ESTATE MAINTENANCE
source of the impact quite often being latent. There is a sufficient body of evidence to indicate that an aged estate is having a detrimental effect on patient health,15
but this
is often couched in clinical research, with estates impact being incidental rather than the focus. In 2020/2021, 123 people lost their lives at work. In the same period an estimated 309 patients lost their lives in English NHS hospitals due to infrastructure failings.3
The impact of
latent harm is currently unknown. It has also been argued that poor infrastructure has a negative effect of staff recruitment,16,17
devastating effect on patients when estate fails. Whether it is the increased deaths seen during COVID-19 due to insufficient and failing mechanical ventilation,18
the
review of MRSA and C. difficile transmissions attributable to restricted natural ventilation and poor mechanical ventilation, or a meta study in 2007 which noted the death of 12 patients, mostly linked back to failings within the estates infrastructure, the studies clearly demonstrate how the Estates department is not only intertwined with the clinical teams, but can be the source of significant impact to both patient and clinical services. Such outbreaks ‘require the co-ordinated efforts of clinicians, nurses, pharmacy and hospital engineers, working in collaboration with the hospital infection control team’.19
Making a change If the level of backlog maintenance and CIR continues to grow over the next five years at the same rate seen over the preceding 10, in 2028/29 the level of backlog will have risen to £25 m green book value, with over one- third being classified as critical infrastructure risk. The risks
which in turn could have a direct impact on
the patient if the facility was under-resourced. There are many isolated studies which demonstrate the
that this level of backlog maintenance carries could be catastrophic for the patients, staff, and the reputation of the NHS. So, something needs to change. Firstly, while the green book value quoted within ERIC is a common cost baseline, it hides a significant cost. Stating that a Trust has £100 m of backlog maintenance is inaccurate, as it omits so many costs. While there is no agreement whether the green book cost should be uplifted by 70%, 80%, or indeed 100%, one thing is certain – the £11.6 bn of backlog is closer to £20 bn. Implementing an agreed uplift for all Trusts will give a far better indicator of the cost impact than simply using green book value.
In 2022/23, ERIC data suggests that over 2,600 patients in acute hospitals had their treatment delayed or cancelled due to infrastructure issues at their hospital.
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October 2024 Health Estate Journal 35
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