This year’s ERIC (Estates Return Investment Collection) data was released in October, showing that NHS backlog maintenance and high-risk backlog maintenance have both risen significantly. The increases are bigger than expected and will impact patient care and efficiency, in turn affecting the economy.

The ERIC data reveals that NHS backlog maintenance has risen from £9.2 billion to £10.2 billion (11% increase). High-risk backlog has also risen from £1.6 billion to £1.8 billion (14% increase). These numbers suggest two things. Firstly, the underinvestment in estates and maintenance over the last 15 years is having a larger impact than expected, despite the development of a number of new facilities during the pandemic, Secondly, greater focus on this area (and greater professionalism in properly assessing estates) is turning up problems that we previously might not have been aware of.

Total NHS backlog cost

Chart depicting the total NHS backlog cost

The high-risk figures are always of greatest concern. High-risk backlog maintenance is where “repairs/replacement must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution”. The consequences of this backlog are severe.

In more positive ERIC results, clinical service incidents driven by infrastructure failure have fallen by 22%. Again, this may reflect increasing attention and professionalism in the management of NHS estates. However, any clinical incident is one too many and the service had 5,105 in 2022. Each of those “resulted in clinical services being delayed, cancelled or otherwise interfered with”.

Why are these findings important?

Healthcare is the UK’s second biggest industry. It is important to the economy in itself, but also because of its impact on the broader economy:

  • Good healthcare gets people back to work sooner.
  • Good healthcare makes an economy more attractive to inward investment.
  • Good healthcare is a magnet for other industries, both supporting and complementary. Life sciences, pharma, and biotech, for example, all rely on a strong academic and clinical healthcare sector.

But good healthcare relies on good quality buildings which is why the ERIC data is so significant.

Worldwide, health systems are struggling to recruit and retain the talent they need. The best clinicians and researchers will be unlikely to choose to work in crumbling facilities in the UK when they can work in much more modern facilities in Australia and the US. If those clinicians go, we lose not only their capacity to deliver healthcare, but valuable research and development opportunities and opportunities for innovation.

From a well-being perspective, good quality healthcare environments almost certainly improve patient experience and therefore patient outcomes. They are better for infection control and reducing readmissions, for example.

Functional and up-to-date healthcare facilities are a core requirement for the UK to keep the economy moving, to compete globally and to enable healthcare that enhances quality of life.

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Further analysis of ERIC data: by region and care setting

Regional analysis

Total backlog costs by region

Chart depicting the total NHS backlog cost

Backlog maintenance is highest in London (27% of the national total), while London also has the highest amount of high-risk backlog – almost half.

High risk backlog by region

Diagram showing the total backlog costs by region

This is not good news for a region that is looking to encourage the growth of life sciences and industry around world-class healthcare facilities.

Care setting analysis

Total acute care backlog cost


The backlog maintenance bill is dominated by acute care settings.

However, there remains a significant need in both mental health and community settings.

NHS mental health care backlog cost


NHS community care backlog cost


For more information, get in touch with Rhiannon Williams.

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