The backlog maintenance bill for England’s NHS has soared yet again to a new high of almost £16 billion, a staggering increase of 166% from the £6 billion estimated figure when The Lowdown first started in early 2019.
By 2021, it had risen by 50% to £9 billion. In 2022, it reached £10.2bn. With the Tory government’s infamous policy of ‘austerity’ in full swing and restricting capital spending right up to the general election in 2024, the total backlog ballooned again to £13.8bn last autumn.
The latest increase, revealed in the 2024-25 ERIC (Estates Return Information Collection), is over 15 percent in a single year. It takes the number of trusts with £100m-plus backlogs up to 51, with a combined total of £10.7 billion, two thirds of the total. 14 trust total backlogs are now above £200m, of which 6 exceed £400m.
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See the Lowdown’s full list of trusts with £100m-plus deficits
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The largest trust totals of all are both in London: Guy’s and St Thomas’ FT at £532m and, as ever, Imperial College Healthcare in north west London again tops the dismal league of crumbling buildings with a backlog of £902m. The Imperial backlog is almost all down to the Trust’s three chronically neglected major hospitals: St Mary’s, Paddington (£296m) Charing Cross, Fulham (£425m) and Hammersmith (£132m).
In total nine individual hospital buildings now have backlogs in excess of £200m: they include St Mary’s and Charing Cross, along with St Thomas’ (£308m) Northwick Park in north west London (£304m); Queen Elizabeth Hospital, Birmingham (£269m); Queens Medical Centre in Nottingham (£236m); Newham General, east London (£235m); Addenbrooke’s Hospital, Cambridge (£235m); and Nottingham City Hospital (£206m).
The latest ERIC figures also include surprisingly low estimates for essential maintenance to prevent the collapse of several hospitals built with crumbling reinforced autoclaved aerated concrete (RAAC), which have been short-listed for replacement … some time in the future as part of the painfully slow and inadequate hospital building programme which Labour ministers inherited from the Tories.
The rebuild costs will be much higher than listed, and for every year that passes the risk grows greater of a disastrous collapse that could injure patients and staff.
As a useful King’s Fund comment has pointed out, the figures break the backlog into four categories—high risk, significant risk, moderate risk, and low risk; however, all of the statistics represent work that should already have been done to ensure services can be delivered reliably and safely.
£3.5 billion of the total (22%) is to tackle the highest-risk issues. The King’s Fund’s
Siva Anandaciva points out that, in addition to these problems which are (with two exceptions) mainly restricted to the acute hospital sector, there are significant problems in primary care:
“… separate data from last month’s BMA premises survey show over 70% of the surveyed GP estate was more than 25 years old and half the respondents said their premises were not suitable for the present needs.”
He goes on to give examples of what these backlog maintenance costs mean in real life:
“It means one staff toilet shared by 35 staff in a GP practice. It means ligature points left in mental health facilities. And it means you can spend years on a waiting list. It means you can then get a call on the day of your surgery to say your procedure has to be postponed. It means you’ll be told that this isn’t because of a shortage of staff but because the ventilation system has failed in your operating theatre, or because sewage is leaking through the corridor outside the ward you would have been recovering on….”
The problem was not caused by the current Labour government, but by 14 years of serious underfunding from 2010. However, Labour ministers created a problem for themselves by opting at the last minute to include a promise in their manifesto to deliver the remains of Boris Johnson’s empty pledge of “40 new hospitals,” which Labour had rightly mocked as the “fake forty” when the promise was first made in 2019.
Failure was guaranteed, and it came quite quickly, as Anandaciva notes:
“Remember, this Labour government pledged to deliver the previous government’s New Hospital Programme only to reprofile and delay parts of the programme within months of taking office.”
Everybody has been told for ever and a day that there is not enough money to sort all the problems of the NHS: but the ERIC figures each year are a reminder that the scale of the deterioration of vital infrastructure tends to escalate, along with the costs of building new replacements for hospitals that still play a vital role in health care for the foreseeable future.
While there might be an argument for preferentially investing in community health, mental health, and primary care services (and, of course, in social care—the forgotten service), this does not mean acute services can be ignored.
It will take years before public health measures tangibly reduce the demand for hospital care – and nobody will thank any government that insists on spending limits that force chaotic closures as buildings cease to be fit or safe for purpose.
All the brave talk of driving increased productivity and “digital first” can result in the demoralisation of staff forced to work with clapped-out kit in leaky, draughty buildings (especially those only held up, like the Queen Elizabeth Hospital in King’s Lynn, by thousands of metal props).
If the hefty bills for brand new hospitals are out of reach for a cash-strapped government, surely it makes sense to maximise the usefulness of the buildings now in place, by finding an extra ringfenced £3.5m per year in additional funds and resources for a rolling programme to tackle the highest risk maintenance, and then move on to tackle the other longer-term threats.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
The backlog maintenance bill for England’s NHS has soared yet again to a new high of almost £16 billion, a staggering increase of 166% from the £6 billion estimated figure when The Lowdown first started in early 2019.
By 2021, it had risen by 50% to £9 billion. In 2022, it reached £10.2bn. With the Tory government’s infamous policy of ‘austerity’ in full swing and restricting capital spending right up to the general election in 2024, the total backlog ballooned again to £13.8bn last autumn.
The latest increase, revealed in the 2024-25 ERIC (Estates Return Information Collection), is over 15 percent in a single year. It takes the number of trusts with £100m-plus backlogs up to 51, with a combined total of £10.7 billion, two thirds of the total. 14 trust total backlogs are now above £200m, of which 6 exceed £400m.
_____________________________
See the Lowdown’s full list of trusts with £100m-plus deficits
_____________________________
The largest trust totals of all are both in London: Guy’s and St Thomas’ FT at £532m and, as ever, Imperial College Healthcare in north west London again tops the dismal league of crumbling buildings with a backlog of £902m. The Imperial backlog is almost all down to the Trust’s three chronically neglected major hospitals: St Mary’s, Paddington (£296m) Charing Cross, Fulham (£425m) and Hammersmith (£132m).
In total nine individual hospital buildings now have backlogs in excess of £200m: they include St Mary’s and Charing Cross, along with St Thomas’ (£308m) Northwick Park in north west London (£304m); Queen Elizabeth Hospital, Birmingham (£269m); Queens Medical Centre in Nottingham (£236m); Newham General, east London (£235m); Addenbrooke’s Hospital, Cambridge (£235m); and Nottingham City Hospital (£206m).
The latest ERIC figures also include surprisingly low estimates for essential maintenance to prevent the collapse of several hospitals built with crumbling reinforced autoclaved aerated concrete (RAAC), which have been short-listed for replacement … some time in the future as part of the painfully slow and inadequate hospital building programme which Labour ministers inherited from the Tories.
The rebuild costs will be much higher than listed, and for every year that passes the risk grows greater of a disastrous collapse that could injure patients and staff.
As a useful King’s Fund comment has pointed out, the figures break the backlog into four categories—high risk, significant risk, moderate risk, and low risk; however, all of the statistics represent work that should already have been done to ensure services can be delivered reliably and safely.
£3.5 billion of the total (22%) is to tackle the highest-risk issues. The King’s Fund’s
Siva Anandaciva points out that, in addition to these problems which are (with two exceptions) mainly restricted to the acute hospital sector, there are significant problems in primary care:
He goes on to give examples of what these backlog maintenance costs mean in real life:
The problem was not caused by the current Labour government, but by 14 years of serious underfunding from 2010. However, Labour ministers created a problem for themselves by opting at the last minute to include a promise in their manifesto to deliver the remains of Boris Johnson’s empty pledge of “40 new hospitals,” which Labour had rightly mocked as the “fake forty” when the promise was first made in 2019.
Failure was guaranteed, and it came quite quickly, as Anandaciva notes:
“Remember, this Labour government pledged to deliver the previous government’s New Hospital Programme only to reprofile and delay parts of the programme within months of taking office.”
Everybody has been told for ever and a day that there is not enough money to sort all the problems of the NHS: but the ERIC figures each year are a reminder that the scale of the deterioration of vital infrastructure tends to escalate, along with the costs of building new replacements for hospitals that still play a vital role in health care for the foreseeable future.
While there might be an argument for preferentially investing in community health, mental health, and primary care services (and, of course, in social care—the forgotten service), this does not mean acute services can be ignored.
It will take years before public health measures tangibly reduce the demand for hospital care – and nobody will thank any government that insists on spending limits that force chaotic closures as buildings cease to be fit or safe for purpose.
All the brave talk of driving increased productivity and “digital first” can result in the demoralisation of staff forced to work with clapped-out kit in leaky, draughty buildings (especially those only held up, like the Queen Elizabeth Hospital in King’s Lynn, by thousands of metal props).
If the hefty bills for brand new hospitals are out of reach for a cash-strapped government, surely it makes sense to maximise the usefulness of the buildings now in place, by finding an extra ringfenced £3.5m per year in additional funds and resources for a rolling programme to tackle the highest risk maintenance, and then move on to tackle the other longer-term threats.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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