weeks have seen a significant rise flu, norovirus and RSV in the NHS, with multiple hospitals having declared critical incidents due to high volumes of patients being admitted.
