Challenges Facing NHS Estates and Their Impact on Patient Experience and Healthcare Outcomes
The NHS faces significant challenges with maintaining and upgrading its estate, especially the upkeep of aging hospital buildings. At LED Architects we have recent experience of this and recognise that as the demands on the NHS continue to grow, these infrastructure issues are not going away. Recent research suggests the pressure on the building estates is not only hampering service delivery but also affecting staff and patient experiences and ultimately effecting healthcare outcomes. This blog explores the primary challenges facing NHS estates and the tangible impact they have on patients and healthcare professionals alike.
image above: The Challenges. An example of a 1970’s protected staircase and ward about to undergo fire upgrade works and reconfiguration to address safety concerns and greatly improve staff and patient use.
1. Aging Infrastructure
A substantial proportion of NHS hospital buildings are several decades old, with many dating back to the mid-20th century. According to research published by Building Better Healthcare a staggering 2,063 NHS buildings in England predate the establishment of the NHS itself in 1948. In some trusts two thirds of all buildings are over 75 years old.
This reliance on aging buildings has left many hospital trusts with a significant backlog of repairs. Deferred maintenance can lead to more frequent breakdowns of facilities and greater likelihood of further impacting clinical safety and patient experience.
Working in old buildings as we do at LED Architects we experience firsthand that healthcare workers are constrained by outdated environments that limit their ability to work efficiently. Aside from safety and productivity concerns these environments are potentially increasing stress and lowering job satisfaction.
2. Funding Constraints
Whilst the aging structures require extensive repairs and renovations, budgets for maintenance during the period of austerity were consistently bellow the required level. Between 2010-19 average spending was £3billion annually. By 2020/21The Kings Fund suggested the cost of tackling the backlog had risen to £9.2 billion. Lord Darzi’s report, published in September 2024 identified a £37 billion shortfall in capital spending over the same period Darzi Report. The report summarised the outcome of such shortfall as a growing backlog of repairs, with essential systems, such as heating, ventilation, and water, often struggling to keep up with modern healthcare needs.
In the October 2024 budget the government announced that capital spending will rise to £13.6 billion by 2025/26 (this is a 10.9% average annual increase in real terms compared to 2023/24). However, Capital budgets for the current year are somewhat lower than expected from the previous Conservative fiscal event, which will further extend the shortfall. What’s more the new 2025/26 figures are allocated to specific areas of spending, not necessarily general building upkeep, this includes, scanners, to IT infrastructure, radiotherapy machines, and a new fund to upgrade 200 (that’s only 3.33%) of GP practices, alongside a £1 billion allocation for critical maintenance issues with NHS buildings, to include those affected by reinforced autoclaved aerated concrete (RAAC).
What is staggering about these figures is that according to the Estates Returns Information Collection, Management Information – Provisional Summary Figures for 2023/24), published by NHS digital ,which is the best source of overall capitol maintenance funding requirements. The total capital budget 25/26 as outlined by the government is almost exactly the same figure as is required to clear the Maintenance Backlog (£13.6 billion), £2.7 billion of which is deemed ‘High Risk’, which basically means that failure is likely to cause injury or lead to prosecution. This means that none of the required expenditure to cover the backlog is covered by additional funding. Simply put if the maintenance backlog were to be prioritised the current figures do not cover general improvements or ongoing maintenance.
According to the Kings Fund what these figures illustrate is how challenging the capital picture is in the NHS, where the total capital budget for the entire health service is still lower than the cost of eradicating problems in existing healthcare care estate.
3. Safety Concerns
As NHS estates age, safety concerns become increasingly prominent. Many hospital buildings contain outdated materials or infrastructure that no longer meet current safety standards. As of 3 October 2024, there are 47 hospital sites in England with confirmed RAAC, a reduction of 7 since February of this year. UK Gov Statement. However it is electrical systems, fire safety measures, and even basic amenities like plumbing and lifts that are largely at risk of failure in these older buildings. Such issues increase the likelihood of disruptions that can affect the continuity of care, delay critical procedures or, in worst-case scenarios endanger lives.
4. Impact on Patient Experience
The environment plays a crucial role in a patient’s experience and well-being. In aging hospital buildings, patients may encounter inconveniences such as leaky roofs, inadequate heating in winter, or overcrowded wards. All of these factors can contribute to discomfort and, at times, anxiety.
Poor, damaged or failing materials, a lack of flexibility and space constraints can increase the constant challenge of infection control.
Poor infrastructure can also undermine the confidence of patients in the care they receive. When patients see rundown facilities, they may question the quality and safety of their treatment. A lack of private rooms in older hospitals also means patients have less control over their privacy and may find it difficult to rest or recover optimally in shared, cramped wards.
5. Environmental Sustainability Challenges
In line with the UK’s commitment to achieve net-zero emissions by 2050, NHS facilities must adapt to more sustainable practices, including reducing energy consumption and minimising waste. However, outdated buildings are far less energy-efficient, with many lacking effective insulation, heating, or ventilation systems.
Investing in environmentally sustainable upgrades would not only reduce operational costs over time but also align the NHS with the UK’s broader environmental goals. These improvements can lead to a healthier indoor environments, contributing to better outcomes for patients and staff.
The Road Ahead: Potential Solutions and Investments
Addressing these challenges is essential for the NHS’s ability to provide effective, compassionate, and sustainable healthcare. Here are some potential steps and solutions that could help overcome these estate-related issues:
- Increased Funding and Targeted Investments: Additional funding dedicated specifically to estate upgrades would reduce the backlog of repairs and improve safety. Targeted investments in critical areas, such as structural safety and energy efficiency, will address both immediate and long-term needs and avoid the building performance cliff edge as identified by the growing High Risk requirements.
- Modernisation Programs: Initiatives that focus on building new hospitals or significantly renovating old ones can create environments designed for contemporary healthcare delivery. These new or improved spaces would also be better suited to accommodate digital and technological advancements.
- Sustainability Measures: Retrofitting older buildings with energy-efficient technology, energy capture, upgraded HVAC systems, and better insulation, would reduce the NHS’s environmental footprint and decrease operational costs over time.
- Enhanced Safety Standards: Conducting comprehensive safety assessments of NHS buildings helps identify the most urgent issues. Following this, the replacement of hazardous materials, alongside better fire and electrical safety measures, can provide a safer environment for both patients and staff. LED Architects work in exactly this way with outstanding estate teams to deliver progressive and targeted improvements with an identified priority approach.
Conclusion
LED Architects work with NHS estates teams who are proactive and incredibly hard working. In the face of over whelming challenges we see firsthand that the upkeep of their buildings is crucial for ensuring a high standard of patient care. Addressing these massive estate wide challenges is fundamental to improving patient experience, improving staff moral and helping them to deliver improved healthcare outcomes.
