Simon Taylor, director of policy, strategy and capital projects at NHS Property Services, discusses the publication of NHSPS’ new guide, Maintaining the NHS Estate.
“Two thirds of NHS estate leaders have told us that the ageing infrastructure is now the single biggest obstacle to reducing the maintenance backlog across the estate. They know the importance of bringing these buildings up to the minimum acceptable standard as left unchanged these issues can impact patient safety and the quality of care delivered, as well as staff productivity.
“NHSPS surveyed 77 estate leaders before publishing the guide Maintaining the NHS Estate. The guide pinpoints exactly where the challenges lie and provides practical considerations to tackle them.
“The survey demonstrates how there is a growing appetite among estate delivery leaders to use smarter technology-enabled solutions that modernise the ageing infrastructure and deliver the much-needed long-term improvements.
“Data collection and digital tools, such as NHSPS’ NHS Open Space, are increasingly being adopted to help change estates but many maintenance teams remain trapped in short-term, reactive approaches.
“What is certain is that the way NHS estates are managed is in transition – as financial pressures are intensifying, the cost of the backlog maintenance has risen sharply – up 15.7 per cent in a single year – reaching £15.9bn in 2024/25. To put this in perspective, the backlog now exceeds the annual cost of running the entire NHS estate.
”Just the high-risk repairs account for more than £3.5bn. These figures represent more than financial pressures; they pose immediate risks to service continuity, operational resilience, and patient safety. The recent announcement of the government’s 10 Year Capital Plan will help ensure red tape is cut to get spades in the ground and ensure NHS funds are spent well – not just on rebuilding hospitals, clinics, and GP practices but on delivering the three shifts: from hospital to community, from analogue to digital, and from sickness to prevention.
“The survey mirrors these facts with nearly two-thirds (63 per cent) of respondents cited ageing infrastructure as the primary challenge. This is partly because many NHS buildings are decades old and were not designed to support modern models of care, making them harder – and more costly – to maintain and upgrade.
“Funding constraints also remain a major concern, with 53 per cent of estate leaders identifying these as a barrier and 38 per cent pointing to the sheer scale of the backlog itself as a complicating factor. A further 25 per cent of estate leaders identifying reducing backlog maintenance as their top priority, while 26 per cent are focused on maintaining and improving compliance with legal and best practice standards.
“The NHS’ commitment to achieving Net Zero carbon emissions by 2040 (and for direct emissions by 2045) is helping push estate leaders to act with more urgency to modernise their buildings. Refurbishing and increasing utilisation within the existing estate is one major way of meeting local targets.
“To establish which buildings to refurbish and how to increase utilisation the guide recommends developing a comprehensive view of the estate. This includes categorising buildings into three groups – core, flex, and tail. Core sites are essential and central to long-term service delivery; flex sites are functional in the short to medium term but may not be suitable for long-term use; and tail sites are outdated, inefficient, or no longer fit for purpose. This classification enables more strategic decision-making about where to prioritise investment, refurbish, or divest and means a longer-term plan can be realised.
“Each plan must first identity which buildings fall under the category of backlog maintenance, this term refers specifically to work required to bring estate assets that have fallen below Condition B – the minimum acceptable standard – back to a safe, compliant, and fully operational state.
“Our guide is designed to support estate leaders who are working to improve how they tackle building maintenance. It sets out the practical considerations estate leaders can take to start reducing their backlog maintenance while modernising the estate for the future.
“We know estate leaders are determined to tackle the ageing NHS estate they manage, and their message is loud and clear, they want the tools to help them improve compliance and take advantage of the latest technologies to harness useful data and increase utilisation.
“The NHS already possesses much of the expertise, framework, and data required to improve estate performance. The task is achievable; success depends on how decisions are made, how evidence is used, and how effectively leaders are aligned from board level through to operational teams. When these are in place, strategy becomes action, leading to better patient care.
“The guide emphasizes the value of proactive, planned investment. Regular reviews of the estate condition can help organisations identify issues early and address them before they escalate into more costly problems. Planned maintenance is consistently more cost-effective than reactive repairs, and it allows estates teams to prioritise interventions that deliver the greatest long-term value.
“Improving utilisation is another key component because by making better use of existing space – through redesign, refurbishment, or consolidation – estate leaders can reduce the overall footprint and the associated maintenance burden. This approach not only cuts costs but also supports the NHS’ Net Zero goals.
“Finally, the guide advocates for a more collaborative approach to estate planning. Bringing clinical leaders into discussions about estate strategy ensures that investment decisions are aligned with service needs and helps avoid the costs of inertia and prioritising the wrong areas. Maintaining a rolling five-year forecast of estate requirements further supports this long-term, approach.
“As the NHS seeks to grapple the on-going financial pressures and rising demand for services; the condition of its estate will remain a crucial factor in its ability to deliver the best care for patients. Without addressing ageing infrastructure and adopting more strategic, data-driven approaches, the backlog maintenance challenge will continue to grow and blight the overall ability of the NHS to delivery patient services. However, with the right plans in place, there is a clear path forward to a modernised and more efficient NHS estate.”
