Health service isn't 'just burning, it's crumbling' say experts following release of NHS estates figures

Annual Estates Returns Information Collection report reveals £9.5bn running costs for NHS estates, but backlog maintenance pressure is increasing, putting patient safety at risk

Some hospitals are now unfit for purpose, with backlog maintenance issues continuing to rise

The total cost of running the NHS estate totalled £9.5billion in the 12 months to March 2019, according to the latest figures from NHS Digital.

And backlog maintenance demands are now so great – 8.4% higher than last year – that patient safety is being put at risk daily.

Released last week, the Estates Returns Information Collection (ERIC) report details the costs of providing, maintaining and servicing the NHS estate.

It includes national and local level information from all NHS trusts in England that delivered secondary care and ambulance services between 1 April 2018 and 31 March 2019.

The report gives information at trust and site level from 227 trusts, including 10 ambulance trusts, and including those operating under a Private Finance Initiative (PFI) arrangement.

We are not talking then about carpets that are looking a little shabby, or letting a building become run down when it is scheduled for closure. We are talking instead about facilities and equipment that are so outdated they no longer comply with statutory safety standards

And it includes comparisons with the previous year at national level in key areas such as: financial information; safety; buildings - quality, function, area and utilisation of space; utilities – energy and water; waste; car parking; and inpatient food, laundry and linen, cleaning and portering services.

As well as the running costs, it showed that total energy usage from all sources across the NHS estate amounted to 11.2 billion kWh.

And the total cost to eradicate backlog maintenance was £6.5billion.

The cost and severity of backlog maintenance issues in NHS buildings is still rising. Figures are given in £billions with red corresponding to issues which pose a high and significant risk, and yellow a moderate or low risk

Citing this as one of the key concerns facing estates and facilities managers, and the NHS as a whole; Siva Anandaciva, chief analyst in the policy team at the King’s Fund health think tank, said that £3.4billion was needed to address issues that present a high or significant risk to patients and staff.

He added: “If these numbers don’t quicken the pulse, a little more context is needed.

“High-risk issues are identified where repairing or replacing NHS facilities or equipment ‘must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution’.

“We are not talking then about carpets that are looking a little shabby, or letting a building become run down when it is scheduled for closure.

“We are talking instead about facilities and equipment that are so outdated they no longer comply with statutory safety standards.

“This has left the NHS with a mix of world-class, state-of-the-art facilities and Victorian hospitals that are no longer fit for purpose.”

People often talk about the need to create a ‘burning platform’ for change. The platform under the NHS isn’t just burning, it’s crumbling

So, what does this mean in practical terms for patients and staff?

Anandaciva said: “One director of an NHS trust told me that broken gutters in his hospital lead to water seeping through the walls when it rains heavily. This happens so frequently that nurses now give ‘water updates’ in their shift handovers, so incoming team members know when they will have to start unplugging electrical equipment – including incubators for newborn babies – from the wall. This is clearly distressing for patients, carers and staff.”

And, the situation may be even worse than the ERIC data suggests, he adds.

“First, we only know the ‘works costs’ of tackling these maintenance issues, and the true costs will be higher once fees, VAT and the costs of displacing and disrupting clinical services are included.

“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; or social care, where it has been estimated that 85% of the UK care home stock is more than 40 years old.

Siva Anandaciva

“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.”

The main reason for this issue, he said, is that over the most-sustained period of austerity in NHS funding, more than £4billion of planned capital investment was reprioritised to support the day-to-day running costs of the NHS.

This left the UK lagging behind other countries in the level of capital investment provided to its health service.

“No wonder, then, that several NHS board members I’ve spoken to have been as focused on getting the hospital boilers fixed, as on the long-term strategic integration of health and care services,” Anandaciva said.

As long as these questions remain unanswered, the NHS estate will continue to deteriorate and fall into disrepair

And he concludes: “The NHS is still waiting for a multi-year capital settlement and there are some big questions left unanswered, such as when this capital review will happen; how much funding will be provided and for how long; the extent to which this funding will be split across maintenance and modernisation; and where the funding will come from, given the previous Chancellor’s decision to end PFI investment.

“And in the interim, as long as these questions remain unanswered, the NHS estate will continue to deteriorate and fall into disrepair.

“People often talk about the need to create a ‘burning platform’ for change. The platform under the NHS isn’t just burning, it’s crumbling.

The ERIC report also gave information on total floorspace utilised by trusts. The gross internal floorspace was 26.7 million sq m. But the amount currently occupied is only 24.6 million sq m, meaning there is still work to be done to ensure buildings are better utilised.

Of that occupied space, 16.1 million sq m is clinical space.

In terms of the running costs of the estate, £4billion came from financing costs; £2.3billion from ‘hard FM’ services; and £3.1billion from ‘soft FM’ services such as cleaning and laundry.

And, of the 227 trusts who submitted information, 176 said they had an estates strategy, 121 were operating waste reuse schemes, and 148 had appointment a waste manager.

An important part of the report concerns the safety of the estate, and the figures reveal that there were 1,942 serious incidents reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR); and a total of 15,844 estates and facilities incidents; with 4,810 clinical service incidents caused by estates and infrastructure failure.

A further 4,482 overheating occurrences were reported which triggered risk assessments in line with trusts’ ‘heatwave plans’.

No wonder that several NHS board members I’ve spoken to have been as focused on getting the hospital boilers fixed, as on the long-term strategic integration of health and care services

Fire incidents totalled 1,541, of which 6,687 involved a call out by the fire brigade.

And, while there were no deaths, 34 people were injured in fires at hospitals.

Other figures given in the report include:

  • £181.1m was spent on onsite storage of medical records. £50.4m was spent on offsite storage
  • 19 trusts still have wholly paper-based medical records; 8 have all-digital medical records; and 190 trusts have a mix of the two
  • There are 37,766 single en-suite patient bedrooms in hospitals
  • Energy costs totalled £666.8m, of which £362m was electricity; £217m was gas; £4.9m was oil costs; and £0.9m was coal
  • Health trusts consumer 2775.1 million kWh in electricity; 7873.2 million kWh of gas; 75.3 million kWh of oil; 34.3 million kWh of coal; and 171 million kWh of steam
  • Water and sewerage costs were £85.6m
  • Waste costs were £115.1m, with the highest costs coming from incineration and clinical waste treatment
  • The cost of parking services at NHS facilities was £71.2m, with 453,712 car parking spaces available
  • Cleaning services cost £1billion, with more than 37,000 staff members
  • Inpatient food services cost £633.8m, with 140.9 million main meals provided
  • Laundry and linen services cost £195.1m, with 534 million pieces laundered over the year
  • Portering staff cost £370.8m, with more than 13,000 members of staff working in this area

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