Just as potholes can be fatal for travellers and should be filled, similarly the potholes in the substantial NHS infrastructure and estates backlog need to be filled, notes Andy Cowper

Once we step outside the community of motor mechanics and carriageway resurfacers (as occasionally we must), I’m not sure we can easily find anyone who actually likes potholes.

The physics of potholes is interesting. Once the surface of a metalled road is damaged by water and traffic, it becomes eroded and eventually breaks. The repeated action of freezing and thawing of water during the winter months exacerbates the effects of ongoing road use in making potholes grow. The RAC offers an entertaining guide to the various kinds of pothole.

Earlier this year, the RAC estimated that in 2017, over 10 per cent more breakdowns they attended can be attributed to damage caused by potholes than in 2016.

Down in a hole

Potholes are dangerous, too. There is the obvious physical risk to cyclists in particular: in 2016, a fatality was attributed to a badly-potholed road.

As well as this, there are risks for emergency service vehicles. Ambulances in particular, already having to contend with speedbumps, face pothole related disruption to journeys on which paramedics may be working to stabilise patients.

In 2014, an ambulance carrying a seriously ill patient was stuck in a pothole for four hours (Though to be fair, a pothole is also credited with restarting a man’s heart near Salisbury.)

Potholes are dangerous to drivers, too. You’re probably familiar with having to take considerable extra care while driving to avoid driving into potholes that could damage your car. The “slaloming” manoeuvres often needed to avoid driving into potholes (and perhaps causing a road traffic accident), have an equal effect of making lane discipline and road positioning unpredictable and impossible to anticipate.

Having to pay this amount of attention to the road surface inevitably means that drivers are paying less attention to other driving conditions and factors, in all likelihood making the country’s roads less safe and increasing pressure on the NHS.

It is estimated that it would cost in the region of £12bn to fix all Britain’s current potholes.

The analogy

You can see the analogy here: the NHS has got a substantial infrastructure and estates backlog. The last data on NHS Estates for 2016-17 shows that “the total costs of running the NHS estate were £8.6bn, an increase of 3.6 per cent on that reported in 2015-16.

“The total cost to eradicate backlog was £5.5bn, an increase of 11.5 per cent on that reported in 2015-16. This is also known as ‘backlog maintenance’ and is measure of how much would need to be invested to restore a building to a certain state based on a state of assessed risk criteria. It does not include planned maintenance work (rather, it is work that should already have taken place)”.

The ongoing mismatch between demand pressures and available resources and workforce has led to widespread use of such existential measures as land sales and capital-to-revenue transfers, worth £1bn in 2017-18.

PFI in the sky

These just aren’t particularly sensible ways to do things. Creating a maintenance backlog is simply deferring the point at which the capital and infrastructure spending will have to happen.

Indeed, this is probably the only good argument that one can retrospectively offer for the untransferred risk and bad value for money of the private finance initiative: that it prevented the possibility of allowing PFI assets to fall into serious disrepair.

Crumbling, inadequate or ill-maintained infrastructure and estates is just the sort of thing the public will notice, of course. And which will inform their attitudes towards the NHS and its funding.

The latest health questions for the long-running British Social Attitudes survey (sponsored by the King’s Fund) notably found that “61 per cent of respondents support tax rises to increase NHS funding, an increase of 21 percentage points from 2014 and 12 percentage points from 2016.

“A majority of respondents support tax increases to pay for the NHS across all age and income groups, including 61 per cent of the highest earners… 56 per cent of Conservative Party supporters backed a tax rise to pay for the NHS, up from 33 per cent in 2014”.

In this climate, it’s been interesting to see Liz “Import Cheese Disgrage” Truss on Treasury Munchkin manoeuvres this week, pouring cold water on expectations of public sector cash in The Financial Times.

Only UK economic growth will bring more public sector spending, Truss explains, grasping the fiscal ropes ever more tightly. (Remind me again: did the UK economy handily grow by an extra billion pounds in the month Theresa May needed to buy a Commons majority from the Ulster Unionists?) 

Of human bondage: oats AND beans AND barley

Ms Truss has tied herself up in political knots here. The ‘“more NHS spending” train has left the station, ably marshalled by the Hunt-Stevens axis, as I noted a fortnight ago.

The Treasury Munchkins can “stamp their foot and clap their hand” all they like, but it won’t help their “oats and beans and barley grow”. 

In fact, the Treasury munchkins will need to be “looking for a partner” who can accurately prioritise which are the most urgent potholes in NHS estates and infrastructure that need to be filled. We shall in due course see whether the Treasury Munchkins can “open the ring and take one in”.