The latest figures for 2019-20 show that the total NHS backlog maintenance bill has rocketed by 38% in a single year — to £9 billion – almost the whole of the latest capital allocation.  

The official figures highlighting this new, higher backlog bill state: 

“This is also known as ‘backlog maintenance’ and is a measure of how much would need to be invested to restore a building to a certain state based on a state of assessed risk criteria. It does not include planned maintenance work (rather, it is work that should already have taken place).”

A look at the details reveals that the number of trusts struggling with backlog bills of over £100m has increased from 12 in 2018-19 to 16 in 2019-20.

Big increases in the reported backlog pushed Guy’s and St Thomas’s into the list with the second-highest total of £562m, while Imperial Health care in northwest London still has the largest backlog, slightly reduced to £671m.

Other freshly increased backlogs have pushed East Kent and East Sussex over the £100m mark, together with Lewisham & Greenwich Hospitals reporting a massive £63m maintenance problem at the PFI-funded Queen Elizabeth Hospital in Woolwich, which only opened 20 years ago, and for which the Trust is still forking out “unitary charge” payments that should cover maintenance.

36 more trusts have reported total maintenance backlogs of more than £40m: and almost 90% of the total backlog is classified as “high” “significant” or “moderate” risk, with only 12% “low risk”. Clearly the building stock is deteriorating faster than the government is willing to recognise, and the Covid impact will make this worse.

Our list of the backlogs over £100m do not include two apparently erroneous entries which show stupendous new backlogs on Mid Cheshire Hospitals (£373.9m) and West Suffolk Hospital Trust in Bury St Edmonds which shows as a monster total of £634.9m – surely more than enough to completely demolish and rebuild the 450-bed hospital more than once.

Even if these apparently rogue figures are set aside the total backlog still rises to £8 billion – 23% up in a year, before the Covid pandemic.

The backlog means is certain to get bigger still, as NHS trusts prioritise work to adapt buildings to cope with Covid, and with capital spending set to fall again in real terms next year.

The announcement by Health Secretary Matt Hancock of a new £600m investment into NHS hospitals across England, apparently aimed at “upgrading and refurbishing” hospital sites does not change the picture, not least because the money has to be spent quickly – by the end of March. It has already been earmarked for almost 1,800 projects across 178 trusts – mostly smaller overdue projects for the maintenance and new equipment.



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