The condition of Northern Ireland’s health estate is deteriorating and a
more strategic approach is needed to ensure the safe and efficient
delivery of services, and to achieve value for money in managing this
highly valuable public asset. These are among the findings of a report
published today (Thursday 2nd July) by the Comptroller and Auditor
General.
Dorinnia Carville’s report considers the management of the £3.7 billion
health estate, which comprises around 1,500 freehold buildings and over
200 leasehold properties across more than 400 sites. It focusses on the
role of Department of Health which retains overall accountability for
managing the estate.
The report finds that, despite its importance, the estate is ageing and
increasingly not fit for purpose. Nearly half of the estate is more than 50
years old, with around one sixth more than 75 years old. Many of these
buildings predate current regulations and standards and, while the
majority of the estate is identified as compliant with statutory regulations,
40 per cent is not fully compliant and is in need of upgrade.
The ageing nature of the estate is also reflected in a substantial and
escalating maintenance backlog, which has risen to over £1.6 billion.
Around £251 million of this relates to backlog maintenance assessed as
high risk. The backlog follows an ongoing period of reduced maintenance
expenditure. The Department has provided around £25 million annually
since 2020-21 to address backlog maintenance, but such funding levels
have been insufficient to substantially reduce or slow the rate of estate
deterioration. While mitigations are in place and services continue to
operate safely, the report finds that risks arising from estate condition
and backlog maintenance will persist and may increase if not addressed.
The report also identifies inefficiencies in how the estate is used, including
prolonged retention of vacant estate with a total Net Book Value of nearly
£40 million. Some of these properties and sites have been vacant for a
prolonged period (in some cases, decades), often with no proper plans in
place for re-use or disposal. Vacant estate not only incurs ongoing costs
but also represents missed opportunities to generate income at an earlier
stage and reinvest this in public service delivery in Northern Ireland.
Commenting on the report’s findings, Dorinnia Carville said:
“The health estate is a critical enabler of frontline health and social care
services. However, our findings show that much of the estate is ageing, in
poor condition, and increasingly costly to maintain. It is important to note
that mitigations are in place to protect patients, staff and services.
However, this reactive approach risks storing up problems for the future
when it will potentially be much more expensive to address them
properly.”
“The condition of the health estate is a longstanding challenge, with the
overall picture remaining broadly unchanged over the past decade.
Progress to address these issues has been constrained by limited
resources, but there has also been an absence of a clear, long term
strategic framework to improve the condition of the estate. Many of the
recommendations in this report are aimed at supporting the Department
and its Arm’s-Length Bodies to develop this more strategic approach and
ensure that the estate is aligned to operational needs.”
“The Department already holds substantial data on the performance and
condition of the health estate. It now needs to use that data better to
improve decision-making and take action to better use the limited
resources available and achieve more value for money.”
ENDS
