David Jones, director of Estates, Facilities, and Capital Development at University Hospital Southampton, and a fourth year PhD candidate, is researching the impact of the growing backlog maintenance level across England on patient safety incidents. He is looking both at the level of incidents directly linked to backlog maintenance, and at how ‘an aged estate’ is affecting staff in undertaking their work, and how this ultimately impacts patient safety. Here he discusses the key factors when looking at the impact of backlog maintenance, and explores what else we should be doing to improve our understanding of it, and reduce the severity of the issue.
Two years ago I wrote an article for HEJ titled ‘Badly maintained buildings can be a risk for all’,1 highlighting the significant concern around the level of backlog maintenance, and the potential for impact on patients and staff alike. At this point the financial position of backlog was £9.2 bn, with the critical infrastructure risk at £1.6 bn.2 So, what has changed? Over the past 10 years, the level of backlog maintenance (BLM) within the NHS England estate has increased from £4.3 bn to over £11.6 bn, with the critical infrastructure risk (CIR) increasing from £0.5 m to £2.4 m (see Table 1).
The chart shows that, based on the average trajectory, the 2023/24 backlog maintenance figures could reach £13.18 bn for BLM and £2.9 bn in CIR. This is an average growth of 13.6% overall for backlog, and 23% for CIR, all when inflation has been running at an average 2.92%. However, the figures are of themselves meaningless without being in context. The level of backlog maintenance is impacting three key areas – patient safety, staff productivity, and Trusts’ financial performance. This article synthesises work across finance, patient safety, and academia, to produce a broad picture on the impact of backlog maintenance within the NHS.
The impact on the financial position from backlog maintenance is not simply the cost to the estates budget to repair whatever failed. The wider impact to the Trust must be considered. Every time a theatre is closed it costs the Trust in question thousands of pounds in lost income and wasted staff hours. In addition, closed beds due to estates issues not only mean direct lost income opportunity for elective care, but also increase the pressure across the whole system, causing delays in admitting patients, and ultimately delays in ambulance handovers. The cost impact to the NHS across all Trusts over the f inancial year would run into tens of millions of pounds in terms of clinical disruption.
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