A new report has shed light on the growing financial and operational crisis facing NHS estates, with data revealing that delaying vital healthcare infrastructure projects can increase costs by over 140% in a decade.

The report by Prime, entitled Deliver or Delay? The Escalating Cost of Inaction on NHS trusts and GP estates, reinforces the urgent need for decisive action.

Escalating costs and increased risks

Five years ago, it was noted that a three-year delay in NHS estates projects could spike costs by more than 40%.

However, recent challenges – including a global pandemic, economic turmoil, and geopolitical tensions – have exacerbated these risks.

The maintenance backlog for NHS facilities has doubled in the past decade, with high-risk backlog items skyrocketing by 500%.

Staggering investment needs

According to an indepth study by the Institute for Fiscal Studies, the required investment to eliminate the NHS England maintenance backlog has soared from £5.5bn in 2013-14 to a staggering £12.5bn in 2022-23.

This underscores the immense financial burden that delays impose on the healthcare system.

Soaring infrastructure costs

The period from March 2020 to March 2024 saw dramatic increases in building material costs, with pre-cast concrete up by 85%, insulating materials up by 58%, and metal doors and windows up by 53%.

These rising costs further stress the importance of timely investments.

Operational challenges and patient safety

Healthcare leaders are navigating complex funding rules, which hampers their ability to maintain equipment and buildings.

And this inaction leads to severe operational challenges, affecting patient safety and staff satisfaction.

Deteriorating infrastructure – evident in broken lifts, leaking roofs, and structural risks from materials like reinforced autoclaved aerated concrete (RAAC) – poses significant threats to both patients and staff.

The impact on NHS workforce

Poor working conditions and inadequate staff facilities are also exacerbating the NHS’s recruitment and retention issues.

Post-pandemic, healthcare professionals are leaving the field for better working conditions and pay, with the NHS currently facing a staggering shortage of 121,000 full-time-equivalent staff, with only 25% of the workforce believing there are enough staff at their organisation.

The reliance on agency staff to cover shortages diverts critical funds from infrastructure projects, creating a vicious cycle.

And, although the NHS Long Term Workforce Plan aims to bolster workforce numbers over the next six years, the necessary infrastructure to support new staff remains insufficient.

A path forward

The newly-released report delves into the current challenges and proposes solutions to break free from the cycle of short-term fixes.

It also highlights successful projects across the country that demonstrate transformative change is possible.

With bold leadership and a revised approach, the report argues, the NHS can achieve significant progress.

Michelle Robinson, associate director of Prime, said: “Navigating the labyrinth of funding streams, approvals, and competing priorities can make building new NHS infrastructure feel like an overwhelming task.

“Add in the disruption of unforeseen global events and cost increases and it becomes a seemingly-impossible riddle to solve.

“However, transformational change is achievable if leaders focus on solutions within their control.”