Estate management is an increasingly urgent issue for the UK government, which is facing a £49 bn public estate maintenance backlog, with £13.8 bn accounted for by the healthcare sector alone – more than twice the 2015/16 figure, highlighting a growing strain on healthcare infrastructure. With limited resources, NHS Trusts must now tap into available support. Here Jonathan Oram, director of Frameworks at procurement specialist, Pagabo, highlights how procurement solutions are key in effectively tackling the healthcare backlog crisis.
The struggle to ensure that NHS healthcare buildings remain fit-for-purpose is at a tipping point, and the mounting backlog maintenance costs for public estates highlight the strain that continues to stretch an already overburdened NHS, where many estates include ageing buildings. Improving healthcare infrastructure is a high priority for the government, as evidenced by the plans for new hospitals set out in New Hospital Programme (NHP). However, equally pressing — certainly in the short-to-medium term, is the fact that the existing estate needs to be refurbished, reconfigured, and revamped in many areas to continue to serve modern healthcare needs. However, for this to be done effectively, collaborative effort to deliver across client and project teams in a way that ensures top-quality clinical care, alongside overall value, will be key.
The cost of a crumbling estate
The National Audit Office’s recent report (NAO), Maintaining public service facilities, published in January this year, spotlighting the staggering backlog in the UK’s estate maintenance, is not something we can suggest has come as a surprise. The detrimental effect on, and risks to, patient safety from issues such as poorly maintained buildings and M&E services are clear, but there are deeper cuts that continue to make the NHS bleed. These include treatment delays, cancelled procedures, and delays in discharge.
As a construction sector, it can be easy for us to look at healthcare buildings for what they are, but with the strain across NHS services continuing, it’s important for us to remember the people those buildings support. Tackling the estate maintenance backlog is thus about more than the structures that make up the NHS, but equally the imperative to restore the conditions necessary for timely, safe, and dignified healthcare.
Aligning with its report, the NAO has explored how the estates backlog as a whole can be addressed. Standardisation is a top consideration, not only for ensuring compliance, but in support of long-term viability, which is the case if the NHS has to be a continued priority, and we are to build a healthcare system fit for the future.
With the backlog increasingly impossible to ignore following the NAO’s high deficit figures, we can no longer deny that action is needed. We instead must turn our attention to how tackling these deficits can be done efficiently, safely, and at pace. Public sector procurement and the framework routes available offer an effective route for this. These are pre-tendered and compliant routes that can provide NHS Trusts with flexible and fast access to specialist providers across estates and facilities management specialties.
From limited internal resources to inconsistent delivery standards, the practical challenges that NHS teams are facing can be supported through framework intervention. Here, Trusts can accelerate urgent maintenance works while standardising quality and compliance, without the burden of complex contracts and procurement cycles.
The benefits of this process are frequently seen in the work delivered through the frameworks Pagabo manages, including the Total Facilities Management Framework (TFM). This fallows for more than just reactive maintenance, and also supports proactive lifecycle planning, monitoring, and sustainability-focused upgrades, allowing us to shift from ‘firefighting’ to forward thinking.
Significant value offered
NHS Estates teams should be focused on supply chain management and project delivery, which is where the deep value of frameworks — including the TFM framework and other sector-specific options — offer significant value. With many of the frameworks Pagabo manages being hosted by NHS Trusts themselves, their design has healthcare in mind throughout. This close alignment with operational realities, alongside extensive engagement with healthcare professionals and ongoing dialogue with Trusts, helps ensure that procurement processes reflect current needs, not outdated models.
Sector-specific framework offerings especially can offer unique respite to the challenges of the declining healthcare estate. Designed with the unique pressures of healthcare facilities in mind — from space constraints in areas like A&E, to the risks of maintaining live sites throughout development — these frameworks offer more than just assistance; they provide tailored, up-to-date solutions. This means that Trusts don’t have to start from scratch when tackling this uphill battle. They can access pre-vetted suppliers with a deep understanding of the healthcare environment, funding limitations, and long-term planning needs — eliminating the need to start from scratch.
The impact of poor maintenance on healthcare buildings is costly, and many issues — whether mechanical, electrical, or safety-related — simply cannot wait for lengthy tender processes. Direct awards through a framework to approved suppliers can significantly reduce critical timescales, enabling urgent repairs and upgrades to be delivered quickly and effectively — still wrapped up in the all-important compliance required.
Sustainable and social solutions
The continued stress on NHS services in recent years — from the effects of the pandemic to our ageing population, has left the foundations crumbling from the bottom up. What were once robust systems for planning and futureproofing have in many cases been sidelined. In this context, frameworks offer not only immediate delivery solutions, but also a critical pathway to reintroduce resilience into estate management. Frameworks aimed at addressing the estates backlog should go beyond immediate fixes, helping to embed long-term goals that align with the NHS’s future vision.
As we know, a prominent and pressing goal for the NHS is the move towards Net Zero goals. There is no doubt that facilities within the healthcare estate represent both major opportunity and challenge in reaching these goals. Utilising pre-approved suppliers that are already aligned with sustainability focuses and routes to realise goals, Trusts can look to accelerate related efforts through elements such as retrofitting and energy-efficient systems — all without compromising day-to-day operations or patient safety.
Effective social value is important across all sectors, and embedding this through framework options is a quick and easy win to hitting those targets — but in a healthcare setting social value impacts can be far-reaching, impacting everything from quality of care and patient outcomes through to staff wellbeing. Using suppliers that work with local facilities management supply chains, for example, offers a great opportunity to give back, with apprenticeships and community engagement also being other top options.
The intrinsic make-up of a procurement offering is clear, offering powerful tools that can help our healthcare sector get back to a point where it can effectively withstand the blows of a tumultuous landscape. That being said, we can’t deny that there is also incredible value in understanding how to use them effectively.
This topic has been a talking point well before the publication of the NAO’s report. For us to effectively tackle it, we need to understand the scale of support available, and find the best collaborative routes. As a supplier on several frameworks managed by Pagabo, global engineering and professional services company, AtkinsRéalis, has reinforced the importance of effective strategic management consultancy within the procurement process. Anna Lewis, Data and Artificial Intelligence lead at AtkinsRéalis, said: “The healthcare sector, along with most of the public sector, is under increasing pressure to drive productivity, improve performance, and reduce costs — all while tackling constrained budgets. The consultancy approach operates to create the structures, processes, technology, and behaviours, needed to turn vision into reality when it comes to a more streamlined operation.
“As we adapt to the age of AI, we’re seeing technology take its place alongside human interaction — with its value becoming clearer when it comes to consultancy and project management. Across all sectors, many are erring on the side of caution with AI, unsure of what the future holds in terms of its ability, place, and purpose, alongside human-built structures.
“Tackling the complicated structures of a national health system, AI use may become increasingly prominent, but it’s important to consider it as more than a tick-box exercise. As with effective procurement, AI utilisation for management needs to be considered, understood, and utilised, in the most efficient and compliant way, as a harmonisation of any framework process or procedure creation.”
Turning insight into action
The NAO’s report at the start of this year presented some hard truths that end in an upward climb. With this comes a feeling of anticipatory anxiety that as a country and a sector we have to break through — doing so together. The effects of not doing so are too detrimental. Over the past two years alone, overall backlog maintenance has increased by £2 bn. This rapid rise can be expected to continue if not tackled from multiple angles — via effective management consultancy, AI use, and all-important stringent framework offerings that can offer solitude in the storm.
With a framework approach, early engagement with framework providers is key, allowing for a holistic and collaborative approach. This approach must be embedded in all we do moving forward to tackle the crisis of our healthcare estate. Cross-sector collaboration — between client estate teams, contractors, consultants, procurement specialists, and facilities management providers — is just one of the essentials needed to harness improvement. Alongside this, central government bodies must adopt this supportive and collaborative approach, working with frameworks as a delivery mechanism with significant positive benefits to the future of the UK’s healthcare system.
For healthcare projects to succeed today and into the future, procurement can’t be an afterthought; it must be a foundational part of the project strategy from day one. By engaging early with those managing healthcare-specific frameworks, NHS leaders can better align procurement routes with clinical outcomes, sustainability goals, and funding realities, all in aid of maintaining estates for the future. It’s not just about getting the job done; it’s about getting it done in a way that builds long-term resilience into the very fabric of the NHS estate.
Jonathan Oram and Pagabo
Jonathan Oram is director of Frameworks at procurement specialist, Pagabo, where his work focuses on the delivery of flexible, compliant frameworks managed on behalf of public sector contracting authorities. Experienced in public sector procurement, his experience also includes a demonstrated history of working in the hospital and healthcare industry, including five years at NHS Supply Chain.
Pagabo is ‘a leading UK procurement specialist’ that manages a suite of frameworks on behalf of public sector contracting authorities. Headquartered in central Hull, and owned by Pagabo Group, the company manages UK and EU procurement law-compliant framework agreements and provides bespoke consultancy – delivered and backed up by a team of MCIPS and NEC-qualified procurement professionals.
With an approach rooted in creating the maximum social value possible, the organisation is also a certified B Corp, Good Business Charter business, and ‘one of only a handful of NHS Accredited Framework hosts in the UK’.