ESTATE MAINTENANCE
Badly maintained buildings can be a risk for all
David Jones, director of Estates, Facilities and Capital Development at the University Hospital Southampton NHS Foundation Trust, argues that more thought must be given to the potential risk to patient, staff, and visitor well-being of operating out of hospital buildings that are neither ‘sound’, nor ‘operationally safe’. He also questions why there is not more published research on the impact of an often ageing and poor quality healthcare estate on both quality of care and patient outcomes.
The recent global pandemic caused by SARS-CoV-2 highlighted significant shortcomings in the infrastructure of healthcare estate across the National Health Service. A report commissioned by the Institute for Government, ‘How Fit were Public Service for Coronavirus’, stated that ‘The NHS could have entered this crisis with a more resilient health infrastructure if it had invested more in recent years’.1 However, while the pandemic has added additional stressors to the estate, this is not a new issue. In 2021, the National Patient Safety
Agency (NPSA) released data which states that clinical service incidents citing work and environmental factors in 2019/20 had doubled to over 115,000 incidents since 2011/12,2
incidents. In the same year, the latest Estates Returns Information Collections (ERIC)3
highlighted that for five years
in a row the cost to eradicate backlog maintenance within the NHS had grown, reaching an all-time high of £9.034 bn in 2020/21.
Definition of backlog maintenance cost The definition of backlog maintenance cost was set down by the Department of Health (DH) in 20044
as: ‘Backlog
maintenance cost (backlog) is the cost to bring estate assets that are below condition B in terms of their physical condition and/or compliance with mandatory fire safety requirements and statutory safety legislation up to condition B’. (4
, pg 3)
Condition B is further described as each element of the estate being ‘sound, operationally safe, and exhibits only minor deterioration’ (4
, pg12). While not stated
within the DH guidance, the extrapolation of this argument is that the estate which is not in condition B is therefore not sound, nor operationally safe, and exhibits more than minor deterioration and, as such, a potential risk to patients. Given the age of the estate, and the static nature of capital funding,5
there 52 Health Estate Journal September 2022
Of the £1.2 bn granted in funding in 2020/2021 by The National Institute of Healthcare Research for research in the NHS, none was directed at estates infrastructure research – despite significant evidence through work on evidence-based design that the environment within which healthcare is delivered strongly impacts patient outcomes.
is little wonder that the NHS has the current levels of backlog maintenance. The New Health Infrastructure Plan (HIP), while extremely welcome among NHS estates professionals, is a £3.7 bn drop in a very large ocean compared with what investment is required to bring the infrastructure to an acceptable standard, i.e. condition B. Chart 1 highlights the impact of the HIP programme on the backlog maintenance position. While this appears a significantly positive step in the reduction of overall backlog, over 25% of the reduction is the result of replacing just two hospitals.
Ageing infrastructure harming patients When looked at from a building-by- building perspective (Chart 2), it is clear that the impact on the age profile of hospitals has barely changed. Why, though, does it matter that the estate is looking
tired, that the lifts don’t always work the way they were designed, or that the wards get a little warm during the summer due to lack of ventilation? The simple answer is that the infrastructure is harming patients. We are aware of over 1.3 m cases since
2003 in which work and environmental factors are cited as having been direct contributory factors to patient incidents. The source of patient risk from infrastructure failure can originate from two main sources. The first source to consider is that of a primary cause/effect relationship, such as the recent concern around Reinforced Autoclaved Aerated Concrete, which reached its life expectancy over a decade ago in a number of Trusts, and has a risk of collapsing, causing harm to patients and staff alike,6
or environmental factors which cause a patient to trip.7
A latent impact? The second source to consider is the
accounting for 5.3% of all reported
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