Balancing act: Operationsamidst project delivery

The NHS estate is one of the largest and most complex public sector property portfolios in Europe, comprising over 24,000 assets across more than 1,200 sites. Many of these facilities are ageing, with 15 per cent of buildings in England constructed before the NHS was founded in 1948.

The estate now has a critical maintenance backlog that is estimated to have reached £13.8 bn in 2023/24 — a figure that has more than doubled in real terms since 2015/16. Of this total, 55% is classified as critical infrastructure risk, meaning failure could result in catastrophic disruption to clinical services. In the same year, over 1,500 critical incidents were reported, with clinical time lost due to infrastructure issues exceeding 600 days. Examples include cancelled surgeries due to electrical faults, chiller failures in operating theatres, and fires caused by water ingress into essential power systems.

The government has allocated over £1 bn to address the most urgent maintenance needs; and efficient execution requires a strategic approach to ensure the delivery models, and controls, are structured to meet the complexity of the challenge, and ensure best value for the individual Trust and the NHS. Modernising the estate and building resilient, future-proofed facilities is essential not only for patient safety but also for meeting NHS performance targets and sustainability goals.