FM experts share blueprint to help NHS tackle £13.8bn maintenance backlog

The NHS estate has long faced a serious and growing challenge: an overwhelming £13.8 billion backlog in essential maintenance, with costs only rising. Delays in upkeep not only endanger patient safety but can also expose Trusts to legal risks, including fines and increased long-term expenditure.

Thirty-three per cent of building maintenance professionals reported “defending maintenance budget cuts” as their biggest challenge, a problem intensified by the Building Costs Information Service’s prediction of a 4.8 per cent rise in maintenance costs in 2023.

In response, Paul Bullard, Product Director at SFG20, the industry standard for building maintenance specification, has shared a step-by-step framework to help address the £13.8 billion maintenance backlog, even amid tight financial constraints.

Reflecting on the true costs of inaction and the risks posed by failing assets, the following strategies identify proven methods for healthcare estates to manage budgets better during inflationary pressures.

1. Establish risk appetite and tolerance

To begin addressing the NHS maintenance backlog, organisations must first define their risk tolerance and appetite, the level of risk they are willing to accept to meet strategic objectives.

Clearly articulating this helps inform cost forecasting and ensures consistency across decision-making and governance. A well-defined risk appetite supports better prioritisation, reduces uncertainty, and strengthens spending reviews and resource allocation.

Fix your asset register

Accurate and up-to-date asset registers are critical for maintenance planning, compliance, and safety in NHS estates. They are also a fundamental part of the Golden Thread of Information under the Building Safety Act 2022, supporting transparency and accountability throughout a building’s lifecycle.

Despite this, 43 per cent of organisations report poor data accuracy, and six per cent have no register at all.

After creating or fixing your asset register, the next step is to match your assets within your asset register to the right maintenance tasks.

Understand your statutory obligations

Delays in maintenance, especially those that are critical, can result in ward closures, cancelled treatments, and increased costs across NHS estates. While non-statutory tasks fall outside legal requirements, completing them can often play a key role in preventing asset failure and minimising disruption.

The Government’s FMS 002: Asset Data standard emphasises the use of SFG20 criticality codes as a basis for producing complete and accurate asset registers. Aligning with this guidance helps healthcare estates plan effectively, manage risk, and maintain safe, compliant operations.

Cost forecasting

Effective maintenance planning depends on applying compliant, standardised tasks to each asset and accurately forecasting the associated costs. Facilities management technologies, such as CAFM systems with integrated finance modules, can support this by linking asset data with cost and compliance tracking.

Without this structure, NHS trusts may struggle to communicate risk profiles and budget needs to decision-makers, hindering efforts to reduce the growing maintenance backlog and increasing exposure to serious legal, financial, and reputational consequences.

SFG20 spoke to David Hemming, Civil Engineer and leading FM expert at NHS Shared Business Services, who said: “Currently, the NHS uses the Premises Assurance Model when they [the board of each trust] look at assurance… they could benefit from having a more directed tool to really understand their resources and their finances, to say this is what we need to get on top of it.

“This is important because if you’re doing asset management well and you’ve integrated tools like SFG20 into CAFM systems, asset management systems, enterprise asset management systems etc., then you should have a clear horizon of when you need to undertake tasks, what it’s likely to cost and the risks involved by not doing it. 

“This is important because it gives you a rich risk picture that you can then use to brief the decision makers about finances and resources.

“Doing things in a standardised way is invaluable and therefore doing a procurement/investment strategy that is linked to that, can save you thousands and thousands of pounds.”

To find more about how NHS trusts can tackle the growing maintenance backlog, download SFG20’s new e-book here.