NHS patients are being put in danger and waiting lists are getting even longer due to a £9bn maintenance backlog and a major lack of capital funding that has left some parts of hospitals “extremely dilapidated” and unfit for patients, health leaders have warned.
Boris Johnson promised in 2019 to “build and fund 40 new hospitals”. But the Infrastructure and Projects Authority (IPA), the government watchdog, later gave the project an “amber/red” ranking, meaning its delivery “is in doubt with major risks or issues apparent in a number of key areas”.
At the same time, the NHS in England is facing a £9bn maintenance backlog. Half of that sum, which is up from £6.5bn just three years ago, is required to tackle failings classed as posing either a “high” or “significant” risk to patients and staff.
Now health leaders are warning that without an urgent injection of capital funding, patient safety is at risk and the waiting list for care – worsened by the pandemic – “will grow even larger”. There are already 6.4 million people on the waiting list in England alone.
Speaking to the Guardian before this week’s NHS ConfedExpo conference in Liverpool, Matthew Taylor, the chief executive of the NHS Confederation, which represents the whole healthcare system in England, Wales and Northern Ireland, said the crisis had become extremely serious.
Patient safety as well as the ability of the NHS to tackle record waiting lists is being “severely hampered”, Taylor warned, because the UK has been “plagued” by one of the worst records for capital investment in healthcare across all OECD countries over the past decade.
“NHS leaders share the government’s commitment to further boost NHS efficiency and productivity and are doing all they can to tackle the care backlog that has built up in recent years, but they are being held back in their efforts by a lack of capital funding which is now a major barrier,” he said.
“The huge gulf in the NHS’s capital budget combined with a decade-long underinvestment in estate, infrastructure and IT systems has left the NHS with rundown buildings, a major maintenance backlog and limited potential for maximising the use of digital technology.”
In a new poll of 182 health leaders by the NHS Confederation, nine in 10 warn that insufficient capital funding is harming their “ability to meet safety requirements for patients” in hospitals, ambulance, community and mental health services, GP practices and other health settings.
They are urging the government to speed up access to capital funding already pledged by ministers, as well as investing further in the autumn budget. Unless they do, NHS leaders warn, the elective care backlog will get worse before it gets better.
One NHS trust chair in London told the survey, carried out this month, that “cramped” space means the trust is not “building up our capacity to deal with waiting lists”, and conditions for patients in some wards were “not fit for purpose”.
A primary care clinical director in the south-east added: “We’re working in a 1950s tin roof health centre servicing 34,000 patients with no ability to provide fit for purpose 21st-century healthcare. Our ability to meet patient expectations and political promises is impossible unless significant investment in infrastructure is made.
“It is like promising the public a safe, effective, modern car and when they go to collect it, they find a 1970s Ford Escort, with rusting roof, wheezy engine, designed to take four people, but being required to carry 10, and with no one to service it or drive it.”
Taylor added: “The government needs to urgently unlock the capital funding that has already been promised so that work can finally begin up and down the country on new builds as well as addressing the maintenance backlog.
“We should be ahead of the pack when it comes to the amount we invest in capital compared to other OECD countries rather than lagging behind as we currently are. Failure to do this will mean patient treatment targets will be missed, the waiting list backlog will grow even larger and patient safety could be put at risk.”
The warning from the NHS Confederation came as a report suggested more than 1,000 patients are spending longer than 12 hours in A&E departments every day.
The Royal College of Emergency Medicine (RCEM) released figures showing that in 2021, 1,047 patients a day, on average, were waiting 12 hours or longer from their time of arrival. The college raised concerns over “alarming” levels of patients in emergency departments as it described current data on 12-hour waits as the “tip of the iceberg”.
A Department of Health and Social Care spokesperson said: “We are delivering the biggest hospital building programme in a generation, with a target of 48 hospitals by 2030. We are also investing £1.7bn until 2025 for over 70 hospital upgrades across England, and in 2020/21 we invested a record £895m in tackling critical infrastructure risk, which included funding for nearly 1,800 urgent maintenance projects across over 170 trusts.”
