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Purpose Lord Carter’s (2015) “Review of Operational Productivity in NHS providers” stated that to improve National Health Service (NHS) England’s efficiency, operational productivity should be targeted in four main areas, one being estates management. NHS England’s estate includes a variety of buildings some of which are considered no longer fit-for-purpose, thus creating risk to patients and staff. These built assets require continuous maintenance, adding pressures to NHS England’s precarious financial situation. The purpose of this paper is to identify positive strategies and major constraints to achieving sustainable management of backlog maintenance (BM) across the NHS assets, and thus suggest balanced actions.Design/methodology/approach The research adopts a qualitative approach and combines: literature review of current BM methodologies; interviews with estates and facilities directors from seven NHS trusts on BM strategies; and a NHS trust detailed case study.Findings The major finding is that sustainable management of BM is achievable if there is a consistent, pro-active and long-term strategic approach where critical levels of BM are prioritised. Additional issues (i.e. appropriate methodology, performance metrics and links with clinical service delivery strategies) also need to be considered.Practical implications This study is relevant to the management of the NHS estate including development and adoption of sustainable strategies.Originality/value This paper offers original insights to the factors influencing healthcare estates’ BM at a time when the UK policy agenda is targeting infrastructure operational efficiency and organisations are seeking more comprehensive methodologies. [ABSTRACT FROM AUTHOR]

Healthcare buildings play a significant role in delivering healthcare services and outcomes (e.g.quality, suitability, cleanliness, patient experience, value for money and risk mitigation). However, the current diffusion of responsibilities in England between central government and healthcare trusts has created gaps and weaknesses in the evidence base, knowledge, skills and tools for creating and assessing healthcare building design quality. How can a national healthcare building design quality improvement strategy be created? This question is explored in relation to policy, strategy and organizational issues. Four evaluation studies and four action research studies indicate the complexity and responsibilities in defining a design quality improvement strategy. It is found that the interdisciplinary development of national standards and tools requires centralized investment to facilitate nationwide learning and improvements in evidence and outcomes. In addition, the inevitable health policy changes made by successive governments require a sustainable and strategic response. The creation and maintenance of capacity and capabilities will require a dedicated team of professionals and a wide interdisciplinary network of long-term contributors who are motivated by a long-term desire to improve healthcare building design quality. [ABSTRACT FROM PUBLISHER]

NHS Trusts in England must adopt appropriate levels of continued investment in routine and backlog maintenance if they are to ensure critical backlog does not accumulate. This paper presents the current state of critical backlog maintenance within the National Health Service (NHS) in England through the statistical analyses of 115 Acute NHS Trusts. It aims to find empirical support for a causal relationship between building portfolio age and year-on-year increases in critical backlog. It makes recommendations for the use of building portfolio age in strategic asset management. The current trend across this sample of NHS Trusts may be typical of the whole NHS built asset portfolio and suggests that most Trusts need to invest between 0.5 and 1.5 per cent of income (depending upon current critical backlog levels and Trust age profile) to simply maintain critical backlog levels. More robust analytics for building age, condition and risk-adjusted backlog maintenance are required. [ABSTRACT FROM AUTHOR]