Edward Gee and Matthew Hellicar of Platinum Facilities reveal how hospital estates can become more efficient through a combination of IoT sensors and building management systems

The most-recent estimates value the NHS’s maintenance backlog at around £13.8bn.

A significant percentage of that is said to consist of urgent repairs to prevent what the NHS describes as ‘catastrophic failure or disruption to clinical services’, stretching hospitals to their limit and threatening patient care.

In May 2025, the Government unveiled funding for repairs and maintenance that will see £750m earmarked for the NHS estate, including 400 hospitals, mental health units, and ambulance sites.

But healthcare leaders have warned it’s unlikely to be enough, meaning NHS estates and facilities managers must get smart about how to tackle the challenge.

There are several reasons for such a large maintenance backlog.

Alongside ongoing budget constraints, much of the NHS’s property portfolio is old – a massive 42% of the estate in England stood before 1985, according to NHS Estates Returns Information Collection (ERIC) data.

The conventional way

Meanwhile, an ageing estate is looked after by a similarly-antiquated approach to maintenance.

In short, much of it across NHS trusts is either reactive or time-based.

When maintenance is reactive, assets are only fixed once they break down.

It’s easy to see how this approach can lead to higher emergency repair costs (including engineer call-outs); unplanned downtime for crucial services, such as operating theatres, A&E departments, and MRI suites; and shortened asset lifespans as equipment continues to run to failure.

In time-based maintenance, engineers service equipment on a fixed schedule, regardless of its condition.

Historically, maintenance regimes in healthcare settings have centred on compliance and risk prevention, and most hospitals have well-established planned preventative maintenance (PPM) schedules as a result.

Applying standards such as SFG20 ensures statutory compliance – NHS estates teams can follow manufacturers’ guidelines on what should be serviced, how often, and to what standard.

A robust PPM schedule can support NHS trusts in meeting requirements of key frameworks such as annual ERIC reporting, the Premises Assurance Model (PAM) estate assessments, and Health Technical Memoranda (HTM) technical guidance.

However, a fixed schedule doesn’t always reflect how building systems behave in real time.

Hospitals are dynamic environments, where demand can fluctuate dramatically at different times of day, week, or year.

Treating every asset the same may, therefore, result in over maintenance in some areas and under maintenance in others.

In these instances, downtime is planned but unnecessary and engineers are likely to miss the early warnings signs of failure.

Data-led transformation

Applying the right technology can help NHS trusts develop a more-responsive and efficient approach to maintenance.

Equipping assets with IoT sensors and integrating them with building management systems allows engineering teams to collect real-time data on their condition and performance – everything from vibration, power consumption, and runtime, to temperature, humidity, and airflow.

Instead of only reacting when things go wrong, or depending on fixed schedules, NHS facilities teams can monitor the real-time data to assess asset condition and usage, adjusting maintenance plans based on actual need.

In practice, a condition-based approach allows for greater uptime across critical areas of a hospital.

An operating theatre, for example, must maintain constant, tightly-regulated airflows to ensure a sterile, temperature-controlled environment.

Ventilation system failure could halt operations, delay care, and compromise clinical outcomes.

Here, a fixed maintenance schedule set at three-month checks might not account for a winter surge, with motors drawing more power due to wear.

By integrating sensors on these fan motors, the data can highlight subtle changes in performance, such as increasing resistance or changes in airflow rates.

With this capability, NHS trusts can plan pro-active maintenance to avoid disruptive failures and schedule repairs around the clinical timetable or redirect surgeries to other theatres to reduce downtime.

ESG goals

Like every other organisation across the public and private spheres, the NHS has ambitious decarbonisation targets. This includes an 80% reduction in its carbon footprint by 2028 to 2032 (and net zero by 2040), a significant undertaking for such a large and complex estate.

A condition-based maintenance approach can help hospitals cut their carbon emissions, reduce utility costs, and demonstrate transparency and accountability.

Even small interventions can have a big impact.

Equipping a cooling tower with a sensor, for example, may pick up an anomaly such as a water leak, causing a significant spike in water use.

Without an intervention, this could go unnoticed for weeks.

Real-time data allows engineers to fix the issue quickly, saving the hospital hundreds of pounds daily and potentially thousands over time.

Similarly, sensors can help facilities teams reduce runtime hours according to occupancy and demand, especially useful in non-critical areas such as administrative offices and outpatient clinics.

If areas are unoccupied, or at low capacity, fans and pumps can be powered down without it impacting compliance or patient care.

Ultimately, this means the NHS trust can avoid wasting energy.

A hybrid approach

The answer isn’t to replace PPM schedules with a fully-predictive approach. Instead, a data-led, demand-driven strategy can help enhance existing PPMs by providing NHS leaders with greater insight into how their operations impact the condition and energy use of their estates.

Barriers to adoption remain, though.

The NHS must contend with legacy infrastructure, limited capital investment, and poor interoperability of existing building systems.

However, working with the right facilities and engineering teams can help NHS trusts leverage technology to develop a more-comprehensive and dynamic approach to estate maintenance and management – which, in turn, lead to better outcomes for patients and staff.