ESTATE MAINTENANCE


Mounting backlog putting patients at risk


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.


Financial impact 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 financial year would run into tens of millions of pounds in terms of clinical disruption. The backlog maintenance position is compounded by other factors: n Deterioration: The longer that investment is


£10 £12 £14


£0 £2 £4 £6 £8


7 6 5 4 3 2 1 0 7 6 5 4 3 2 1 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 0


withheld from backlog maintenance, the more assets will continue to deteriorate. This increases the cost when a repair becomes a replacement. This deterioration is clearly seen in the 23% increase in CIR. While overall backlog increases at an average 11%-13% per annum, CIR has started to increase at almost double the rate. This can only be down to deterioration of assets.


n Inflation: On top of the increasing cost due to asset deterioration, the cost of inflation plays a part in the increasing cost of backlog maintenance. However,


Table 1: Growth in backlog maintenance and critical infrastructure risk in England over 10 years.


BLM CIR


Linear (BLM) Linear (CIR)


The author says: “There is a general acceptance that maintenance is crucial in healthcare settings, and that the failure of key infrastructure systems – heating, water, ventilation, electrics – could have significant impact on patients. However, the lack of research into the impact of failing infrastructure is hard to assess…”


October 2024 Health Estate Journal 33


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132