The NHS is grappling with a £13.8 billion maintenance backlog, a crisis threatening patient safety, legal compliance, and financial stability across its estate. Rising costs, predicted to increase by 4.8% in 2023 according to the Building Costs Information Service, exacerbate the challenge. Delays in essential upkeep risk ward closures, cancelled treatments, and legal fines, while 33% of building maintenance professionals cite defending budget cuts as their top issue.

Paul Bullard, product director at SFG20, the industry standard for building maintenance specifications, has outlined a practical framework to tackle this backlog despite financial constraints. His strategies, rooted in risk management and data-driven planning, aim to help NHS trusts prioritise resources and ensure compliance with safety regulations.

Strategies to address the NHS maintenance backlog

• Establishing risk appetite and tolerance. Defining the level of risk an organisation is willing to accept is critical for effective decision-making. A clear risk appetite informs cost forecasting, improves prioritisation, and ensures consistent governance. This approach reduces uncertainty, strengthens spending reviews, and optimises resource allocation, enabling trusts to address urgent maintenance needs systematically.
• Fixing asset registers. Accurate asset registers are essential for maintenance planning, safety, and compliance with the Building Safety Act 2022, which mandates a Golden Thread of Information for transparency throughout a building’s lifecycle. Yet, 43% of organisations report poor data accuracy, and 6% lack registers entirely. Trusts must create or update registers and align assets with appropriate maintenance tasks to enhance planning and accountability.
• Understanding statutory obligations. Delays in critical maintenance can lead to significant disruptions, including ward closures and increased costs. While non-statutory tasks are not legally required, they often prevent asset failures. The Government’s FMS 002: Asset Data standard recommends using SFG20 criticality codes to build accurate asset registers, helping trusts plan effectively, manage risks, and maintain safe operations.
• Improving cost forecasting. Standardised, compliant maintenance tasks linked to accurate cost forecasts are vital for effective planning. Facilities management technologies, such as Computer-Aided Facilities Management (CAFM) systems with integrated finance modules, enable trusts to track asset data, costs, and compliance. Without this, trusts struggle to communicate risk profiles and budget needs, increasing exposure to legal, financial, and reputational risks.

David Hemming, a civil engineer and facilities management expert at NHS Shared Business Services, emphasised the value of structured asset management. “Currently, the NHS uses the Premises Assurance Model when they look at assurance… they could benefit from having a more directed tool to really understand their resources and their finances, to say this is what we need to get on top of it,” he said.

“This is important because if you’re doing asset management well and you’ve integrated tools like SFG20 into CAFM systems, asset management systems, enterprise asset management systems etc., then you should have a clear horizon of when you need to undertake tasks, what it’s likely to cost and the risks involved by not doing it. This is important because it gives you a rich risk picture that you can then use to brief the decision makers about finances and resources. Doing things in a standardised way is invaluable and therefore doing a procurement/investment strategy that is linked to that, can save you thousands and thousands of pounds.”

The growing maintenance backlog underscores the urgency for NHS trusts to adopt these strategies. By prioritising risk management, accurate data, and cost forecasting, trusts can mitigate risks, ensure compliance, and safeguard patient care. Failure to act could deepen the crisis, with long-term consequences for the NHS estate and the communities it serves.