PROCUREMENT
Procurement solutions can tackle the backlog
Estate management is an increasingly urgent issue for the UK government, which is facing a £49 bn public estate maintenance backlog, with £13.8 bn accounted for by the healthcare sector alone – more than twice the 2015/16 figure, highlighting a growing strain on healthcare infrastructure. With limited resources, NHS Trusts must now tap into available support. Here Jonathan Oram, director of Frameworks at procurement specialist, Pagabo, highlights how procurement solutions are key in effectively tackling the healthcare backlog crisis.
The struggle to ensure that NHS healthcare buildings remain fit-for-purpose is at a tipping point, and the mounting backlog maintenance costs for public estates highlight the strain that continues to stretch an already overburdened NHS, where many estates include ageing buildings. Improving healthcare infrastructure is a high priority for the government, as evidenced by the plans for new hospitals set out in New Hospital Programme (NHP). However, equally pressing – certainly in the short-to- medium term, is the fact that the existing estate needs to be refurbished, reconfigured, and revamped in many areas to continue to serve modern healthcare needs. However, for this to be done effectively, collaborative effort to deliver across client and project teams in a way that ensures top- quality clinical care, alongside overall value, will be key.
The cost of a crumbling estate The National Audit Office’s recent report (NAO), Maintaining public service facilities, published in January this year, spotlighting the staggering backlog in the UK’s estate maintenance, is not something we can suggest has come as a surprise. The detrimental effect on, and risks to, patient safety from issues such as poorly maintained buildings and M&E services are clear, but there are deeper cuts that continue to make the NHS bleed. These include treatment delays, cancelled procedures, and delays in discharge. As a construction sector, it can be easy for us to look at
Lincoln County Hospital Urgent Treatment Centre. Contractor – GF Tomlinson, procured through the Medium Works Framework.
healthcare buildings for what they are, but with the strain across NHS services continuing, it’s important for us to remember the people those buildings support. Tackling the estate maintenance backlog is thus about more than the structures that make up the NHS, but equally the imperative to restore the conditions necessary for timely, safe, and dignified healthcare.
Aligning with its report, the NAO has explored how
the estates backlog as a whole can be addressed. Standardisation is a top consideration, not only for ensuring compliance, but in support of long-term viability, which is the case if the NHS has to be a continued priority, and we are to build a healthcare system fit for the future. With the backlog increasingly impossible to ignore following the NAO’s high deficit figures, we can no longer deny that action is needed. We instead must turn our attention to how tackling these deficits can be done efficiently, safely, and at pace. Public sector procurement and the framework routes available offer an effective route for this. These are pre-tendered and compliant routes that can provide NHS Trusts with flexible and fast access to specialist providers across estates and facilities management specialties. From limited internal resources to inconsistent delivery standards, the practical challenges that NHS teams are facing can be supported through framework intervention. Here, Trusts can accelerate urgent maintenance works while standardising quality and compliance, without the burden of complex contracts and procurement cycles. The benefits of this process are frequently seen in
the work delivered through the frameworks Pagabo manages, including the Total Facilities Management Framework (TFM). This fallows for more than just reactive maintenance, and also supports proactive lifecycle planning, monitoring, and sustainability-focused upgrades, allowing us to shift from ‘firefighting’ to forward thinking.
Significant value offered NHS Estates teams should be focused on supply chain management and project delivery, which is where the deep value of frameworks – including the TFM framework and other sector-specific options – offer significant value. With many of the frameworks Pagabo manages being hosted by NHS Trusts themselves, their design has healthcare in mind throughout. This close alignment with operational realities, alongside extensive engagement with healthcare professionals and ongoing dialogue with Trusts, helps ensure that procurement processes reflect current needs, not outdated models. Sector-specific framework offerings especially can offer unique respite to the challenges of the declining healthcare estate. Designed with the unique pressures of healthcare facilities in mind – from space constraints in areas like A&E, to the risks of maintaining live sites throughout development – these frameworks offer more than just assistance; they provide tailored, up-to-date solutions. This means that Trusts don’t have to start from scratch when
52 Health Estate Journal September 2025
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