Tackling the NHS backlog maintenance

Hospitals sit at the heart of the communities they serve, yet many face the ongoing and complex challenge of backlog maintenance. At Kendall Kingscott, we work with the NHS to help address these issues. Many hospital buildings are older and not designed for the current demands of modern healthcare provision. Keeping them updated, compliant, and operational while any work takes place is no small task.

Backlog maintenance is the essential works that are known about but not yet completed, often due to limited budgets or competing priorities. This work frequently comes about from compliance requirements such as checks on health and safety, fire safety, water temperatures, air quality etc. We then work with clinical advisors to agree compliance and derogation of the Health Building Note’s (HBN’s) and Health Technical Memoranda (HTM’s) which are core NHS Design standards for healthcare buildings.

As NHS funds are stretched thinly, repairs can sometimes only happen when absolutely necessary, from ageing pipes to replacement of rooves and windows - the result is a growing list of priorities across NHS estates.

The reality of the work

Our projects in backlog maintenance are not the exciting new wards, the provision of specialist new healthcare facilities or the cosmetic upgrades, they focus on maintaining critical infrastructure and service continuity. Typical examples include:

• Boiler and pipework replacements: essential but technically challenging in old buildings.

• Roofing and window renewals: vital for energy efficiency and safety.

• Fire safety improvements: extensive fire door and compartmentation works following the changes in the Building Safety Act review.

• Compliance upgrades: bringing legacy systems as close as possible to modern standards.

All of this work takes place on live hospital sites, where patient safety and minimal disruption are paramount. Through “Operational Impact Meetings”, we plan carefully with estates managers and clinical teams to phase works and maintain services.

Working within constraints

Adapting existing buildings to meet today’s standards is a constant challenge. Narrow corridors, limited accessibility and ageing layouts can in some cases make full compliance impossible. We work closely with NHS organisations to agree pragmatic, safe solutions that respect the limitations of the existing fabric, finding the balance between ideal standards and real-world conditions.

Optimising the estate

Backlog maintenance also presents opportunities. As healthcare delivery evolves, spaces can be repurposed to meet new needs, for example, reallocating under-used departments to expand outpatient facilities. This helps the NHS make the most of every square foot of its estate.

Forward looking

The maintenance backlog is not just a financial issue; it’s a strategic challenge as decisions impact safety, efficiency, and sustainability.

Our role as consultants is to help the NHS to prioritise investment, manage risk, and deliver complex works safely. The task is significant, but so is the commitment of everyone involved in maintaining these vital community assets.

With careful planning and collaboration, we can ensure that even the oldest hospitals continue to serve patients for generations to come.