ESTATE MAINTENANCE Ventilation Domestic water
Electrical Life safety
Heating/Cooling Medical gas
to act on them remain constrained. Estates risks are often clearly identified and well known by the maintenance teams. However, they are presented across multiple reports and datasets, which are often incomplete, including six facet surveys, statutory compliance records, Trust risk databases, specialists’ reports, Authorising Engineer reports, and staff-held knowledge. Many hospital systems and processes exist to record
risks and non-compliances; however, processes to rectify them are often less developed or require a high level of approval, complicating corrective actions. Asset capture and system updates can be further
Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Yr 6 Yr 7 Yr 8 Yr 9 Yr 10
Graph showing example multi-year risk profile by type of backlog maintenance.
projects, which may result in Trusts delaying much needed planning and projects in high buildings. As a result, project scopes are reduced, increasing pressure for hospital groups to approve or derogate modifications that are not fully aligned with Health Technical Memoranda. In parallel, policies and procedures are not always be consistently applied, introducing tension between maintenance and project teams.
Ryan Elliott
Director at Hoare Lea, Ryan Elliott is a data-driven technology consultant with 13 years’ experience delivering complex technology strategies across construction, development, and operational estates. He supports NHS trusts in using data and software to reduce maintenance backlog, improve asset performance, and prioritise investment. With specialist expertise across healthcare, life sciences, and higher education, Ryan helps clients simplify digital technologies, focus on whole-life outcomes, and implement practical solutions that support user experience, operational resilience, and the drive to zero carbon.
Short-term solutions The reduction in project scopes, combined with the need to remediate problems within short timeframes, leads to the implementation of short-term solutions. While necessary in the moment, these solutions introduce additional risks, increase energy consumption, place an additional load on existing infrastructure, and work against long term sustainability objectives. A common example is heating systems; full system replacement may not be possible due to timeframes (summer months) and budgets, and temporary electrical heaters are introduced to ensure patient comfort and maintain safe care environments. However, this increases electrical costs, strains the electrical capacity of the building systems, and introduces a new fire risk. The impact of projects on clinical areas also needs to be taken into consideration. Additional measures and procedures, not typically required in other types of construction, are necessary in hospitals to ensure patient safety. Clinical operations must continue, projects may need to be scheduled at night, and construction activities such as dust generation can pose significant risks to patients. There is also an increased risk when new systems are integrated with existing older infrastructure such as water distribution or fire safety alarms. Pressure to complete projects on time due to clinical needs leads to poor soft landings, resulting in incomplete handover to maintenance teams, incomplete asset lists, and lack of maintenance, which introduces further problems in the future. Miscommunication between maintenance and project teams, or the by-passing of procedures in an occupied hospital, significantly impacts the whole estate. Risks that were previously contained at asset level will escalate to system wide issues if not properly managed. Finally, any surplus budget which emerges at the end
of the financial year, driven by the need to ‘break even’, cannot always be utilised effectively due to project timescales and delivery constraints. The cumulative effect is a continuous cycle of constrained budgets, short-term interventions, rising risk, and sustained pressure on estates teams to maintain safe and operational environments for patients and staff.
Governance and translation of technical risk While risks are often clearly identified, the mechanisms
70 Health Estate Journal September 2026
affected by poor soft-landing of projects, resulting in unknown or unmaintained assets. Over time, system information can become outdated, including asset registers and infrastructure drawings. This complicates maintenance and increases risks where assets are not properly maintained. In some cases, teams rely on historical knowledge or incomplete records, while new projects have to start using outdated information, leading to delays and increased costs. This data fragmentation complicates maintenance, compliance analysis, and risk assessment for already overstretched estates teams. Integrated Care Boards have a balancing act to determine the risks and needs of all organisations within their control and the impact on service delivery and operational pressures. As a result, estates decisions are not always made on technical risk alone, but within a wider funding context. At the same time, complex technical risks and findings
are often simplified through layers of committees and reporting to a level that does not fully represent their severity or their potential consequences. When information reaches the Board, which often has no estates or technical representation,3
risks may not be fully articulated, limiting
informed decision making and resulting in underinvestment in estates priorities.
The way forward A shift is required, from identifying technical risks to translating them into multi-year programmes of work, demonstrating that estates teams, often perceived primarily as an operational function, play a critical role in strategic decision making. This requires an evidence-based approach that allows for decision-makers to examine options on an objective basis. In a reactive and high-risk environment there is a tendency to focus on solely big, high-risk issues that can become emotive but are also very difficult to implement. We have seen in many cases where this paralyses decision-making and progress resulting in budgets not being spent and projects not being delivered. When a methodical approach is implemented that removes human bias and looks at what the best path forward is based on facts and data, meaningful progress can be achieved. This can mean challenging some pre- conceptions around how to address a problem such as backlog risk, specifically that often a mix of high risk-high effort projects paired with some easy wins is far more likely to make meaningful progress over time, as opposed to a focus on only the largest projects. In terms of removing bias, applying methods to risk assessments that focus on establishing facts rather than subjective scoring is also essential to better decision- making. For example, asking risk assessors a series of questions around the maintainable life of equipment, quality of maintenance records, and resiliency of the system, and using the answers to calculate a reliability score. We found that this creates a much better evidence base than asking individuals to apply a 1-5 score without a clear rationale.
TOTAL RISK SCORE
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