News / Backlog maintenance increase sparks call for capital boost

15 December 2023 Steve Brown

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There have been renewed calls for increased capital investment after new figures show the NHS backlog maintenance has grown to £11.6bn.

Siva Anandaciva

The estates return information collection (ERIC) data for 2022/23 was published this week showing that the total costs of eradicating backlog maintenance in the English NHS had risen by 13.6% on the previous year to £11.6bn.  Within this, the cost of eradicating the high-risk backlog has increased by nearly £560m to £2.4bn. And more than half of the overall backlog is considered to be high or significant risk.

Siva Anandaciva (pictured), chief analyst at the King’s Fund said that promises to build new hospitals had not been realised, leaving parts of the NHS estate in such a poor condition they pose serious risks to staff and patients.

‘The repeated raiding of long-term investment budgets to cover day-to-day spending is illustrative of the short-term thinking that has plagued NHS finances in recent years,’ he said. The UK has consistently spent a lower proportion of its gross domestic product on NHS capital than comparable countries and exacerbated this general trend between 2014/15 and 2018/19 by transferring £4.3bn from capital budgets to support revenue spending and reduce deficits.

In November, the Commons Public Accounts Committee called on the Department of Health and Social Care ‘not to reduce planned capital investment to meet day-to-day spending needs in future’. It added that if officials considered doing this again, the committee would expect the permanent secretary to write to ministers explaining the consequences of this course of action.

However, some of November’s increased allocation to systems to offset this year’s costs of industrial action was funded via a transfer of capital resources. NHS England’s finance paper to its December board meeting put the Department of Health and Social Care provider capital budget for 2023/24 at £7.48bn. The October paper put this figure at £8.08bn. Healthcare Finance asked NHS England to clarify the budget reduction.  

Rory Deighton, director of the NHS Confederation’s acute network, said the growing cost of the high-risk maintenance needed to prevent catastrophic failures or major disruption to clinical services is ‘particularly worrying’, especially given capital budgets had already been ‘raided’ to plug the rising deficits in the day-to-day budget.

‘NHS leaders have told us that increased capital spending is their priority for any new investment after the next election and underinvestment has been the number one issue holding back their progress towards greater productivity,’ he said. ‘The next government must boost capital funding to allow the service to address the maintenance backlog.’

Julian Hartley, chief executive of NHS Providers said the safety of patients and staff is at stake, with the NHS needing ‘safe, efficient and reliable buildings, facilities and equipment’. He highlighted the discovery in October that more hospitals had problems with reinforced autoclaved aerated concrete than previously thought and trusts from all parts of the NHS, including community, mental health and ambulance services – were in need of major investment.

‘We need the government to shift gear and inject a significant shot in the arm of capital investment in the NHS,’ he said.

The ERIC data also showed that the total running costs of the NHS estate in 2022/23 were £12.4bn – a 12% increase on 2021/22. And total energy usage across the whole estate was 11.2 billion kilowatt-hours – a small decrease on the previous year.

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