Three years ago we produced a blog titled “NHS backlog could reach £13m, Are modular buildings the answer?”. This came fresh after the COVID-19 pandemic which placed extraordinary financial pressure on the NHS, diverting funds from maintenance budgets towards the emergency COVID-19 response. This funding gap worsened an already substantial maintenance backlog and added to the list of urgent repairs and refurbishments that remain unaddressed.
The need for well-maintained, modern facilities has become more apparent in recent years as the pandemic and the discovery of unsafe reinforced autoclaved aerated concrete (RAAC) used in many facilities highlighted significant problems within the NHS’s infrastructure. Many NHS buildings are as old as the NHS itself and require consistent maintenance to meet safety standards.
Post-pandemic, the maintenance backlog has continued to grow, with capital budget increasingly hard to come by and deferred projects becoming more costly to address. Essential repairs and modernisation now also face inflated costs due to inflation in construction materials and labour.
Scale and Impact of the NHS Maintenance Backlog
According to NHS England, the total cost to eradicate the backlog is £13.8 billion, which does not include planned maintenance as this should already have taken place. The Autumn budget reported an additional £3.1 billion in capital spending in 2025/26 taking the total to £13.6bn. This is an increase of 10.9%, although it is still lower than the overall value of the maintenance backlog (£13.8bn).
The backlog not only significantly impacts a hospital’s finances, but it can also directly impact patient care and staff morale.
Issues such as poor ventilation, inadequate heating, and malfunctioning elevators can lead to uncomfortable and unsafe conditions for patients. In some instances, failures in infrastructure can result in postponed treatments or an increased risk of infection. Additionally, some hospitals may have outdated or poorly maintained equipment, which can delay medical procedures and treatments, potentially impacting patient outcomes.
Poor working conditions in deteriorating environments can result in lower staff morale and an increased risk of burnout. The state of the physical environment significantly impacts staff satisfaction, when employees work in outdated, uncomfortable, or unsafe conditions, it can negatively affect their overall well-being and productivity.
Financial Implications of Delayed Maintenance
Addressing the backlog requires significant financial investment, which puts additional strain on already stretched NHS budgets. Delaying maintenance can cause several problems that will likely impact the hospital in the future.
Deferred maintenance
Delaying essential repairs increases costs over time as minor issues worsen, requiring more extensive and expensive repairs. When infrastructure like heating, ventilation, and electrical systems degrade, it leads to more costly emergency callouts, which will incur additional costs.
Increased Operational Costs
Ageing infrastructure typically has lower energy efficiency due to outdated heating, cooling, and insulation systems. These inefficiencies result in higher utility bills by increasing the energy required to maintain the necessary temperatures and lighting conditions.
Increased Liability and Risk of Litigation
Outdated facilities may not meet current safety, accessibility, and regulatory standards, leading to fines and potential shutdown of the facility until these standards have been met. These necessary modifications often require extensive resources to ensure compliance with fire safety, accessibility, and health regulations, which have likely changed since the facility was originally built.
There are also potential risks to both patients and staff due to unsafe conditions, poorly maintained buildings, outdated medical equipment, or inadequate sanitation put patients at greater risk of injury, infection, or improper care. Incidents like slips, falls, or exposure to infections can lead to harm and, in turn, legal action from patients or their families.
Role of Modular Solutions in Alleviating the Backlog
Modular construction offers an effective solution to maintenance backlogs by enabling faster, cost-effective, and flexible building solutions that can be rapidly deployed to reduce the strain on outdated infrastructure and serve as decant facilities whilst repairs are ongoing.
Modular facilities are an ideal solution to alleviate immediate capacity challenges whilst also having the structural design life to serve as long-term, permanent structures, which gives NHS estates the flexibility to meet evolving healthcare requirements.
Modular facilities deployed for short-term projects can be readily relocated and re-utilised once they are surplus to requirements and serve another Trust in need. This allows other healthcare providers to achieve cost savings, reduce construction time, and minimise environmental impact, all while maintaining high standards of patient care and operational efficiency.
How Managed Service Agreements can offer additional support to NHS Trusts
With a Managed Service Agreement (MSA) in place, Trusts benefit from proactive and planned maintenance, minimising downtime and extending the life of essential infrastructure. This planned approach can reduce the chances of unexpected failures that cause cancellations and exacerbate backlog issues.
By including hard and soft services in the agreement, such as maintenance, cleaning and security, NHS Trusts can focus on core services, knowing that critical maintenance and additional services are handled. This allows Trusts to dedicate internal resources to clinical needs rather than facility management, allowing them to focus on what they do best.
An MSA can allow the Trust to recover VAT on the hire cost payment which can significantly reduce the financial burden, making modular solutions more affordable.
Benefits of ModuleCo Healthcare’s Activity Based Revenue Solution
ModuleCo Healthcare’s (MCH) activity based revenue solution (ABRS) has the significant benefit of utilising revenue budgets when capital budgets are not available due to other clinical activities taking precedence.
An ABRS offers NHS Trusts the ability to achieve cost efficiencies with payments made based on actual usage, with clear invoicing that reflects the daily usage. This transparent approach simplifies budgeting and provides additional flexibility during the term.
MCH work closely with key stakeholders to assess expected usage through dedicated workshops, ensuring cost estimates are accurate and aligned with the hospital’s operational needs, helping to build a strong business case for the revenue model.
Addressing the NHS maintenance backlog is not just a matter of infrastructure management—it’s a critical investment in the future of healthcare delivery. Through adopting innovative solutions like modular healthcare facilities and flexible financing options such as activity based revenue solutions (ABRS), NHS Trusts can tackle their maintenance backlogs whilst improving patient care and operational efficiency ensuring that healthcare environments remain safe, functional, and adaptable to evolving needs.
We’d love to discuss how our hire solutions for our modular facilities can provide the perfect solution for your hospital to tackle its maintenance backlog in state-of-the-art permanent facilities. Get in touch with a member of our team via sales@healthcarehire.co.uk
