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1 week ago
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A decade-long failure to address urgent repairs in hospitals across England has led to a dramatic rise in issues posing a “high risk” to patients and staff, ministers are being warned.
The cost of dealing with this backlog has almost tripled since 2015 in real terms, to £2.7bn this year. High-risk repairs have been the fastest growing part of the lengthy maintenance list over that time. It includes issues that could lead to serious injury to both staff and patients, or to major disruption of services or “catastrophic failure”.
The NHS lost more than 600 days – or 14,500 hours – of clinical time because of infrastructure failures in the last year, according to a new analysis seen by the Observer. The total maintenance backlog has now ballooned to £13.8bn in 2023-24, an 18% increase from last year. The figure is more than the NHS’s entire capital budget for the year.
There were some 22 incidents of lost clinical time a day on average, according to the analysis of official data by the House of Commons library. Close to 80% of the time lost was due to incidents deemed to have the most clinical impact, including faulty roofs, water leaks, and broken lifts or heating systems. There were 1,584 “critical incidents” recorded, the most severe kind.
Helen Morgan – the Liberal Democrats’ health and care spokesperson who commissioned the House of Commons library to review data on the hospital repair backlog – blamed the “shocking figures” on years of neglect.
“Patients are no longer confident that desperately needed treatment will go ahead without being interrupted by hospitals crumbling around them,” she said. “How can the government expect to get the NHS waiting times down when the buildings are in such a state of disrepair? It is a situation that the new government must grip urgently and bring to an end.
“That should start by ministers bringing forward a 10-year plan to eradicate the repair backlog and ensure that our NHS is fit for purpose so that patients can finally get the care they deserve.”
Essex Partnership University NHS trust recorded 300 critical incidents in 2023-24, the most of any trust in England. It said it was having to manage more than 200 sites in partnership with other providers. It is now focusing on a programme of refurbishment of inpatient wards, investing £20m since 2020.
Princess Alexandra Hospital NHS trust recorded 229 critical incidents. Tom Burton, its director of finance, said the trust continued to face challenges as a result of an “ageing estate”, including electrical issues and older systems. The trust is prioritising maintenance that ensures compliance with health and safety standards and improves resilience of its infrastructure.
The rise in severe maintenance problems is worrying NHS experts. “We’re seeing faster growth in the higher risk categories, where the consequences of not doing that maintenance would be more substantial,” said Katie Fozzard, an economist at the Health Foundation. “The highest risk category has almost tripled since 2015.”
Rory Deighton, acute network director at the NHS Confederation, said the increasing amount of clinical time lost to disrepair across the NHS was “very concerning” and warned it was the result of long-term underfunding. “Healthcare leaders know first-hand the impact that crumbling buildings and outdated equipment is having on the care they and their staff can provide to patients,” he said. “This is a direct result of the dearth of capital invested into the NHS over the last 10 years or more.
“Greater investment in NHS estate, buildings and kit is desperately needed given the maintenance bill for these buildings, and this infrastructure is now higher than the allocated capital budget as a whole. We need to simultaneously fix the broken and run down, but also build and modernise for the future, including in the technology and digital equipment required.”
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He also called for an overhaul of the bureaucracy that often held up the plans of hospital bosses to deal with the essential repair and modernisation work. “The process of getting the funding that does exist out to the frontline needs urgently simplifying,” he said.
Charles Tallack, director of research and analysis at the Health Foundation, warned that the poor condition of the NHS estate was hampering efforts to make the service more efficient. “NHS productivity has declined,” he said. “There’s been at least a 20% increase in hospital staff since before the pandemic, but we’ve seen nowhere near that increase in hospital activity.
“Part of the reason is that we’ve not invested sufficiently in maintaining buildings, so the extra staff aren’t being used as well as they could be. There are some really stark examples of this. If you have theatres with leaking roofs or under water, then staff can’t get on with caring for patients.“
The government is now investing £1bn to tackle the existing backlog of critical maintenance. While the Tories had pledged to build 40 new hospitals under the new hospitals programme, the scheme was widely criticised for failing to provide the necessary funds to deliver it. The Labour government is now reviewing the programme and is prioritising hospitals built using reinforced autoclaved aerated concrete (Raac), now deemed a serious risk.
A Department of Health and Social Care spokesperson said: “Buildings and equipment across the NHS have been left to crumble following years of neglect, disrupting patient care and hindering staff. We are investing over £1bn to tackle the existing backlog of critical maintenance, repairs and upgrades. Repairing and rebuilding our NHS estate will be a vital part of our 10-year health plan.”
