Maintenance Backlog in NHS Wales Nears £1bn
The backlog of maintenance and repairs in NHS buildings in Wales classified as "high" or "significant risk" has reached nearly £1 billion, according to recent figures.
With the Senedd election approaching in May, several political parties have included promises to build new hospitals in their policy platforms. However, regardless of which party forms the next Welsh government, it will need to address the challenges posed by an ageing health service estate that could strain budgets.
An analysis of 210 NHS Wales sites, ranging from community clinics to major general hospitals, reveals a "high" and "significant" risk backlog totaling £917 million, marking a 71% increase over four years, based on data from NHS Wales Shared Services Partnership.
This figure includes over £616 million required to address the most critical issues at 12 of Wales' 13 main hospitals.
Detailed Breakdown of NHS Wales Building Issues
A map illustrating the main hospitals and health boards across Wales highlights widespread maintenance challenges throughout the country.
The only exception is the recently opened £350 million Grange University Hospital near Cwmbran, which has no maintenance problems. Although it opened early during the Covid-19 pandemic, the hospital was initially proposed in 2004 and represents the first major new hospital constructed in Wales in 20 years.
This example underscores that new hospital projects not only require substantial financial investment but also involve lengthy planning and construction periods.
Annual surveys assess the condition of buildings across health boards, and a further breakdown of these figures was obtained for 2024-25.
When considering a "risk-adjusted" backlog—which focuses on major problems potentially affecting safety—the total for all NHS buildings in Wales exceeds £1 billion.
The largest portion, nearly £278 million, pertains to the Betsi Cadwaladr health board area.
Despite having a relatively new main hospital, the Aneurin Bevan health board has a backlog nearing £233 million. This includes nearly £150 million in repairs and maintenance at its two older hospitals, the Royal Gwent and Nevill Hall.
In the Hywel Dda health board, where a proposed new hospital for west Wales remains several years away, the backlog stands at £221 million. This includes issues at three hospitals, notably Glangwili Hospital in Carmarthen, which requires £82 million in high and significant risk repairs and maintenance.
The chair of Cardiff and Vale health board has recently acknowledged that the condition of University Hospital of Wales (UHW), built in 1971, is negatively impacting staff morale and operational efficiency, describing the maintenance, age, and quality of the buildings as "a continuing concern."
'Worryingly Large' Backlog
The maintenance backlog issue is not unique to Wales; NHS England faces an estimated £16 billion in repair and maintenance backlog.
Experts note that the NHS has generally underinvested in buildings, IT, and equipment over the past two decades.
Mark Dayan, a policy analyst at the health think-tank the Nuffield Trust, stated: "In Wales there was a 'worryingly large backlog of maintenance by anyone's standards' and more than twice what the entire NHS in Wales spends a year on all buildings and permanent equipment."
He added, "The condition of buildings and infrastructure can have a really limiting effect, on healthcare. In particular, often, if you want to try to do things differently. So, for example, if you want to reconfigure your emergency department, if you want to try to shift more planned care onto one site so you can get through it quicker. If you're struggling at the limit of the amount of safe space you can actually use at any given time, that poses an extra problem for those practical things the NHS might want to do."
Political Parties' Proposals to Address the Backlog
Welsh Labour has pledged a £4 billion Hospitals of the Future fund aimed at constructing state-of-the-art new hospitals, including replacements for Wrexham Maelor Hospital and University Hospital Wales, as well as a major hospital development in west Wales.
The funding would come from a combination of conventional capital, borrowing, and the mutual investment model. Labour has stated that a new government would collaborate with health boards on specific hospital plans and timelines after the May election.
The party emphasized that its commitment to building new hospitals would resolve many estate backlog issues, while also continuing to provide discretionary capital to health boards for ongoing maintenance.
Plaid Cymru described the maintenance backlog as "eye watering" but criticized Labour's £4 billion pledge as unrealistic.
Health and social care spokesman Mabon ap Gwynfor said: "It's nothing more than another empty promise from Labour that once again won't be delivered."
Plaid Cymru plans to prioritize addressing the high-risk maintenance backlog and undertake urgent repairs to ensure safety for staff and patients, assessing the NHS estate on a case-by-case basis.
Additionally, within the first 100 days, a Plaid Cymru government would develop a digitization strategy to position Wales as a leader in digital health innovation, improving NHS estate efficiency, and initiate a telehealth plan to enhance patient access and reduce pressure on physical estate.
Reform UK Senedd Member James Evans MS highlighted unacceptable conditions such as crumbling buildings, burst sewage pipes, and rodents in hospitals.
He stated: "Pragmatism and realism are essential for dealing with the substantial maintenance backlog across the Welsh NHS. Reform is the only serious and credible party on this issue, because we would prioritise the Welsh government's capital budget on clearing the maintenance backlog, instead of promising a multitude of brand-new hospitals, like other parties have."
Welsh Conservatives attributed the poor state of the NHS estate to 27 years of mismanagement and Labour budget deals with Plaid Cymru and the Liberal Democrats.
A spokesperson said the estate was "quite literally crumbling."
The party claims to have a clear and credible plan to declare a health emergency, restore NHS performance, build four new community hospitals with minor injuries units—including a hospital in Rhyl with 30 beds—and ensure timely care for people across Wales.
Welsh Liberal Democrats intend to prioritize upgrading the worst parts of the NHS estate and deliver modern facilities that support faster diagnosis, shorter waiting times, and improved patient outcomes. This includes backing a replacement for the University Hospital of Wales.
Party leader Jane Dodds said: "Crucially, we would link capital investment with reforms to social care and community services, reducing pressure on hospitals in the first place."
The Green Party described the maintenance backlog as "a disgrace" that undermines patient care and staff morale.
A spokesman said: "We will prioritise a multi-year programme to bring existing facilities up to a safe, modern standard, with transparent national reporting on progress."
The party also plans to develop a network of local health and wellbeing centres that integrate GPs, social care, mental health, and community services under one roof.
