NHS: Backlogs

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of (1) the backlog of the maintenance of NHS buildings, and (2) the impact of the backlog on the capacity of the NHS to deliver services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The NHS publishes the annual Estates Returns Information Collection, which provides a detailed breakdown of backlog maintenance. Patient and staff safety is our top priority. While individual NHS organisations are responsible for their estates, we recognise that backlog maintenance can have a significant impact on NHS services. That is why £12 billion in operational capital will be provided to the NHS over the next three years for trusts to maintain and improve the estate.

[Baroness Merron (Lab)]

My Lords, last month, NHS Digital reported that the maintenance backlog had increased by 11% from last year to over £10 billion, with more than half of it posing a high or significant risk to safety or the delivery of healthcare. So does the Minister agree that, if more facilities, operating theatres and buildings had been properly maintained, they could have been used to provide care and reduce waiting times? Having allowed the maintenance backlog to double over the past 12 years, will the Government now fix this?

[Lord Markham (Con)]

I agree that it is an area of key priority; that is why the spend in this year as reported by NHS trusts has gone up by 57%—an increase to £1.4 billion. So we recognise that this needs to be worked on, but I put it in the context of an overall £10 billion capital programme, including a new hospital build. We very much recognise that making sure we have excellent facilities is key to success in the NHS.

[Lord Lexden (Con)]

My Lords, what has become of the great hospital building programme that Mr Boris Johnson promised in the 2019 Conservative election manifesto?

[Lord Markham (Con)]

I am very pleased to say that the hospital programme is very much a feature. We are already working on five hospitals, which are in the process of being delivered. The programme for the 40 hospitals is very much in progress, and we see it as a real opportunity for the UK to take a lead, as we are looking at using a whole new series of modern methods of construction, which we believe will be world leading in this space.

[Lord Morse (CB)]

My Lords, the Minister will no doubt be aware that for a long time it has been the practice of the NHS to rob Peter to pay Paul by appropriating capital budget to supplement revenue deficits. That really needs to stop, as it has led to a massive deficit in estate maintenance across the NHS. Care is being delivered in dilapidated surroundings across the system. That means that this building programme really matters—it is not a question of leaping forward but of making good long-term neglect. So I express to the Minister that if, as a result of the financial review, we find the programme being either delayed or cut, that would be deeply unsatisfactory.

[Lord Markham (Con)]

I agree on the importance of that; as the noble Lord says, often these are easy savings to make, but they are not the right ones. I assure the House that it is a key priority of mine that even such things as operational maintenance, which sounds very unsexy, are a key element in all this. As I say, that is why we have seen a 57% increase in the past year. At £10 billion a year, I hope we all agree that this is a good plan, albeit that there is a lot that needs to be done.

[Baroness Manzoor (Con)]

My Lords, the Public Accounts Committee has stated that £8.6 billion was lost by the DWP last year in overpayments to benefit claimants and fraud. That is £8.6 billion that could be used to maintain the NHS estates. Can my noble friend the Minister say what the Government are doing to ensure that not only are the inefficiencies cut in the NHS, but efficiencies are made within the wider government departments?

[Lord Markham (Con)]

Thank you. I am sure the whole House will agree the need for efficiencies to make sure every pound is well spent. I have a little knowledge in the DWP space. Although it falls outside my responsibilities now, I was the lead NED there and I know that the team worked very hard during the pandemic to make sure that universal credit reached people quickly, and as a result they did not proceed with as many checks as they would do normally. It was deliberate policy to make sure money was paid quickly to those who needed it. At the same time, they absolutely understand that they need now to get on top of it and it is key to their action because, as my noble friend says, the more money we can free up in other departments, the more we can focus it on the front line where we really need it.

[Lord Blunkett (Lab)]

My Lords, I recognise that the noble Lord is new in post and the Secretary of State is sort of new, having been in and out and then back again. But the backlog in repairs is mirrored by the exponential increase in waiting lists. Has this something to do with the atrophy that now exists in the health service due to the changes brought in by Matt Hancock, which have led not to the integration of services but the integration of bureaucracy?

[Lord Markham (Con)]

I can assure the noble Lord that bureaucracy is not the aim of the game and that getting money to the front line is the priority. We have record levels of investment in this area. We are currently devoting about 12% of GDP to health spending, which sits alongside the highest in the world. That is not to say we do not have to make sure every penny of that is spent effectively and, where possible, on the front line rather than on back office and bureaucracy.

[Lord Stoneham of Droxford (LD)]

My Lords, the key test of any organisation with a backlog of maintenance is whether it sustains that expenditure when it is under financial pressure. So will the Government commit that the extra money they have budgeted for maintenance in the health service will be maintained in real terms when inflation is running at 10%?

[Lord Markham (Con)]

We understand the importance of the programme, as I mentioned, and, in terms of the finances of the country, we have people in high positions who know its importance in the health debate. So the noble Lord can rest assured that it is top of our agenda, and we will be fighting hard to make sure that the capital programme is given the priority it needs.

[Baroness Masham of Ilton (CB)]

My Lords, would the Minister like to visit Masham GP surgery, where I live? He will find it is a GP surgery that needs updating. It was turned down, and one of the doctors left and went to Canada. It is now totally unsuitable for a growing population, for both patients and the staff working there.

[Lord Markham (Con)]

I do recognise the importance of primary care. We know that a lot of the people who turn up to A&E would be better served in the primary care system, so making sure we have good facilities in this place is vital, and again it is something that is part of our agenda. There was an excellent report in this space recently, and it is something we are working towards—so, yes, GP surgeries are very much an important part of this £10 billion programme.

[Lord Kamall (Con)]

My Lords, in response to an earlier question about the hospital building programme, my noble friend the Minister mentioned the modern construction techniques of hospitals. I wonder whether he could enlighten the House on some of the leading technology methods we are looking at when it comes to the new hospital programme.

[Lord Markham (Con)]

Absolutely; I look forward to sharing this with the House in a lot more detail shortly. This is a real opportunity to create a world-leadership position. The idea behind it is to have a standardised approach to building hospitals—hospitals 2.0, as I like to call them—where we look as much as possible to have standard processes, procedures and components, so that we can build them quicker, cheaper and more efficiently, and get economies of scale from doing that. I believe that it will not only pioneer the way we build hospitals in this country but give us an opportunity to be a pioneer worldwide and create a major export industry.

[Lord Berkeley (Lab)]

My Lords, I believe that Prime Minister Johnson promised 40 new hospitals, but the Minister has mentioned five—what has happened to the other 35?

--- Later in debate ---

[Lord Markham (Con)]

The other 35—I will happily read them out if the noble Lord wishes—are very much part of the programme, and extensive work and business plans are being performed. I visited one myself, Watford General Hospital, just the other day to go through the plans, so the noble Lord can rest assured that the other 35 are very much still part of the programme.