Chart of the week: NHS backlog maintenance is shooting through the roof

Each week we present analysis of data in chart form to illustrate some key issues and invite discussion. This week, John Appleby looks at how the cost of the maintenance backlog in the English NHS has changed over the years, with the latest rise in the costs of necessary repairs and maintenance in the health service making it an even more pressing factor in calculations ahead of the Spending Review.

Chart of the week

Published: 19/08/2021

The latest estimates of the cost of repairs and maintenance that should have been carried out for English NHS trusts rocketed by 37% in one year to over £9 billion in 2019/20. This is now equivalent to the total annual cost of running all accident and emergency departments, ambulance services and critical care services combined.

It is also equivalent to an average of over £40 million for each of the 224 hospitals, ambulance services, community and mental health units in the country.

But backlog costs are not spread evenly. Three trusts – Imperial, West Suffolk and Guy’s and St Thomas’ – account for over a fifth of the total, with backlog costs ranging from £563 to £672 million.

Although some of the backlog maintenance is low priority, around 17% is not. Over £1.5 billion of the total cost is for high priority repairs or replacement which must be addressed urgently, “… in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution”. The costs of such high-priority maintenance have increased nearly four-fold in real terms over the last decade.

Recent reports of materials used in roofs coming towards the end of their lifespan over a decade ago, threatening the structural integrity of some hospitals built in the 1960s to 1980s, highlight the reality of accumulated maintenance problems over the years.

With this year’s Spending Review set to announce funding for the NHS in the coming weeks, there will be competing priorities. The huge growth in maintenance backlog has become an even more pressing factor in calculations of what the NHS needs to provide a safe environment for patients.