Les Bewick, facilities management expert at SFG20, explains how the NHS can tackle the £15.9 million maintenance backlog problem.
The NHS estate is under strain in a way that can no longer be dismissed as background noise to a system already grappling with staffing shortages, waiting lists, and rising demand. A maintenance backlog now standing at £15.9 billion is not simply a number to be reported and absorbed into the next cycle of policy debate. It is a visible and growing symptom of deeper structural challenges that are beginning to affect not just buildings, but the safety and efficiency of healthcare delivery itself.
Across the UK, many hospitals and healthcare facilities are operating within ageing infrastructure that was never designed to meet the demands placed on it today. Decades of underinvestment have created a situation where reactive fixes have become the norm, rather than proactive maintenance. At the same time, operational pressures continue to mount. More patients, more complex care needs, and tighter budgets mean estates teams are being asked to do more with less, often without the data or tools needed to make informed decisions.
The true cost of delaying maintenance
The consequences of this growing backlog extend far beyond deteriorating buildings. Poorly maintained estates directly impact patient safety, staff wellbeing, and operational efficiency. In recent years, enforcement action from the Health and Safety Executive has resulted in fines reaching hundreds of thousands of pounds for failures linked to estate management.
These penalties are only part of the cost. Asset downtime disrupts services and delays care, placing further pressure on already stretched systems. A reactive approach is also inefficient. Delaying essential maintenance does not save money. In fact, it can cost up to 1.5 times more than completing work proactively. In a system where budgets are already under intense scrutiny, this is a cost the NHS cannot afford.
Despite the scale of the challenge, simply calling for more funding is not enough. In the current financial climate, NHS estates teams must be able to demonstrate not only need, but value. Securing investment increasingly depends on the strength of the business case presented to decision-makers.
Without clear, credible evidence of how funds will be used and what outcomes they will deliver, even urgent maintenance needs risk being deprioritised. The challenge is not just about highlighting problems, but about presenting solutions in a way that demonstrates efficiency, compliance, and long-term savings.
1. Start with a complete and accurate asset register
A fundamental starting point is understanding the estate itself. Yet many organisations still lack a fully accurate and up-to-date asset register. SFG20’s State of Facilities Management Report 2026 revealed that 8% of facilities management teams do not have an asset register, and 38% either do not update their register or do not know how frequently it is updated. Without a clear picture of what assets exist, where they are, and how they should be maintained, effective planning becomes almost impossible.
An incomplete register undermines compliance reporting and weakens any argument for additional funding. If decision-makers cannot see the full scope of the estate and its associated risks, investment is unlikely to follow. In contrast, a comprehensive and accurate asset register provides the foundation for maintenance planning, risk management, and cost justification.
2. Build a credible data-driven business case
Equally important is the ability to evidence maintenance costs in a meaningful way. Too often, funding requests rely on high-level estimates that fail to reflect the complexity of maintaining a modern healthcare facility. Estate teams must go further, detailing not just total costs, but the frequency of maintenance activities, the time required to complete them, and the resources involved.
This level of detail provides transparency and credibility. It allows stakeholders to understand where money is being spent and why, while supporting more accurate forecasting. A strong business case does more than justify current expenditure. It demonstrates a clear, sustainable approach to managing the estate over time.
3. Prioritise compliance and risk
Not all maintenance tasks carry the same level of urgency. Statutory maintenance, which is legally required, must be clearly separated from best practice activities and discretionary tasks. This distinction allows estates teams to present a more focused and compelling case for funding.
By highlighting where failure to invest would result in legal non-compliance or safety risks, organisations can ensure that limited resources are directed where they are most needed. This risk-based approach strengthens decision-making and ensures that critical issues are addressed first.
4. Compliance is fundamental to patient safety
In a healthcare setting, compliance is not optional. It underpins both patient safety and staff wellbeing. Failures can lead to financial penalties, reputational damage, and in the most serious cases, harm to those relying on NHS services.
Compliance should therefore be viewed not as a box-ticking exercise, but as a central driver of investment. Organisations that can clearly demonstrate compliance are not only reducing risk but also strengthening their position when seeking additional funding.
Ultimately, the challenge facing the NHS is not just one of funding, but of approach. The £15.9 billion backlog highlights the consequences of prolonged underinvestment and reactive decision-making. Addressing it will require clearer visibility of assets, stronger data, and more robust, evidence-based cases for investment.
