Boris Johnson’s spending commitments are not enough to clear the NHS maintenance backlog
The scale of repair, maintenance and renewal in the NHS is huge, failure to keep buildings safe poses significant risk to NHS patients and staff, writes Baroness Thornton.
We know that the backlog maintenance bill across the NHS has now climbed to record levels. It is patients who pay the price for years of capital neglect when for example, they are forced to wait longer for treatment because of faulty scanners or the NHS is unable to provide treatment for mental health conditions in appropriate wards or settings.
In recent reports from the Kings Fund, NHS Providers, the Health Foundation and indeed the NHS own information collection – charmingly known as ERIC (Estates Returns Information Collection), the scale of the need for repair, maintenance and renewal is huge.
Billions of pounds are needed to make the UK’s National Health Service buildings safe, with figures showing the cost of tackling the maintenance backlog has risen 8.4 per cent to £6.5bn. More than half the sum, £3.4bn, is needed to sort out issues that present a high or significant risk to patients and staff, according to the official data.
This neglect poses significant risk to patients and staff. I am not talking about carpets looking a little shabby or buildings run down prior to closure. This concerns facilities and equipment and working conditions which do not comply with statutory safety standards and mean patients may not be safe.
For example, one NHS Trust director reports that the broken gutters lead to water seeping through the walls when it rains heavily – so staff do a water update when they hand over shift, because they might have to unplug electrical equipment – including baby incubators if the walls are too wet.
And ageing medical equipment is also leading to higher costs and poorer care for NHS patients – as one trust chief executive said, she now has radiologists who are younger than some of the equipment they are using.
Old medical scanners are less productive and process images more slowly than their modern counterparts. In some cases, replacement parts are no longer manufactured so the NHS has to bespoke engineer older scanners at a higher cost. Images from older scanners can sometimes lack the granularity and resolution needed for effective clinical care – potentially risk to life with some conditions and certainly a poorer patient experience as appointments have to be rebooked at hospitals that have more modern equipment.
The situation may be even worse than the ERIC data suggests. These costs do not include VAT and the costs of displacing and disrupting clinical services. Second, the ERIC data does not include the maintenance needs of buildings and equipment in primary care, where only half of GP practices report their premises as fit for present needs, even worse social care, where it has been estimated that 85 per cent of the UK care home stock is more than 40 years old. And finally, ERIC data only records the costs of restoring the existing NHS estate. The capital costs of modernising and transforming the estate – through new community hubs for primary care networks or improved diagnostic facilities that will improve early detection of cancer – are additional to (and competing with) these maintenance costs.
How did this happen?
Over the most sustained period of austerity in NHS funding, more than £4 billion of planned capital investment has been reprioritised to support the day-to-day running costs of the NHS (eg, paying for staff salaries and medicines. We are now only beaten to bottom place for the level of capital investment in our NHS across the EU, by Greece.
We now face the fact that the UK has the lowest level of both CT and MRI scanners per capita among similar countries. These scanners are vital for screening people’s symptoms and helping to catch conditions, including cancer, at an earlier stage. With our cancer survival rates lagging behind comparable countries, investing in this equipment is vital.
When he became Prime Minister, Boris Johnson announced £1bn additional spending power for the NHS to spend on vital improvements to facilities in 2019/20, plus an additional £850 to cover 'upgrades for 20 hospitals'. In September 2019, this was supplemented by a welcome commitment from government to rebuild six acute hospitals, invest £200m in new diagnostic equipment and provide seed funding for a further 21 hospital schemes between 2021 and 2025. However it was deeply disappointing that no mental health, ambulance or community investment was included.
However welcome as the apparent priority being given to capital investment, these announcements still fall short of what is required to clear the maintenance backlog and invest in modern, innovative care for patients for the future.
NHS Providers calculate that the current NHS capital budget of circa £6bn a year needs to double over the next five to 10 years to address the maintenance backlog and meet patient need. This would match current capital spend in comparable countries, ensure safe care and help create the right environment for staff (OECD, 2017). There is still confusion about the level and target of investment after 2021, and my question to the Minister seeks to gain some clarity on when we see a multiyear settlement on capital that brings spending into line with other comparable economies, together with a better way of ensuring the money gets to where it’s needed most.
Baroness Thornton is a Labour and Co-operative Member of the House of Lords and Shadow Spokesperson for Health.