The NHS’ efforts to deliver national priorities, including elective recovery and improvements in productivity, are at risk because of a damaging lack of investment in “dilapidated” buildings and facilities, NHS Providers have warned in a new report released on Wednesday, 1 March.

According to a new report from NHS Providers, No more sticking plasters: repairing and transforming the NHS estate, major capital investment is needed to enable NHS trusts to improve productivity, operational performance and patient care across all sectors.

But NHS Providers, which represents every NHS hospital, mental health and community service in England, says that historical underinvestment has had serious effects on the system, including the significant deterioration of NHS infrastructure. They say that this has created “major risks” to patient safety, quality of care the NHS’ ability to tackle and reduce waiting lists. “From fixing leaking roofs and broken boilers,” the report warns, urgent investment is needed to “bring long-neglected parts of the NHS estate into the 21st century.”

The report warns that buildings used by patients are at risk of “sudden collapse” and calls for the replacement of reinforced autoclaved aerated concrete (RAAC) planks, which were commonly used in hospital construction between the 1960s and 1980s. Made of precast concrete, RAAC planks are used in flat roof construction and have an expected lifespan of about 30 years. However, some have been in place for more than 50 years, including at 14 hospitals, seven of which are described as “at a critical level of risk.”

Only two of those seven hospitals are currently included in the government’s New Hospitals Programme. While the government has pledged to remove all RAAC from the NHS estate by 2035 and has committed £3685m to do so, “it is currently unclear how much additional capital will be made available for trusts impacted by RAAC planks,” and whether all RAAC will be removed from the NHS estate within the government’s timeframe, according to the report.

“Investment in the NHS has simply not kept pace with rising demands.”

The latest NHS data shows that the maintenance backlog has doubled since 2010/11 and currently stands at £10.75bn at today’s prices. To eradicate the highest risk maintenance issues across the NHS estate (those which must be urgently addressed to prevent catastrophic failure or major disruption to clinical services), is now more than £1.89bn, five times the amount needed in 2010/11.

The report also warns that major shortfalls in capital funding risk undermining efforts to increase bed capacity, which is significantly lower in England than in equivalent OECD countries, as well as harming efforts to harness digital developments and to curb emissions.

NHS Providers says the government must publish its long-term capital strategy as soon as possible and clarify how it plans to transform the wider health and care estate. Responding to the report, the Chief Executive of NHS Providers, Sir Julian Hartley said: “Capital investment in the NHS has simply not kept pace with rising demands on the NHS over the last ten years.

“Trusts welcomed the multi-year capital budget set at the October 2021 Spending Review and the contribution this will make towards improving productivity and performance after years of under-investment. But the fact remains that there is not nearly enough ‘give’ within the system to meet rising operational pressures on the capital budget.

“This is not just about pounds and pence. It’s about ensuring patients have the safe, timely, high-quality care they deserve. It’s about providing a modern, well-equipped therapeutic environment where staff can work efficiently and effectively. And it’s about ensuring NHS resources are invested strategically, to meet current and future needs, to improve productivity and prevent waste.

“The government needs to make some major decisions about the growing maintenance backlog as well as the New Hospitals Programme (NHP), which has been beset by delays and indecision over funding.”

A spokesperson for the Department of Health and Social Care said: “We are investing record sums to upgrade and modernise NHS buildings so staff have the facilities needed to provide world-class care for patients, backed by £4.2 billion this year and £8.4 billion over the next two years.

“We will also deliver 40 new hospitals as part of the biggest hospital building programme in a generation, as well as over 70 hospital upgrades across England, and will eradicate RAAC from the NHS estate by 2035.”