£15.9bn
Current NHS maintenance backlog
72%
Increase in backlog costs over five years
£1bn
Reduction in DHSC capital budget over four years
The NHS estate is one of the health service’s most important assets, yet often one of its least visible. Patients and clinicians rarely think about building fabric, ventilation systems, fire safety measures or critical infrastructure. When these systems function effectively, they fade into the background, despite underpinning every aspect of care delivery.
From enabling safe clinical environments and supporting workforce productivity to facilitating innovation and service transformation, the estate provides the foundation on which healthcare is delivered.
But maintaining that foundation is becoming increasingly challenging. Many NHS organisations are managing ageing buildings, growing compliance requirements and rising maintenance demands, placing significant pressure on estates teams and available resources.
In 2024/25, the cost of eliminating NHS estate maintenance backlog reached £15.9 billion, up 72% in five years. Much of this growth sits within higher-risk categories where infrastructure failures could disrupt services, compromise patient safety or affect organisational resilience. The backlog is now greater than the annual cost of running the NHS estate itself, highlighting the scale of the challenge facing NHS organisations.
The wider funding envelope is also changing, with the Department for Health and Social Care’s capital budget set to reduced by £1 billion over the next four years.
As a result, the conversation can no longer be limited to maintenance alone. Estate condition is increasingly linked to clinical performance, operational sustainability and the ability of organisations to deliver safe, effective care.
Recognising the challenge nationally.
Lord Darzi’s Independent Investigation of the NHS highlighted how years of underinvestment in capital infrastructure have left ageing estates and equipment constraining productivity, resilience and service improvement. The report reinforces a growing reality: investment in estates is not simply about maintaining buildings, but enabling the modernisation of healthcare delivery.
That principle is reflected in the NHS 10-Year Health Plan, which places greater emphasis on prevention, digital innovation and new models of community-based care. Delivering those ambitions will depend on healthcare environments that are safe, compliant, adaptable and fit for the future.
Moving from reactive maintenance to strategic estate management.
Addressing the backlog requires more than simply investing in repairs. NHS organisations need a coordinated strategy that balances immediate compliance and maintenance requirements with long-term transformation, sustainability and service objectives.
This is where NHS SBS framework agreements can support trusts throughout the entire estates lifecycle.
How our solutions help address maintenance backlog:
Move from reactive to proactive maintenance with Hard Facilities Management 3 (Hard FM3)
As buildings and assets age, reactive maintenance becomes increasingly expensive and disruptive. Through Hard FM3, organisations can access specialist providers that help improve asset performance, implement planned preventative maintenance programmes and reduce the likelihood of critical failures.
By moving from reactive to proactive maintenance, Trusts can improve estate reliability, reduce downtime and better manage risks associated with high-priority backlog items.
Assess risks, maintain compliance & create safer environments with Building Safety and Fire Compliance
A substantial proportion of estate risks are linked to statutory compliance obligations. Building safety failures and fire compliance issues can create significant operational, regulatory and reputational challenges.
Building Safety and Fire Compliance helps organisations assess risks, maintain compliance and create safer environments for patients, visitors and staff. With safety increasingly recognised as a board-level concern, maintaining robust compliance arrangements is critical to operational continuity.
Plan, manage & deliver complex estates projects with PS-Works
Many trusts face resource constraints and skills shortages when delivering major estates programmes.
Through PS-Works: Public Sector Construction Works, organisations can access specialist professional services, project management expertise and technical consultancy support to help plan, manage and deliver complex estates projects.
Whether tackling backlog maintenance, implementing infrastructure upgrades or delivering transformation programmes, access to specialist expertise can strengthen delivery and improve outcomes.
Ensure projects are set up for success from the start with Healthcare Planning, Construction Consultancy and Ancillary Services
The healthcare estate is evolving in response to changing patient needs, new technologies and integrated models of care.
Healthcare Planning, Construction Consultancy and Ancillary Services supports organisations with strategic planning, business case development, design, infrastructure planning and project delivery. By aligning estates investment with long-term clinical objectives, trusts can ensure that today’s decisions support tomorrow’s healthcare requirements.
Mobilise temporary or permanent buildings quickly & efficiently with Modular Buildings
Many organisations need additional clinical or operational space but face lengthy traditional construction timelines. Modular Buildings 3 provides rapid access to additional clinical and operational space, enabling organisations to respond more quickly to changing demand while minimising disruption to services.
Align sustainability and infrastructure investment with Decarbonisation of Estates
The drive to modernise NHS estates also presents an opportunity to advance sustainability goals. As organisations work towards net zero ambitions, estate improvements can simultaneously enhance building performance, reduce energy consumption and lower operating costs.
Decarbonisation of Estates supports Trusts in identifying and delivering projects that reduce carbon emissions while improving the efficiency and performance of their estate. By integrating sustainability into wider infrastructure programmes, organisations can maximise the value of capital investment and future-proof estates against evolving environmental requirements.
Independent assurance with Audit Services
Large-scale infrastructure and compliance programmes require strong oversight to ensure that investments deliver intended benefits and risks are appropriately managed.
Audit Services for Health can provide independent assurance across estates governance, risk management, compliance arrangements, programme controls and value-for-money assessments. This independent perspective can help boards make informed decisions, demonstrate accountability and maintain confidence that estate investments are delivering sustainable improvements.
Turning challenge into opportunity
As the NHS responds to the ambitions of the 10-Year Health Plan, the estate will play an increasingly important role in enabling service transformation. Whether supporting new models of care, improving productivity, embracing digital innovation or strengthening organisational resilience, the quality of the built environment matters.
Addressing backlog maintenance is therefore not simply a matter of repairing buildings. It is an opportunity to create safer, more adaptable healthcare environments that support better outcomes for patients, staff and communities.
By leveraging NHS SBS framework agreements, NHS Trusts can access the specialist expertise, assurance and delivery capability needed to turn today’s estates challenges into a foundation for tomorrow’s healthcare system.
If you’d like to discuss how our solutions could support your maintenance challenges, get in touch: sbs.hello@nhs.net
