NHS patients are at risk as the cost of emergency repairs in hospitals triples in a decade

A decade-long failure to carry out urgent repairs at hospitals across England has led to a dramatic increase in problems posing a “high risk” to patients and staff, ministers have warned.

The cost of clearing this backlog has almost tripled in real terms since 2015, to £2.7 billion this year. High-risk repairs were the fastest growing part of the long maintenance list at the time. It includes issues that could lead to serious harm to both staff and patients, or to major service disruption or “catastrophic failure”.

The NHS has lost more than 600 days – or 14,500 hours – of clinical time in the past year due to infrastructure failures, according to new analysis from the Observer. The total maintenance backlog has now risen to £13.8 billion by 2023-2024, an increase of 18% on last year. This figure is more than the entire NHS capital budget for this year.

According to the House of Commons Library’s analysis of official data, there was an average of 22 cases of lost clinical time per day. Nearly 80% of lost time was due to incidents considered to have the most clinical impact, including defective roofs, water leaks and broken lifts or heating systems. 1,584 ‘critical incidents’ were recorded, including the most serious.

Helen Morgan – the Liberal Democrats’ health and social care spokesperson, who commissioned the House of Commons Library to review data on the hospital repair backlog – blamed the “shocking figures” on years of neglect .

“Patients no longer have confidence that much-needed treatment will continue without being interrupted by hospitals collapsing around them,” she said. “How can the Government expect to reduce waiting times for the NHS when the buildings are in such a state of disrepair? It is a situation that the new government must urgently address and end.

“That should start with ministers bringing forward a 10-year plan to tackle the repair backlog and ensure our NHS is fit for purpose so patients can finally get the care they deserve.”

The Essex Partnership University NHS Trust recorded 300 critical incidents in 2023-2024, the most of any trust in England. It said it had to manage more than 200 sites in partnership with other providers. It is now focusing on a program of inpatient ward renovation, investing £20 million since 2020.

The Princess Alexandra Hospital NHS Trust recorded 229 critical incidents. Tom Burton, chief financial officer, said the trust continues to face challenges due to an ‘aging estate’, including electrical issues and older systems. The trust prioritises maintenance that ensures compliance with health and safety standards and improves the resilience of infrastructure.

The rise in serious maintenance problems is worrying NHS experts. “We see faster growth in the higher risk categories, where the consequences of not doing that maintenance would be more substantial,” said Katie Fozzard, an economist at the Health Foundation. “The highest risk category has almost tripled since 2015.”

Rory Deighton, acute network director at the NHS Confederation, said the increasing amount of clinical time lost to lapses within the NHS was “very concerning” and warned it was the result of long-term underfunding. “Healthcare leaders know firsthand the impact that crumbling buildings and outdated equipment have on the care they and their staff can provide to patients,” he said. “This is a direct result of the lack of capital invested in the NHS over the last decade or more.

“Greater investment in NHS estates, buildings and equipment is urgently needed given the maintenance bill for these buildings, and this infrastructure now exceeds the allocated capital budget as a whole. We must simultaneously repair what is broken and worn, but also build and modernize for the future, including the necessary technology and digital equipment.”

He also called for an overhaul of the bureaucracy that has often held up hospital bosses’ plans to carry out vital repair and modernization work. “The process of getting existing funding to the frontline urgently needs to be simplified,” he said.

Charles Tallack, director of research and analysis at the Health Foundation, warned that the poor state of the NHS estate was hampering efforts to make the service more efficient. “The productivity of the NHS has declined,” he said. “Hospital staff have increased by at least 20% since before the pandemic, but we haven’t seen that increase in hospital activity in a long time.

“Part of the reason is that we have not invested enough in building maintenance, so the additional staff is not used optimally. There are some very poignant examples of this. If you have theaters with leaking roofs or flooding, staff cannot continue to care for patients.”

The Government is now investing £1 billion to tackle the existing critical maintenance backlog. While the Tories had promised to build 40 new hospitals under the new hospitals programme, the plan was widely criticized for failing to provide the necessary funding to deliver it. The Labor government is now reviewing the program and prioritizing hospitals built with reinforced autoclaved aerated concrete (RAAC), which is now considered a serious risk.

A spokesperson for the Department of Health and Social Care said: “Buildings and equipment in the NHS are crumbling after years of neglect, disrupting patient care and hampering staff. We are investing more than £1 billion to tackle the existing backlog of critical maintenance, repairs and upgrades. Repairing and rebuilding our NHS estate will be a vital part of our ten-year healthcare plan.”