Maintenance backlog in NI's health estate more than £1.6bn, report finds

The maintenance backlog in Northern Ireland’s health estate has grown to more than £1.6 billion, an Audit Office report has found.

The report also said that 40% of the buildings are not fully compliant with current regulations and in need of an upgrade.

The £3.7 billion health estate comprises around 1,500 freehold buildings and over 200 leasehold properties across more than 400 sites, including hospital complexes, residential accommodation, day centres, health clinics, ambulance stations and fire stations.

Comptroller and Auditor General Dorinnia Carville said the overall condition of the estate is deteriorating and a more strategic approach is needed to ensure the safe and efficient delivery of services.

Her report said the estate is “ageing and increasingly not fit for purpose”.

It found that nearly half of the estate is more than 50 years old, with around one sixth more than 75 years old.

The report said: “Many of these buildings have seen increased footfall and demand for services and are no longer considered fit for purpose in delivering modern health, public safety and social services.

“According to independent surveys, only 40% of the estate is assessed as being in acceptable overall condition.

“Just under one fifth of the estate (19%) is assessed as becoming largely untenable for the delivery of services.

“In addition, while the majority of the estate is identified as compliant with statutory regulations, 40% is not fully compliant and in need of upgrade.

“Of this, some 10% of the estate requires major expenditure to become compliant. 

“A further 2% is assessed as too expensive or impractical to upgrade.”

The report said that essential maintenance spend has been “reduced to absolute minimal levels in recent years”.

It added: “The estimated backlog has increased to over £1.6 billion, reflecting the cumulative impact of ageing assets, the condition of the estate, reduced maintenance spend and also the impact of inflation.

“Of this, around £251 million has been assessed as high risk.”

The report said the Department of Health has provided around £25 million annually since 2020-21 to address backlog maintenance.

It added: “Funding levels are insufficient to reduce or materially slow the rate of estate deterioration.

“The risks arising from backlog maintenance will continue to persist and are likely to intensify in future years as more assets are classified as no longer being fit for purpose.”

The report also identifies “inefficiencies” in how the estate is used, including prolonged retention of vacant estate with a total net book value of nearly £40 million.

It said that some of these properties and sites have been vacant for a prolonged period, often with no proper plans in place for re-use or disposal.

Ms Carville said: “The health estate is a critical enabler of frontline health and social care services. 

“However, our findings show that much of the estate is ageing, in poor condition, and increasingly costly to maintain.

“It is important to note that mitigations are in place to protect patients, staff and services.

“However, this reactive approach risks storing up problems for the future when it will potentially be much more expensive to address them properly.

“The condition of the health estate is a longstanding challenge, with the overall picture remaining broadly unchanged over the past decade.

“Progress to address these issues has been constrained by limited resources, but there has also been an absence of a clear, long term strategic framework to improve the condition of the estate.

“Many of the recommendations in this report are aimed at supporting the department and its arm’s-length bodies to develop this more strategic approach and ensure that the estate is aligned to operational needs.

“The department already holds substantial data on the performance and condition of the health estate.

“It now needs to use that data better to improve decision-making and take action to better use the limited resources available and achieve more value for money.”

A statement from the Department of Health said it welcomed the publication of the report. 

The statement added: “The priority remains ensuring that health estates continue to safely support frontline services, while delivering best value for public money, particularly within the context of constrained resources.

“The department will consider these recommendations carefully and is grateful to the NIAO for their work in this area.”

It said work has already begun to tackle some of the issues found in the report.

The department added: “For example, departmental guidance has been issued to health and social care (HSC) trusts to unify the approach to calculating and reporting backlog maintenance, which has been a long-standing issue, particularly as many assets are ageing and challenging to maintain.

“The HSC trusts have also provided assurance that all risks associated with the estate not being fully compliant with current statutory regulations, are identified, noted and managed to ensure buildings remain in a safe state to support service delivery.

“The department recognises the need for wider service and investment planning to inform a more strategic, long-term approach to estate management, and officials will continue to work to achieve this.

“Officials are also undertaking a review of vacant and underused assets to ensure more timely and strategic decisions are taken to deliver value for money.”