The NHS in England has a record repair bill of almost £12bn, new figures show, with ministers needing to find more than £2bn for urgent maintenance to prevent catastrophic failure. The annual report on the condition of the health service’s estate said on Thursday that the cost of improving rundown buildings and decrepit equipment was two and a half times larger than in 2011-2012, when it stood at £4.7bn. The cost of the “high-risk” backlog – situations where the need to repair or replace facilities and equipment must be urgently addressed to prevent serious failure, significant injury or major disruption to clinical services – rose by almost a third to a record £2.4bn. This was £0.3bn in 2011-2012. However, investment to reduce the backlog fell in the last year from £1.41bn to £1.38bn, a fraction of what is needed to restore the NHS estate back to acceptable levels of risk. The stark figures cover a time prior to the health service becoming embroiled in the crumbling concrete crisis which initially hit school buildings. Sir Julian Hartley, the chief executive of NHS Providers, said that “too many NHS buildings are quite simply falling to bits”, and that we need “a step change in the government’s approach to planning and funding essential capital investment in the NHS”. He said: “The eye-watering cost of trying to patch up creaking infrastructure and out-of-date facilities is mounting at an alarming rate. “Mental health, hospital, community and ambulance services are crying out for much-needed funding for critical projects to overhaul ageing estates and to give patients and staff the safe, reliable conditions they need. “We should be planning for how to transform the NHS estate as well as addressing urgent maintenance challenges.” The costs of the “high-risk” backlog have risen by 31% in 2022-2023, while the overall repair bill has risen by 13.6% in the same period. The level of investment only covered 11% of the cost. The hospital with the largest high-risk backlog was Airedale general, where it would take £335.2m to fix all of the serious safety and maintenance issues. Airedale is part of the NHS programme to remove reinforced autoclaved aerated concrete (Raac) from its buildings. Raac is a lightweight construction material that is susceptible to structural failure. There were 42 hospital sites confirmed to contain Raac as of October, 18 of which had joined the national Raac programme since May, meaning the cost of any repairs needed was excluded from the latest figures. However, the maintenance crisis is broader than one single issue. Charing Cross hospital in London had the second-largest high-risk backlog, with £173.7m worth of repair work needed. But it did not appear on the government’s list of hospitals with Raac. Neither did St Mary’s hospital in London, Croydon university hospital or Wycombe hospital, which had the third, fourth and fifth largest high-risk backlogs respectively. The Health Service Journal recently reported that Doncaster Royal Infirmary, some of which dates back to the 1930s, had been testing contingency plans for a “full or partial site closure” because of the problems it faces with parts of its infrastructure. In 2021, a leak from a water pipe got into the electricity supply for the women and children’s hospital. This knocked out power cables for an entire wing of the hospital, started several fires and forced staff to evacuate premature babies and mothers who were in labour. Siva Anandaciva, the chief analyst at the King’s Fund, said the government’s failure to build the “40 new hospitals” Boris Johnson promised in 2019 “has left parts of the NHS estate in such a poor condition they pose serious risks to staff and patients”. In September Julian Kelly, NHS England’s deputy chief executive, told MPs on the Commons public accounts committee that the NHS had “examples all the time where hospitals are having to shut units, decant patients into other spaces, where we are losing [operating] theatres … which limits our capacity to treat patients”. Rory Deighton, the director of the NHS Confederation’s acute network, said: “The growing cost of the high-risk maintenance needed to prevent catastrophic failures or major disruption to clinical services is particularly worrying.” NHS trust bosses regarded the “urgent” need for more capital investment as the NHS’s top funding priority, he added. Separate figures show the NHS was badly hit by the rise in the cost of energy due to Russia’s invasion of Ukraine. The service spent £1.2bn on energy costs in 2022-23, up by 53% on the year before, despite using less energy overall (down by 1.7%). A Department of Health and Social Care spokesperson said: “We have invested significant sums to upgrade and modernise NHS buildings so staff have the facilities needed to provide world-class care for patients, including £4.2bn this financial year. “Trusts are responsible for prioritising this funding to maintain and refurbish their premises, including the renewal and replacement of equipment. “This is on top of the £3.7bn made available for the first four years of the new hospital programme and a further £1.7bn for over 70 hospital upgrades across England alongside a range of nationally funded infrastructure improvements in mental health, urgent and emergency care and diagnostic capacity.”