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Purpose This paper aims to identify costs related to dementia care provision and explore how purpose-built environment investments can help control these costs and improve quality of life and clinical outcomes. Design/methodology/approach This research adopts a multi-method approach where the findings of a literature review drove the analysis of data obtained from the 115 pilot projects funded by the Department of Health England’s National Dementia Capital Investment Programme. Findings Under the UK Government’s new productivity challenge, it is fundamental to identify actions that provide value for money to prioritise policy and practice. This paper identifies healthcare spaces (e.g. bathroom) where the impact of the built environment on healthcare costs are most evident and building elements (e.g. lighting) to which these costs can be directly associated. The paper advocates the development of evidence and decision support tools capable of: linking built environment interventions to the healthcare costs; and helping the healthcare and social care sectors to develop effective and efficient capital investment strategies. Research Limitations/implications Further work needs to develop more systematic ways of rationalising proactive and timely built environment interventions capable of mitigating dementia (and older people) care cost escalation. Originality/value This research takes an innovative view on capital investment for care environments and suggests that appropriate built environment interventions can have a profound impact on costs associated with dementia care provision.

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.

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. First Publish Online: 19 Jun 2015