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Government response:

A Department of Health and Social Care spokesperson said:

“We have invested significant sums to upgrade and modernise NHS buildings – including £4.2 billion this financial year – so staff have the facilities needed to provide world-class care for patients.

“Trusts are responsible for prioritising this funding to maintain and refurbish their premises, including the renewal and replacement of equipment.

“This is on top of the expected investment of over £20 billion for the New Hospital Programme, a further £1.7 billion for over 70 hospital upgrades across England, and a range of nationally funded infrastructure improvements in mental health, urgent and emergency care and diagnostic capacity.”

Background

  • Individual NHS organisations are legally responsible for maintaining their estates.
  • The government has been clear that it expects NHS organisations to use existing capital budgets and assets to maximum effect.

Rights-of-replies from NHS trusts

IMPERIAL COLLEGE HEALTHCARE NHS TRUST had the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) according to the most recent figures.

Eric Munro, director of estates and facilities at the trust, said: “Much of our estate pre-dates the NHS – some of our buildings are nearly 180 years old. We spend around £25 million a year just to deal with the highest risk maintenance issues so that we can stay operational and keep everyone safe.

“The only realistic way of properly addressing the maintenance backlog is through the redevelopment of our sites, with a full rebuild of St Mary’s Hospital in Paddington our most pressing need. All three of our main hospitals are included in the Government’s New Hospital Programme and we are doing all we can to accelerate our schemes.”

Additional background information for editors:

  • We have not identified any issues related to reinforced autoclaved aerated concrete (RAAC).
  • Examples of high risk backlog: replacing and updating heating, ventilation and power systems, lifts and building fabric (such as roof, walls and floors etc) and upgrading electrical supplies. Much of this infrastructure is past its recommended life span but is required to meet growing demand and new technologies.
  • For more details about our redevelopment plans, including the need: St Mary’s https://www.imperial.nhs.uk/st-marys-development; our three main sites https://www.imperial.nhs.uk/about-us/building-better-hospitals

THE QUEEN ELIZABETH HOSPITAL KING’S LYNN NHS FOUNDATION TRUST was among the 10 trusts with the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) according to the most recent, published figures.

Paul Brooks, Director of Estates and Facilities at the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, said: “The QEH is a Reinforced Autoclaved Aerated Concrete (RAAC) hospital, and we continue to invest national capital funding to maximise the safety the Trust’s current building. Working with a skilled engineering team, we have implemented an intense installation programme over the past two years to create a steel and support structure to maintain the safety of the roof, for our patients, visitors and staff.

“We appreciate it can be disconcerting for our patients and visitors when they see building work taking place - teams across the Trust are doing their utmost to keep disruption to a minimum. In May 2023 the Government announced that the QEH had been added to New Hospital Programme so as a Trust we are working at pace with enabling work to bring a new hospital to King’s Lynn and West Norfolk by 2030.”

In response to Rebecca’s experience, Paul Brooks, Director of Estates and Facilities at the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, said:

“We continue our rolling Reinforced Autoclaved Aerated Concrete (RAAC) programme of installing steel and timber support props across the hospital to maximise the safety of our buildings for our patients and staff. We currently have 3,397 steel and timber support props across the Trust. We appreciate these props and the work around the site can be unsettling for patients. These measures are proactive steps to maximise safety at our hospital. We are working with the national New Hospital Programme team who are supporting us to find a long term solution.

“In January [2023] the Trust suffered a blockage in a drainage system near to the West Wing area of the hospital. Our Estates team responded immediately to clear the blockage and clean down the area. Monitoring of the drainage system is carried out by the Estates team on a daily basis, to prevent sewage leaks. Our hospital is in a semi-rural location, with several sides surrounded by woodland. We have a local provider responsible for our pest control which performs regular visits to audit the site and responds on the same day to any reports to take immediate action.”

LEEDS TEACHING HOSPITALS NHS TRUST was among the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23, according to the most recent, published figures.

Craige Richardson, Director of Estates and Facilities, Leeds Teaching Hospitals NHS Trust, said:

“The Trust, like many organisations across the NHS, has a significant maintenance backlog, with large parts of our sites spanning as far back as Victorian times. It’s not unusual to see movement when compared year on year, especially across such a large/diverse estate.

“We have recently carried out a full, comprehensive survey of our buildings across all sites, and as a result some elements were re-graded. A large proportion of this increase was expected, and we have plans in place to address it, either through investing in ‘greener solutions’ or imminent building disposal.

“The safety of our patients, visitors and staff remains a priority of the Trust.

“We have plans to halve the overall backlog maintenance at Leeds Teaching Hospitals, through a new state-of-the-art hospital on the Leeds General Infirmary site . The project is fully funded by the Government, and we are currently awaiting the go ahead from the New Hospital Programme to start construction. It will provide a new home for Leeds Children’s Hospital, a new adults’ hospital and one of the largest single-site maternity centres.”

BEDFORDSHIRE HOSPITALS NHS FOUNDATION TRUST was among the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23, according to the most recent, published figures.

A spokesperson for Bedfordshire Hospitals NHS Foundation Trust answered our questions.

Q: Referring to your trust, can you tell me how this high-risk repair bill has accumulated?

A: “Our Trust estate is ageing with a number of high and significant risks that can no longer proactively be managed. This is due to changes in building regulations and compliance requirements, hyper-inflation within the construction market, pressure on specialist resourcing in terms of skill and capacity, as well as our estates being pushed to the limit to support clinical activity, priorities and risk.”

Q: Can your trust afford to complete these repairs? Have you asked for help with these repairs? If so, from whom (eg government) and what was the response?

A: “Our Trust’s backlog stands at £193m and is growing, which we are unable to afford to address. These risks are regularly reported via local forums and the annual ERIC return. There is national recognition that capital funding is inadequate, with limited funding opportunities available to address high and significant risk.”

Q: Should patients be concerned to see these figures? What would you say to them?

A: The figures shown are concerning, however a schedule of high risk backlog maintenance is rolled out on an annual basis, focusing on the highest risks to clinical service provision.

Q: What has caused the repair bill to increase by the percentage it has at your trust from 2021-22 to 2022-23 – was that down to a survey of your buildings in that time period for example? Has the discovery of RAAC concrete played a role in the size of this repair bill at your trust?

A: This is caused by our ageing estate and the number of risks that can no longer be proactively managed. As mentioned above, this is due to changes in building regulations and compliance requirements, hyper-inflation within the construction market, pressure on specialist resourcing in terms of skill and capacity, as well as our estates being pushed to the limit to support clinical activity, priorities and risk. To date, no RAAC has been found in the Trust estate.

Q: What solutions can you put in place before and in order for these high-risk repairs can be carried out? How soon can those repairs be carried out and what would the impact be on patients for those repairs to be carried out eg necessary part-closure of the hospital site? What impact would that have on patients? Is that something about which you have already made patients aware if and when repairs can be scheduled?

A: “An annual programme of high risk maintenance is proactively rolled out across the Trust Estate. Significant consideration is given to the operational estate to ensure minimal impact on patient services where possible. The estate would benefit from a substantial uplift in capital funding to address estate risks and allow for the proactive maintenance and upkeep.”

LONDON NORTH WEST HEALTHCARE NHS TRUST was among the 10 trusts with the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) according to the most recent, published figures.

A spokesperson for London North West University Healthcare NHS Trust answered our questions.

Q: How has this high-risk repair bill accumulated?

A: “Northwick Park Hospital is now more than fifty years old, while Ealing Hospital is approaching fifty. Despite ongoing regular maintenance work, the ageing infrastructure on both sites presents a significant challenge. In addition, modern healthcare requires additional space, higher intensity of use, and a greater level of engineering systems, requiring considerably more maintenance than would have been the case when the sites were built. We have already invested significantly to fix a number of these issues, including building a new energy centre at Northwick Park to move away from steam, improving our electricity generators for our secondary electricity supply, and replacing or upgrading a range of other systems such as fire alarms, water systems and medical gas supply mechanisms. However, other complex systems, such as ventilation and lifts, continue to need substantial work.”

Q: Have you asked for help with these repairs? If so, from whom (eg government) and what was the response?

A: “We bid for funding support from various sources, including from capital funding from NHS England. Modernising and investing in new facilities remains one of the most effective ways to reduce this kind of backlog, and therefore this year we have already made some substantial improvements to critical aspects of our estate, including important refurbishment work to our maternity unit and birthing centre, and other crucial site developments including the development of the community diagnostic centre at Ealing and the acute medical unit at Northwick Park.”

Q: Should patients be concerned to see these figures? What would you say to them?

A: “Our patients can be confident that we monitor any issues associated with our sites very closely, and that we anticipate and swiftly deal with any issue that could have an immediate impact on our ability to provide care. This includes rigorous risk management, governance and health and safety processes and reporting, which ultimately are overseen by our board of directors.”

Q: Has the discovery of RAAC concrete played a role in the size of this repair bill at your trust?

A: No.

Q: What solutions can you put in place before and in order for these high-risk repairs can be carried out? How soon can those repairs be carried out and what would the impact be on patients for those repairs to be carried out eg necessary part-closure of the hospital site? What impact would that have on patients?

A: “We have a long-term plan to address these repairs, but as with any older hospital site, maintenance is an ongoing activity that requires constant monitoring and updating. We work closely with our partner trusts in north west London to minimise any impact on our patients and communities and will always seek to minimise disruption to our services. This means completing work in a phased and coordinated way that allows healthcare to continue. Wherever possible, we align repairs with other important improvements to our sites, as we are currently doing with the community diagnostic centre at Ealing and hope to do by developing a new critical care unit at Northwick Park.”

AIREDALE NHS FOUNDATION TRUST was among the 10 trusts with the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) as well as being among the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23, according to the most recent, published figures.

Foluke Ajayi, Chief Executive of Airedale NHS Foundation Trust, said: “Our RAAC risks are well-known, and this figure highlights the extent of the work being carried out to address the structural issues at Airedale.

“Being on the New Hospital Programme means that we can now look forward to a future in a RAAC-free hospital estate. But in the meantime, we continue to take every step possible to maintain safety within the building. This includes a comprehensive programme of rolling inspections and putting in structural supports and installing structural solutions where necessary.”

WEST SUFFOLK NHS FOUNDATION TRUST was among the 10 trusts with the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) according to the most recent, published figures.

Craig Black, executive director of resources for the West Suffolk NHS Foundation Trust, said:

“The safety of patients, staff, and visitors is our priority and we have always followed expert, independent advice when it comes to the management of our buildings.

“Due to our ageing estate and the prevalence of RAAC across much of our West Suffolk Hospital site, we have undertaken a large programme of remedial works to support our RAAC infrastructure and made improvements in areas that include asbestos, ventilation and fire safety.

“As part of these works, which are well advanced and sit alongside general maintenance, we continually address areas of ongoing concern and do so as and when further risks are identified.

“In addition, we are a ‘priority site’ under the Government’s New Hospital Programme and are on track to deliver a new healthcare facility on Hardwick Manor in Bury St Edmunds by 2030.”

Background for editors:

  • The Trust is well advanced in a programme of remedial works across its West Suffolk Hospital estate to mitigate the risks associated with RAAC (reinforced autoclaved aerated concrete), which has required significant investment. Several safety measures to help manage the site are in place including:
    • Regular survey and monitoring programme, assessing the condition of RAAC planks. Increased surveillance is ongoing until the main hospital relocates to a new site.
    • If an issue is found, remedial and mitigating work is undertaken immediately and short-term, temporary props installed to reinforce the plank.
    • Substantial additional precautionary measures: as of December 2023, 88% of RAAC roof planks have precautionary supports in place, the majority of these are failsafe roof supports of steel and timber beams – a support system being implemented across the hospital
    • A specific treatment scheme for wall panels is using zinc anode technology to prevent further deterioration; 100% of the RAAC wall panels have been treated.
    • There have been no plank failures at the West Suffolk Hospital.
  • To provide additional capacity and minimise disruption to patients while the RAAC estate maintenance programmes have been ongoing, the Trust designed and commissioned a decant ward.
  • The vast majority of the £65.7m repairs backlog is associated with the remedial works undertaken to mitigate the risks associated with RAAC, for which the Trust has received significant funding from the government.
  • Due to the ageing estate, the West Suffolk Hospital site’s asbestos works have been ongoing for many years and will continue to be a core area of work now and in the future. A large amount of the asbestos works have come under the Trust’s estates maintenance programme which mitigates the risks associated with RAAC.
  • Continual remedial works and improvements have been made across the estate’s fire safety requirements, which also sit alongside the estates maintenance programme which mitigates the risks associated with RAAC.
  • Much of the current high and significant risk ventilation works are anticipated to be completed by summer 2024.
  • To Trust carries out a whole estate review every five years (20% of the site assessed annually) to determine what it needs to do to maintain its land and property to an accessible standard in line with best practice. This annual review means the costs attributed to the backlog change as works for the following year are identified. Therefore, the size of the backlog can increase or decrease between years.
  • West Suffolk NHS Foundation Trust is a ‘priority site’ under the Government’s New Hospital Programme and is on track to deliver a new healthcare facility on Hardwick Manor in Bury St Edmunds by 2030.

OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST was among the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23, according to the most recent, published figures.

Mark Holloway, Chief Officer for Estates and Facilities at Oxford University Hospitals NHS Foundation Trust, said: “Here at OUH, we are one of the largest Trusts in the country and have four hospital sites, as well as other satellite properties.

“The uplift at OUH is as a result of a newer, detailed and more targeted building condition survey. In terms of RAAC, a very small amount was identified at the Churchill Hospital site in Oxford. Whilst having established the level of risk, the identified RAAC is currently safe and inspected regularly, however the Trust has been successful in receiving national RAAC remedial funding and will be removing all identified RAAC material from the hospital this year.

“Patient safety is our number one priority at the Trust, and continual investments and improvements in our estate do not compromise or impact patient or staff safety. It is our ambition to improve and replace our oldest estate and make the best use possible of our more modern buildings for the benefit of our patients and staff.”

Background for editors:

  • Our approach to capital investment to reduce backlog maintenance is prioritised on a risk-based approach, and we prioritise the areas in greatest need.

CROYDON HEALTH SERVICES NHS TRUST was among the 10 trusts with the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) and among the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23, according to the most recent, published figures.

A spokesperson for Croydon Health Services said: “We are working hard to improve our estate to support the delivery of high quality care, and through a planned maintenance regime we continuously monitor our buildings and infrastructure to ensure these remain safe and compliant as possible with the required standards for healthcare settings.

“Our new Estates Strategy, which launched in December 2023, followed a deep dive audit that informed the latest NHS ERIC data, and established our priorities to tackle the backlog on maintenance and also identified how we can further optimise and future proof our estate.”

BUCKINGHAMSHIRE HEALTHCARE NHS TRUST was among the 10 trusts with the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) according to the most recent, published figures.

It referred us to background on its website, which related to the age of its buildings and the cost of the continual upkeep of the tower at Wycombe Hospital: https://www.buckshealthcare.nhs.uk/our-organisation/where-your-care-is-delivered/

HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST was among the 10 trusts with the largest high-risk repairs backlog in 2022-23 (filtered to general acute hospitals only) and the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23.

A spokesperson for Homerton Healthcare Foundation Trust said: “The vast majority of our hospital buildings and community sites are in a sound condition.The Trust has in place the appropriate health and safety mitigations to ensure we keep our patients and staff safe. Our estates team work very hard to limit interruptions to patient care resulting from estates maintenance. The Trust uses a risk-based approach to prioritising capital funding, and we are developing a comprehensive 10 years estates capital programme. In the short term, we are carrying out a number of fire compliance works in wards and departments. All maintenance requests are logged and prioritised in line with clinical need or risk.”

A spokesperson for UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST, which was among the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23 in its acute hospitals, sent us the following background for editors, but not to be used as quotes.

Please find below some background information that we hope is helpful for factual accuracy in your reporting. Please treat this as background rather than for us as quotes from the Trust.

  • University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) has five sites across two counties, with more than 14,500 staff. From analysis we have done, we understand that the figures shared by the BBC link to just one of our acute hospital sites, Queen’s Hospital Burton. As a whole Trust, our High-Risk backlog maintenance in 22/23 was £10,277,970, with £8,942,261 being for the Queen’s Hospital Burton site.
  • Circa £6m of this Queen’s Hospital Burton backlog relates to work around orthopaedic theatres on the site, and a feasibility survey is underway to establish the full scope of these works. Patients who need orthopaedic care continue to be treated safety while this is underway.
  • Throughout 23/24, work has already taken place to address nearly £1.5 million of high-risk backlog maintenance.
  • The year-on-year increase is due to a variety of factors, including a formal review by external advisors who have updated figures to reflect inflation and risk classification changes for some areas of work.
  • We prioritise areas which directly support patient care and clinical activity, and conduct the work based on funds available within our annual capital allocation. All of our estate is monitored and regularly reviewed to ensure it is safe and appropriate for use by staff and patients.
  • The Trust does not have RAAC in any of its sites. This has been additionally verified through an independent survey.

From a spokesperson for ASHFORD AND ST. PETER’S HOSPITALS NHS FOUNDATION TRUST, which was among the 10 trusts with the highest percentage increase in the cost of high-risk repairs from 2021-22 to 2022-23, according to the most recent, published figures.

Q: Referring to your trust, can you tell me how this high-risk repair bill has accumulated?

A: The % change is only sizable because of the very low starting point from the previous year, and this backlog category for the Trust is very low compared in a national perspective.

Q: Can your trust afford to complete these repairs?

Yes

Q: Have you asked for help with these repairs? If so, from whom (eg government) and what was the response?

N/A

Q: Should patients be concerned to see these figures? What would you say to them?

A: The risks in this backlog category are all manageable and will be resolved.

Q: What has caused the repair bill to increase by the percentage it has at your trust from 2021-22 to 2022-23 – was that down to a survey of your buildings in that time period for example? Has the discovery of RAAC concrete played a role in the size of this repair bill at your trust?

A: The figures in this category have been updated following a conditions survey but still remain low. ASPH does not have a RAAC problem.

Q: What solutions can you put in place before and in order for these high-risk repairs can be carried out?

A: These repairs are being planned for as part of the capital prioritisation planning programme

Q: How soon can those repairs be carried out and what would the impact be on patients for those repairs to be carried out eg necessary part-closure of the hospital site? What impact would that have on patients? Is that something about which you have already made patients aware if and when repairs can be scheduled?

A: These repairs relate to Estates infrastructure projects that can be replaced without closing down critical patient services or affecting delivery of patient services.