The poor physical state of NHS buildings has become ‘a severe hindrance’ to plans to increase productivity, according to health think tank, The King’s Fund.

Responding to the recent release of the Department of Health and Social Care’s latest Estates Returns Information Collection (ERIC) data – a critical instrument for collecting information related to the costs and operations of the NHS estate – Charlotte Wickens, policy adviser at The King’s Fund, said patients and healthcare leaders were ‘in limbo’, with NHS maintenance backlog data showing £13.8bn will need to be invested to restore buildings and equipment to acceptable levels – a figure higher than the entire Department of Health and Social Care capital budget for this financial year.

She added: “The scale of the maintenance backlog means there will have to be some difficult decisions about which buildings and what equipment is prioritised for investment at the upcoming comprehensive spending review.”

And Liberal Democrat Health and Care spokesperson, Helen Morgan MP, said: “These shocking figures outline once again just how broken our NHS is after years of neglect.

“Patients are no longer confident that desperately needed treatment will go ahead without being interrupted by hospitals crumbling around them.

“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.”

The provision ERIC data for 2023/24, which was released at the end of December, is a mandatory data collection for all NHS trusts including ambulance trusts.

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

Key takeaways from this year’s collection include:

The estate

• The total cost of running the NHS estate was £13.6bn – up 9.25% on the previous year
• The total cost to eradicate backlog maintenance (BLM) is £13.8bn – up 18% on previous year. The estimated cost to eradicate ‘high risk’ BLM is £2.7bn, ‘significant risk’ BLM is £4.9bn, ‘moderate risk’ is £4.6bn, and ‘low risk’ stands at £1.5bn, all showing an increase on the previous figures
• The number of trusts with an Estate Development Strategy is down from 211 to 209
• Estates and Facilities RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) incidents were up by 3.8% to 7,966. Those related to critical infrastructure risk stood at 1,584, down nearly 2% on previous year. In particular, flood occurrences triggering a risk assessment increased by 28% to 358
• The number of fires recorded was down 19% to 1,102, but false alarms were up by nearly 5% to 23,651. 6,049 of those led to emergency services callout and there was one reported death and 21 injuries, though no patients sustained injuries during evacuation
• Gross internal floor area of NHS buildings stands at 27.5 million sq m – up 1.2%, while occupied floor area is 25.3 million sq m, an increase of 1.1%
• There has been no change in the number of single patient ensuite bedrooms, with 40,012 recorded, but a slight increase in isolation rooms from 1,892 to 1,907
• The cost of water and sewage was £101m – up 9%
• Waste costs were £180.5m – up 9.5%
• On a more-positive note, clinical service incidents due to infrastructure failures decreased by 4.8%

Commenting on the figures, Issy Whitelock, senior consultant at construction and facilities management specialist, Sewell Group, told Healthcare Property: “The newly-released provisional NHS ERIC data gives us a telling snapshot of the NHS estate’s current state. And, as you might expect, managing buildings, infrastructure, and costs is a growing challenge for NHS trusts.

“Total running costs increased, continuing the sizeable upward rising trend seen over the last four years, with these outpacing revenue growth and intensifying the financial strain on the service.

“Despite an increase in capital spending, reaching £11.2bn in 23/24, this only returns capital investment levels to where they were in 2010, after years of underfunding.

“Compounding these pressures, the IFRS 16 accounting standard now requires leases to be included as capital expenditure, putting restrictions on an already-stretched capital budget, limiting available funds, and impacting NHS trusts’ financial flexibility.”

Wickens adds: “Many patients and staff alike will be familiar with the issues that come with the poor condition of the NHS estate, such as slow scanners, broken lifts, leaking roofs, and the relocating of services to work around dilapidated buildings.

“The neglect of the NHS estate led to 751 dangerous incidents to patients and staff, such as through equipment failures or infection outbreaks.

“The latest NHS maintenance backlog data shows £13.8bn will need to be invested to restore buildings and equipment to acceptable levels. That figure is higher than the entire Department of Health and Social Care capital budget for this financial year. And this data only covers hospitals, much more would be needed to restore outdated GP practices and other primary and community care buildings.”

The figures reveals that the top 20 trusts with the highest BLM account for 30% of the total BLM across the NHS estate.

However, only nine of the 20 trusts with the most-critical infrastructure risks are included in the New Hospital Programme (NHP), highlighting a significant funding gap for urgent repairs and upgrades.

A welcome sign, according to Wickens, is that ministers have set about changing how NHS capital budgets are planned and set.

She said: “The recent budget earmarked a rise in capital spending, including £1bn for critical maintenance issues with NHS buildings, and a promise to set longer-term capital budgets so that NHS organisations can better plan for future modernisation.”

Sustainability and carbon reduction

• The total energy usage from all energy sources across the NHS estate was 11.1 billion kWh – down 0.86% on the previous data return
• Total energy costs stand at £1.4bn – up 16%. Total cost of electricity was £769m – up 21%
• The number of CHP units operated on site remains unchanged at 223
• The number of trusts operating a waste reuse scheme increased by 11% to 93. 155 trusts now have a waste manager and 125 have an energy manager

Whitelock said: “Energy remains one of the NHS’s largest financial burdens, with costs rising by 13% this year, an additional £185m.

“While the proportion of these energy costs resulting from gas and oil dropped by 2% compared to previous years, these sources still make up a substantial 40% of total energy spending.

“This highlights the NHS’s continued heavy reliance on traditional energy sources, even as it seeks to move toward more-sustainable options.”

She added: “Sustainability remains a key goal, with 76% of trusts creating estates development strategies to support some of these ambitions.

“However, many trusts face a tough choice: improve energy efficiency or manage rising costs?

“Progress is visible in some areas, with solar panel investments, EV fleets, and energy upgrades, though budget constraints limit larger-scale green projects.

“Seven Integrated Care Boards (ICBs) saw a reduction in their trust’s gas emissions by over 10%, and there’s been a 38% rise in trust-owned solar power consumption, which is promising.

“LED lighting is also expanding, though 1,778 sites still have less than 50% LED coverage. This could offer substantial benefits, but will need capital investment.”

And she warned that, with the added pressure of backlog maintenance costs, the challenge of achieving net-zero emissions across the healthcare estate could be in jeopardy.

“This data paints a vivid picture of an NHS estate under growing strain, with rising costs across almost every area,” she said.

“Trusts are making difficult choices: fix urgent issues or invest in long-term transformations like digital upgrades and sustainability.

“It’s a tough call, and the risk is that sustainability projects may be sidelined in the short term and the forthcoming risks associated with the rising BLM and critical infrastructure risk continue to grow.”

Soft FM

• The total cost for cleaning services was £1.5bn – up 10.5%
• The number of cleaning staff rose by 0.4% to stand at 42,000
• The total cost of providing inpatient food was £0.8bn – up 5.6%
• Inpatient food ingredients cost increased by 21% to £291.7m
• The number of inpatient main meals requested increased by 3% to 143 million; meals provided to A&E and urgent care patients increased by 10% to 5.2 million; and staff/visitors meals served stood at 43 million, an increase of 10%
• The number of catering staff rose by 5.8% to stand at 17,900
• Food waste – the first time this had been recorded as part of the ERIC return, was 11,800 tonnes
• Parking costs rose by 6% to £77m. Income generated from patient and visitor parking was £172m – up 18.5%; while income from staff parking fees was £70.5m – up by 51%

Looking to the future

According to Whitelock and Wickens, the data shows a need to look more long-term at the NHS estate and to embrace technology.

Whitelock told Healthcare Property that Sewell Group had devised a tool to support trusts, adding: “One of the key takeaways from the 2023/24 ERIC data is that while estates costs are rising, many trusts struggle to pinpoint exactly where efficiencies can be made.

“This is where data can make a tangible difference in managing the estate and making data-driven decisions.

“We have developed a tool which allows trusts to make sense of their ERIC data to help tackle estate management and cost control challenges – by taking a deep dive into their ERIC data, our estates dashboard can help trusts benchmark performance both between their own sites and nationally, and identify opportunities for cost-saving or operational improvements.

“For instance, we recently worked with an NHS trust in England helping them uncover discrepancies in their data reporting, which were skewing their performance metrics.

“By correcting this, and advising them on how to better utilise their space, we were able to cut down their estates spend while improving the quality of care offered to patients.

“These kinds of insights are vital at a time when NHS funding is tight, and making sure every pound is used effectively can have a direct impact on patient services.”

The King’s Fund has also teamed up with Epsom and St Helier University Hospitals NHS Trust to shine a light on what the capital backlog means for them on a local level.

Every year the trust invests millions in improving its buildings so that staff can provide safe care to patients.

However, its estate is deteriorating faster than the trust can fix it, and the outdated infrastructure causes significant disruption to teams and patients.

In the last year the trust has had to postpone hundreds of operations due to ventilation issues in its theatres.

Even though the trust has now fixed the issue, it anticipates this happening repeatedly due to the deteriorating buildings.

Working with The King’s Fund the trust has devised a plan which will help deliver on the recommendations in Lord Darzi’s review to shift care closer to home and cut surgery waiting times faster. This includes

• 85% of services staying at Epsom and St Helier hospitals with care closer to home, including urgent treatment, frailty, and ambulatory care services, which will better support the population immediately around St Helier
• Reducing waiting lists faster because Epsom and St Helier theatres will be dedicated to planned surgeries
• The trust’s new specialist emergency care hospital will be located next to The Royal Marsden hospital, helping to improve access to specialist oncology services and reduce the need for local patients to travel