Backlog Maintenance in the NHS

The latest NHS ERIC Return is reporting a substantial increase in Trusts’ backlog maintenance data, with the cost to eradicate backlog increasing from £6.4 billion in 2018-19 to £9.1 billion in 2019-20.

Some of the additional backlog comes from the 210 additional sites now reported into ERIC.  Most of this is because of changes implemented to ambulance trust sites as a result of feedback from a dedicated working group.  Next year a similar focus will be given to community and mental health sites, ensuring that ERIC remains relevant and fit-for-purpose across all sectors.  Additional sites added to ERIC account for £126m of the backlog reported.

Looking at a like-for-like comparison of sites reported in 2018-19 and again in 2019-20 shows an overall backlog increase of £2.6bn.

Comparing the backlog categories for 2018-19 and 2019-20 shows the following:

As can be seen, the main increase across the various backlog lines is in Moderate backlog, which increased by £1.2bn.

Critical Infrastructure Risk (i.e. High and Significant backlog) increased by £1.3bn overall (£401m of which is the most serious, High level category).  This backlog is that which has the potential to affect the safety and service resilience for the NHS.  In 2020-21, the government provided £600m of additional funding to NHS Trusts to address Critical Infrastructure Risk, so it will be interesting to see whether that provides a benefit in next year’s ERIC Return.

For 2019-20, five sites reported backlog increases of more than £100m. Note this was per SITE, not per Trust.  Those sites combined account for £1.6bn of the backlog increase. Of these sites, 3 are in London, one is East of England and one is North West.

At Trust level, the picture was similar, with 4 Trusts showing increases of over £100m which accounted for £1.6bn of the backlog – the majority of this backlog rests with two Trusts alone, who have increased their reported backlog position by over half a billion pounds each.

A further 33 sites saw backlog increases of between £10m-£66m, which accounted for another £832m of the overall increase.

250 sites reduced their backlog maintenance position, one by £21m – for that site it looks like all backlog was addressed as no backlog is now being reported.  In all, 68 Trusts reported a reduced backlog maintenance position, with the total cumulative reduction over those Trusts being £260m.

Health Infrastructure Plan

It is a challenging task to try to align backlog mitigation to the proposed 40 new hospitals earmarked under the Health Infrastructure Plan because of the lack of detailed publicly available data available at this time, mainly because the scheme is in its infancy.  From the data that we were able to obtain, we estimate that approximately £2.8bn of the backlog maintenance reported in 2019-20 sits within sites which will be rebuilt or substantially reconstructed through the Health Infrastructure Programme.  Whilst this is positive, the mitigation of this backlog represents only 31% of the whole backlog position, which will likely worsen in the time that it takes these hospitals to be built.  This demonstrates that rebuilding infrastructure can only partially address the backlog mitigation task which the NHS estates community faces.

At Community Ventures, we have a wealth of experience in understanding ERIC data, both before and after submission.  We can provide the following assistance: 

  • Analysis of individual Trust returns prior to submission to improve processes and highlight any anomalies
  • Assurance reporting to Boards on ERIC data, including a ‘look back’ over previous years to show performance progress or to make cases for investment
  • Support to ICPs/ICS’ to show an estates profile for an area, which can then be used to help to inform Estates Strategies
  • Consideration of specific items for improvement, for example soft facilities management process improvement

We are currently developing a high level dashboard tool which we are hoping to share with our partner organisations in the near future for free, as part of the ‘value add’ that comes with working with your local LIFTCo.  If you are interested in accessing this, let us know and we will come to you first!

We also have broad experience in managing NHS backlog mitigation through minor and major capital works programmes.  If you’d like some advice, then get in touch.