Addressing the maintenance backlog in NHS hospitals

Across the NHS, a growing backlog of planned maintenance is significantly affecting the operational efficiency and productivity of hospital facilities.

This backlog has developed over time as mounting pressures on estates and facilities management teams have overwhelmed operational capacity. The consequence is that unresolved maintenance jobs are impacting the ability of NHS staff to provide high-quality care and, most importantly, jeopardising patient safety.

At Specialist Door Solutions (SDS), we understand that while doors are a small component within the vast infrastructure of a hospital building, they play a pivotal role in maintaining productivity, safety and controlling the spread of infection. When doorsets in need of repair or replacement are left unaddressed, they can contribute to safety risks and operational challenges that further strain the healthcare system.

Understanding the NHS maintenance backlog

NHS England carries out an annual Estates Return Information Collection (ERIC), which details just how much backlog maintenance there is – specifically, this is not work that is planned, but maintenance work that’s yet to be scheduled or resolved.

In Chancellor Rachel Reeves’s October Budget, £1 billion was allocated to address the NHS estates maintenance backlog, however according to the latest data, it would cost £13.8 billion to eradicate the backlog of essential maintenance work in NHS facilities across England.

With resources often spread thin across the NHS, essential areas of maintenance, including door systems, can be neglected. This delay in maintenance can make routine tasks harder for staff and lead to more serious consequences. Properly functioning doors, especially fire doors, are essential for hospital buildings to perform effectively and safeguard the patients, staff and visitors within them.

How inadequate door maintenance impacts safety and care

Specialist Door Solutions’ products are often fitted in high-traffic areas, so they are subject to frequent use and often must withstand force when they are pushed open with heavy items such as stock trolleys, patient beds, metal cages or wheelchairs. There are an estimated 1.5billion doors in NHS spaces in the UK, and delayed management of the inevitable wear and tear to doors can lead to a host of issues, including:

1. 1. Increased fire risk: Fire doors are critical for hospital safety, acting as a protective barrier in the event of a fire by containing smoke and slowing the spread of flames. If fire doors are not maintained properly, they may not close correctly or fail to withstand fire as designed, endangering the lives of patients, staff and visitors.
   2. Reduced infection control: Many hospital doors are specially designed to support infection control measures, particularly in areas such as isolation rooms and operating theatres. Broken or improperly functioning doors can compromise the containment of infections, posing a risk to immunocompromised patients and increasing the likelihood of hospital-acquired infections.
   3. Operational inefficiencies: If NHS staff must struggle with doors that don’t open or close smoothly, or that fail to lock properly, it can lead to delays in care delivery, hinder the movement of equipment, and add stress to an already demanding environment.
   4. Increased security risks: Doors that are unable to close or lock securely can compromise security, which can lead to unauthorised access to restricted areas and pose a risk to patient confidentiality and safety.

Fire safety doors: a critical component

The proper function and maintenance of fire safety doors is not only a regulatory requirement but also a crucial aspect of a comprehensive fire safety strategy. Though no NHS trust wilfully allows fire doors to degrade, when there are too many things vying for time and budget, it’s a sad fact that some things will slip down the priority list.

SDS fire doors are meticulously engineered and tested to ensure they can contain fire, slow the spread of smoke, and provide a safe escape route for individuals within a hospital building. The NHS maintenance backlog is likely to have left many fire safety doors in a vulnerable state, with doors potentially failing to meet safety standards due to delayed repair and maintenance.

In 2023/24, a total of 1,102 fires were recorded in NHS facilities, which is an average of three every day and highlights the significant risks of not repairing or replacing fire doors in a timely way. A fire in a hospital is already a dangerous scenario due to the immobility of certain patients and the density of critical, life-saving equipment in these facilities. Broken or compromised fire doors can lead to uncontrolled spread of fire and smoke, making evacuation more challenging and increasing the likelihood of casualties.

How can the NHS address the issue?

While it’s clear that the task of addressing the NHS maintenance backlog is significant, the difficulty lies in balancing this against the ongoing pressures on all areas of the NHS. When every department needs more people, more equipment and more funding, making decisions on allocating precious resources can be a thankless task.

The need for maintenance work requires a long term view to consider the impact of work efficiency, patient care and increased costs further down the line; the closure of wards, theatres or clinics, lost bed days and disruption to patient flow are all potential outcomes and are already being seen across the NHS.

Recent ERIC data showed that over 2,600 patient treatments were delayed or cancelled due to infrastructure issues, and a 2022 report from the British Medical Association (BMA) found that 43 per cent of doctors believed poor workplace conditions were negatively affecting patient care, while 38 per cent rated their facilities as poor or very poor.

NHS executives face an unenviable challenge in addressing the existing backlog. Here we have some suggestive strategies to help tackle this challenge:

1. 1. Prioritise high-risk areas: This is particularly relevant in areas related to fire safety or infection prevention and control. Assessing the condition of fire doors and ensuring they are compliant with fire safety standards is essential for protecting lives.
   2. Develop a preventative maintenance schedule: As well as dealing with reactive repairs, a preventative maintenance schedule ensures that small issues are addressed before they become critical failures. This approach is more cost-effective in the long run and enhances the reliability of hospital infrastructure.
   3. Engage specialist providers: Specialists have the expertise to assess compliance, identify specific issues, and deliver maintenance services tailored to the unique demands of healthcare environments and can support the estates workforce by providing technical training.
   4. Allocate funding for essential safety features: While addressing the entire maintenance backlog may take years, immediate budget allocation of smaller amounts for critical safety features, such as fire doors, will maintain safety.

The cost of inaction

The areas of work that are part of the maintenance backlog in the NHS aren’t merely a matter of inconvenience. Fire safety doors that do not function correctly, for instance, pose a potentially fatal risk in emergency situations. Poorly maintained doors in high-infection areas can lead to higher rates of hospital-acquired infections, putting patients at further risk and increasing pressure on NHS resources. And as maintenance issues add up, they can create bottlenecks in patient flow, leading to delays and operational inefficiencies that negatively impact both staff and patient experiences.

As pressure on the NHS continues to grow, developing a robust strategy for reducing the maintenance backlog and taking proactive steps to address high-priority items is essential for maintaining a safe, functional healthcare environment. NHS executives who take decisive action on this issue will mitigate risks, protect patients, and support healthcare staff in delivering the highest quality of care.

Working together to address the backlog

At SDS, we understand the significant challenge of addressing the NHS maintenance backlog. By working collaboratively—bringing together NHS leaders, facilities and estates teams, and solution providers—we aim to enhance the long-term efficiency and productivity of NHS facilities.

Let’s explore how SDS can help you maximise the value of your healthcare estate while minimising disruption to essential services.

Get in touch with the SDS team at 01420 543222 or email us at sales@specialistdoorsolutions.com .