Estates Returns Information Collection (ERIC) data shows backlog maintenance has continued to rise since 2015-16, with high-risk backlog increasing from around £1 billion to £3.5 billion in 2024-25¹.

Addressing the total backlog would require approximately £15.9 billion of investment². The impact is already visible. In 2022-23, more than 12,000 infrastructure failures disrupted clinical services, including power, water, heating and ventilation failures, as well as structural issues that limit how space can be used³.

In some cases, care has moved into temporary, non-clinical spaces. That can keep services running, but it also adds pressure for patients, staff and operational teams.

This article explores how NHS organisations can build the insight to act with confidence, protecting services today while improving estate performance for the long term.

Many NHS organisations struggle to understand the true condition, performance and compliance status of their estate.

Information often sits across multiple systems. It may be incomplete, inconsistent or out of date. That makes it harder to prioritise investment, compare risks or plan for future service change. The issue becomes more pressing as Private Finance Initiative (PFI) assets return to NHS management. Facilities management arrangements may change, and assets may not transfer in the expected condition.

A structured digital maturity assessment can help establish a clearer baseline. This includes understanding whether:

• Digital estate information exists and is up to date
• Systems used to manage assets are being applied effectively
• Compliance and asset records are current
• Assets are appropriately identified and monitored

Estates, operational and clinical teams all need confidence in data and digital approaches if information is to support better decisions. We’ve seen first-hand how assessments and insights can provide greater certainty around the capital, revenue and operational implications of estate decisions, enabling more informed investment choices. 

Standard condition surveys remain useful, but they do not always reveal the full picture. Some risks are more complex, less visible or more systemic than a headline rating can show.

Where there are concerns such as subsidence, structural deterioration or wider safety issues, targeted investigation can provide the depth needed to understand what’s happening. Deeper structural surveys, focused on areas of greatest concern, help organisations prioritise interventions more effectively.

This matters because estate failures are rarely isolated. They often reflect wider weaknesses in building systems, maintenance history or asset performance. Aligning investigation and funding to the highest-risk areas supports more proportionate decisions.

It also sharpens governance. Infrastructure risk does not sit with estates teams alone. NHS Trusts need clear senior board-level ownership and oversight that reflects the potential impact on care, safety and continuity.

Backlog maintenance is often treated as a repair challenge, but it is also a signal that the estate may no longer be aligned with how care needs to be delivered.

Estate decisions are often shaped by local pressures, including retaining services in existing facilities, protecting access in specific geographies and responding to local authority expectations. These factors matter, but they can make it harder to ask a more strategic question. Is care being delivered in the right environment?

In the context of backlog maintenance, it becomes important to step back and assess whether:

• Care is being delivered in the most appropriate environment
• Facilities are fit for purpose
• Space is being used effectively
• There are opportunities for improvement or reconfiguration

This system-level perspective becomes more important as clinical models evolve. It also affects new developments. Buildings need flexibility from the outset, so they can adapt to changing use without major structural intervention or complex contractual change. Design decisions made today will shape how easily services respond tomorrow.

Backlog maintenance grows when planning is subject to one-year revenue funding cycles. However, this has recently changed with the advent of the Estates Safety Fund and a four-year spending allocation.  When intervention is deferred, assets run closer to failure. The result is more reactive work, delivered under operational pressure, with greater risk of disruption to clinical services.

A longer-term planning horizon helps organisations move from reaction to prevention. It also aligns more closely with the lifecycle of healthcare buildings, which typically operates over many decades.

Earlier intervention can reduce overall cost, particularly where deterioration accelerates if left unchecked. This is especially relevant as PFI expiry approaches. Around 150 healthcare PFIs, representing approximately 12 million square metres of space, are due to return to NHS management, many by 2036⁴. Preparing now, including planning for decant space, can reduce future cost and disruption, particularly where assets may not be handed back as expected. Surveying NHS assets regularly over its design life enables better lifecycle maintenance planning and ultimately an overall reduction in the whole life backlog maintenance cost.

References

1. https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection/summary-page-and-dataset-for-eric-2024-25 
2. https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection/summary-page-and-dataset-for-eric-2024-25 
3. https://researchbriefings.files.parliament.uk/documents/CBP-10313/CBP-10313.pdf 
4. https://www.gov.uk/government/publications/pfi-and-pf2-projects-2024-summary-data