Concerns raised over 'deteriorating' health buildings

There are significant concerns that a substantial number of Northern Ireland's healthcare buildings cannot deliver safe and effective services, according to a new report from a public spending watchdog.

The Auditor General's latest analysis of what is known as the health estate said only 40% of facilities were in an acceptable condition, with many categorised as being "high risk" and requiring urgent maintenance costing more than £250m.

The report said almost half of the estate was more than 50 years old and about one sixth more than 75 years old.

The Department of Health welcomed the report and said work had already begun to tackle some of the issues identified.

It added that health trusts had "provided assurance" that all associated risks were managed to ensure buildings remained "in a safe state to support service delivery".

While the department is ultimately responsible for the £3.7bn health estate, almost all of the buildings and land are owned and managed by health trusts and the fire service.

The Northern Ireland Audit Office said the condition of buildings was deteriorating and a more strategic approach was needed to ensure safe and efficient delivery of services, and achieve value for money.

With essential maintenance spend now reduced to "absolute minimal levels" and with increasing future costs, there was a danger of seeing a "cycle of deterioration", said the report.

The Auditor General Dorinnia Carville said high-risk maintenance related mostly to building structures, including roof replacements, and "the potential for material to fall from height and cause injury to staff, service users or visitors".

The health estate was a critical enabler of frontline health and social care services, but "much of the estate is ageing, in poor condition, and increasingly costly to maintain," she said.

"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."

She added: "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."

The value of the estate is made up of £3.4bn in property and £300m in land, with 1,500 freehold buildings and more than 200 leasehold properties across 400-plus sites.

The healthcare facilities include hospitals, residential accommodation, day centres, health clinics, ambulance stations, fire stations, warehouses, and storage and administration buildings.

There are also a large number of vacant properties, mostly in larger and older hospital sites.

More than half of the £251m needed for high-risk maintenance is within the Western Health Trust and centred mostly around Altnagelvin Hospital in Londonderry and the Tyrone and Fermanagh Hospital site in Omagh.

In a statement, the Department of Health said it was "grateful" to the Northern Ireland Audit Office for its work and would consider its recommendations carefully.

It said the recommendations would support the development of the Departmental Strategic Asset Management Plan, due to be finalised by March 2027.

It added that calculating and reporting backlog maintenance had been "a longstanding issue", particularly as many assets were "ageing and challenging to maintain".

But the department said it has issued guidance to health trusts to "unify the approach" to this.

Health officials are also reviewing "vacant and underused assets" in order to ensure value for money.

The statement added that the priority was to ensure health estates continued "to safely support frontline services, while delivering best value for public money, particularly within the context of constrained resources".