ESTATE MAINTENANCE
Translating estates risk into strategic decisions
NHS estates are under pressure from ageing infrastructure, a rising maintenance backlog, and constrained capital investment, leaving organisations operating in a cycle of reactive interventions and growing risk. While these risks are often well understood at an operational level, they are not consistently translated into structured, deliverable investment programmes. Blanca Beato Arribas, associate, Ryan Elliott, director, and Andy Vernon, director and healthcare sector lead from building consultants firm Hoare Lea explore how a systematic data analysis and risk-led approach can support better decision-making, reduce long-term risk, and improve environments for patients and staff.
Despite the government’s announcement to invest in hospitals in the New Hospital Programme (NHP), the programme only addresses 20 per cent of England’s Trusts, leaving many existing Trusts in England, Scotland, Wales, and Northern Ireland to continue to deal with an ageing estate and increasing backlog risks.1
This raises the
need to avoid the NHS evolving into a two-tier system, where some organisations benefit from new infrastructure while others continue to manage ageing estates. Backlog maintenance persists not because risks are
unknown, but because technical estates intelligence is insufficiently translated into structured, multi-year Board- ready investment programmes. Estate teams face significant pressures, from day-to-day
operational pressures to keep clinical operations ongoing, fragmented data, and continuous pressure to deliver projects under stricter procurement, building safety act (fire) regulations, and reduced budgets. As a result, small- scope projects designed to minimise immediate clinical risks are more likely to be delivered, leading to increasing overall risks, placing additional strain on existing infrastructure, raising maintenance costs, and impacting sustainability goals in the long run. Analysing data from multiple sources, however incomplete – including estates risk databases, backlog items, and six facet surveys – and applying NHS backlog risk categorisation to the results, is not a straightforward exercise. In addition, a large amount of information sits with individuals and is not formally captured. However, when information is approached in a systematic manner it can unlock solutions that address the backlog. It can then support the development of multi-year, deliverable programmes of work. These enable estates teams to present data clearly and in an evidence-based manner, alongside multiple investment scenarios to board level decision makers, supporting tangible risk reduction over time. This improved visibility also allows estates teams to engage more effectively with the supply chain, providing greater certainty around future workstreams and enabling partners to plan, invest, and support delivery over the longer term.
The persistent backlog problem The NHP, originally set to deliver 40 hospital schemes by 2030, has been welcome news in the NHS. NHP is being delivered across multiple waves, with only a limited number of schemes currently in construction, and many remain in early planning stages. Project delays and programme reprioritisation means that some trusts will not see a new hospital complete in 20 years, while others
are not on the NHP list at all. This situation leaves many Trusts in charge of maintaining ageing estates, where risks continue to increase, systems are under constant strain, and funding constraints limit the ability to deal with increasing backlog costs. Existing NHS England hospitals are facing a maintenance backlog that has grown from £1bn in 2015 to £15bn in 2026,2
with critical repairs and costs both
on the rise, while funds to address this backlog remain constrained. The most critical issues include failures that can lead to significant clinical disruption, such as heating outages, flooding, or infrastructure failures requiring the closure of wards or relocation of patients.
Constant financial pressure Estates teams are under constant pressure to ensure that failing systems continue to work without impacting clinical areas or operations. Although teams are knowledgeable about the systems, the development of a programme of works for the next financial year (or years) tends to be decided under time constraints and with possible area-of- expertise bias. Projects drafted for the following financial year
are often impacted by delays in budget allocation and procurement regulations, which severely affect project completion deadlines, as projects cannot commence until budget is released. Project teams are often closing out works from the previous financial year, while beginning to scope new schemes without confirmed budgets. Once funding is released, these teams are under pressure to complete projects in a reduced timeframe. Additional fire safety requirements under the Building Safety Act (BSA) can introduce further delays and significant costs to
Graph showing example multi-year budget by type of backlog maintenance.
Annual budget
Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Yr 6 Yr 7 Yr 8 Yr 9 Yr 10 TIME
Ventilation Domestic water
Electrical Life safety
Heating/Cooling Medical gas
September 2026 Health Estate Journal 69
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