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NHS estates backlog maintenance costs at record high

Estimated cost of addressing backlog maintenance has hit more than £9bn, up 37% in just 12 months, new figures show

The estimated cost of backlog maintenance across NHS sites in England and Wales was more than £9billion in the year 2019-20, and increased by more than 37% in just 12 months, according to worrying new data from NHS Digital.

The figures are outlined in the annual Estates Return Information Collection (ERIC) report, a mandatory collection for all NHS trusts in England and Wales, including ambulance trusts, which also reveals that the cost of running the NHS estate over the same year was £9.7billion.

Delayed due to the Coronavirus pandemic, the data covers the period from April 1 2019 to March 31, 2020, shortly before the first COVID-19 lockdown, which is expected to have impacted services further.

It covers information relating to the costs of providing and maintaining the NHS estate, including buildings, maintaining and equipping hospitals, the provision of services including laundry and food, and the costs and consumption of utilities.

This year it covered a total of 10.081 sites, with a total gross internal floor area of 26.8 million sq m, including 221 general acute hospitals, 656 mental health facilities including specialist services, 248 community hospitals, and 51 specialist hospitals.

And the data shows that running costs for the NHS estate were £9.7billion, compared to £9.4billion in 18/19, an increase of 2.55%.

This increase can be attributed to pay inflation for EFM staff, rates payable to local authorities, and an increase in the numbers of sites which are now reported on.

Also significant was the estimate that a staggering £9billion is now needed to cover the cost of backlog maintenance, up nearly 37.5% on the previous year.

This figure is a measure of how much would need to be invested to restore a building to a certain state based on assessed risk criteria.

It does not include planned maintenance work, but is rather work that should already have taken place.

Of this figure, £1.5billion is for work deemed ‘high risk’, £3.1billion is ‘significant risk’, while ‘moderate risk’ work totals £3.2bn, and ‘low risk’ improvements stands a £1billion.

All these figures are a significant increase on the previous year, and have been described as ‘alarming’ by Chris Hobson, chief executive of NHS Providers.

He said: “These figures show there's been an alarming nearly-40% increase in the NHS maintenance backlog bill from £6.5billion to £9billion in the space of a year.

“It shows how rapidly our very-old NHS estate is falling into disrepair, putting patient lives at greater risk and making it much more difficult for frontline staff to provide the right quality of care.

“The backlog is now broadly equivalent to the annual cost of running the entire NHS estate.

“More worrying still, over half of this is for work of ‘high’ or ‘significant’ risk.

“In short, this problem poses an increasing threat to safety. It's also impacting directly on the response to the pandemic.”

To address some of the issues, Health Secretary, Matt Hancock, last year announced a £600m moneypot to tackle critical maintenance work.

The funding has been released to 178 NHS trusts to cover almost 1,800 maintenance projects, which will be completed by March.

Simon Kydd, head of healthcare at WSP, said: "Five years ago I was talking about the ticking timebomb of backlog maintenance, which was then around £5billion, and now it's nearly double that.

"When you think the whole NHS capital budget is around 4.5billion a year, then even if we did nothing else for the next two years but spend it on backlog maintenance, we wouldn’t address all the issues, and more would build up. The ones deemed to be 'significant' risk would then become 'high' risk very quickly. It is quite alarming.”

He added: "Over recent years there has increasing pattern of NHS trusts dipping into capital budgets because of revenue overspends and, if you are going to sacrifice capital to deal with short-term funding issues then this is always going to cause problems down the line."

Also revealed in the ERIC data are the cost of essential facilities services such as waste management, cleaning, utilities, car parking, portering and catering.

Key figures include:

·       The total cost for cleaning services was £1.1billion

·       The total cost of providing inpatient food was £600m, with 140 million meals requested

·       Laundry and linen services cost £209m and covered 543.4 million items

·       Water and sewerage costs hit £88m

·       Portering services cost £340m, with a total of 12, 000 portering staff

And, for the first time, gross income generated from car parking, both for staff and visitors, is reported as a negative value, down £199.2m for patients and visitors and down £90m for staff parking.

The total cost of car parking services was £70m, with an estimated 457,000 available spaces.

And the number of electric vehicle charging points has increased by 34% to 1,333 in line with the Government’s ‘green’ agenda.

However, efforts to further reduce the health service’s carbon impact in line with tough new net-zero targets are stalling.

The total energy usage from all energy sources across the NHS estate amounted to 11.3 billion kWh.

Electricity was the highest cost, at £368m; followed by gas at £219m; and oil at £4.6m.

This constitutes savings of just 0.9-1.7% on the previous year.

Commenting on the surprisingly-low energy savings, despite the increased focus on the green agenda, Kydd said: "When you have such a huge estate, changing some lightbulbs to LED, with the best will in the world, is just tickling the edges.

"We need to look more widely at how efficient our buildings are, starting from the very-earliest planning stages."

According to the ERIC data, the total cost of managing waste – totalling around 624,000 tonnes – was £136m, with most spent on incineration (£29.8m) and alternative treatment for clinical waste (£27m), up 8.8% and 19.8% respectively on 2018/19.

Water and sewerage costs were £88m.

But trusts are showing an increased focus on these areas, with the number of trusts reporting they have an estate development strategy now standing at 178 out of 224.

And 123 have a waste reuse scheme in operation; with 150 of the 224 having a dedicated waste manager.

Safety was also a key focus of the report, with RIDDOR incidents classified as having an estates and facilities cause down 12.8% to 1,693.

The total overall number of estates and facilities-related incidents was 12,981.

The total number of fires recorded was 1,560, up 1.2%, with 21,635 false alarms, of which 6,523 received a callout from the fire brigade.

While there were no deaths from these incidents, there were 46 injuries and one patient suffered an injury during evacuation.


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