• HSJ analysis reveals extent of backlog maintenance issues in each health economy
  • High levels of outstanding repairs and refurbishment work are likely to be one indicator of where services need to be reconfigured and centralised
  • But many areas will struggle to address the problems due to continuing high levels of demand for acute services and difficulties accessing capital funding
  • See trust level data here

The current pressures on acute services could prevent or delay crucial improvements that need to be made to hospital buildings, according to NHS estates directors.

Analysis by HSJ has revealed the extent of backlog maintenance issues within each health economy in England (see map below). Many areas will struggle to address the problems due to continuing high demand for acute services and difficulties in accessing capital funding.

High levels of outstanding repairs and refurbishment work are likely to be one indicator of where services need to be reconfigured and centralised, as the backlog will often relate to buildings that are unfit and unsuitable for further investment.

The analysis, which is based on NHS trust data contained in the 2015-16 estates return information collection, suggests a huge disparity between different sustainability and transformation plan areas. It does not include primary care estates.

Map: The cost of backlog maintenance in each STP (click on the region for details)

North west London has the largest backlog, which would cost nearly £1bn to address, while Derbyshire is at the opposite end of the scale, with outstanding work valued at £11m.

National capital funds, which are needed to pay for maintenance work, have been repeatedly raided in recent years to prop up revenue budgets. Department of Health officials admitted last week that these raids would continue for several years.

Paul Fenton, chair of the Health Estates and Facilities Management Association and estates director at Ipswich Hospital Trust, told HSJ: “There are real concerns around capital funding from our members, but we also have to balance that by recognising healthcare delivery is changing, and reducing the need for patients to come to an acute site.”

However, continuing demand pressures, which have seen dozens of trusts report operational problems in the last fortnight, will “hinder the ability to redesign the estate to enable the shift of care out of hospital due to the need to continue to deliver in the here and now”, he added.

Mr Fenton said while much reconfiguration will be clinically led and inform the estates strategy, some elements of the STPs could also be “estates led”, as a high backlog of maintenance problems is one indicator of where reconfiguration might be needed, regardless of clinical use.

HSJ calculated the total maintenance backlog for each STP by collating site specific data for every NHS trust. The costs of eradicating the backlog were then calculated per square metre of occupied space. 

The backlog in north west London relates largely to Imperial College Healthcare Trust, London Northwest Healthcare Trust and Hillingdon Hospitals Foundation Trust. A major reconfiguration of services has long been planned for the area and is central to the STP proposals.

A spokeswoman for the south west London STP said buildings on two of its acute sites, at St George’s and St Helier hospitals, are “increasingly unfit for purpose”. The area’s STP plan says the number of hospital sites could be reduced from five to either three or four.

A spokeswoman for the Lincolnshire STP, where there is £91m of backlog maintenance, said a survey of its acute sites is being carried out, and the backlog maintenance costs will be used to inform any reconfiguration plans. She added: “Capital will be limited and we are exploring all options, however we are realistic about what can be achieved and is affordable… Options for capital will include Department of Health sourced, public private partnership/joint venture, third party developer etc.”

All three acute trusts within the Hertfordshire and West Essex footprint face large maintenance backlogs. There is a particular focus on the Princess Alexandra Hospital in terms of the buildings and its capability to deliver sustainable services. An STP spokeswoman also said a redevelopment agreement will need to be secured for the Mount Vernon Cancer Centre in Northwood.

Traditionally, the ERIC data has been deemed fairly unreliable by estates directors. However, Mr Fenton said the 2015-16 collection is “the most accurate that’s ever been recorded” because of efforts that have been made as part of the Carter review of NHS productivity.

The data is published by NHS Digital.


Mapped: Cost of backlog hospital repairs facing every STP area