Hospital maintenance: Backlogs faced by health boards in Wales

What are the problems with out-of-date buildings across the NHS in Wales?

There is at least £261m worth of urgent repairs and refurbishments necessary.

Most health boards have said they cannot even afford to pay for the reviews of their maintenance backlogs - which they are required to do every five years, at a cost of £250,000 each.

The total backlog is more than £500m, but also includes millions deemed high or significant risk if they are not dealt with.

So what are the problems faced by each of Wales' seven health boards?

How many properties? 68

What is the backlog? £23.3m high or significant risk out of a £100.8m total - £4m spent on maintenance in 2017-18.

Where are the problems? Nearly half of properties, are more than 40 years old, but more than 90% of buildings meet statutory requirements under performance indicators. Royal Gwent Hospital in Newport has a £2.8m maintenance backlog, some facilities at County community hospital near Pontypool are in a poor condition and there are issues at three out of four mental health units.

What is it doing? A new 471-bed hospital is being built at Llanfrechfa Grange, Cwmbran. It will provide a 24-hour emergency department and more than 40 specialist services and is due to open in spring 2021. The two existing general hospitals will be reconfigured. There is an estates strategy being drawn up for the next five to 10 years.

How many properties? Wales' biggest health board has 137 facilities, including three general hospitals. The ages range from the Denbigh Infirmary - more than 200-years-old - to Flint health and wellbeing centre, which opened in 2018. The buildings cost £63m a year to run.

What is the backlog? £48.7m in the high risk or significant risk category, out of a total of £141.8m.

Where are the problems? About a third of buildings pre-date the mid-1970s and this portfolio is "not viable in the long term and is unable to support the future vision of care".

More than a quarter are not classed as sound or operationally safe and 22% do not comply with statutory requirements. Betsi estimated it would cost about £838m to ensure all its accommodation was of a reasonable standard.

There is a long list of challenges, including modernising Wrexham Maelor - a £54m plan for immediate work has been drawn up - and Ysbyty Gwynedd, while the design and layout of some elderly and mental health units are not considered fit for purpose.

What is it doing? £172m to refurbish Glan Clwyd Hospital, while a £40m community hospital is being built in Rhyl. It has outlined a three-year plan for improvements, including a Llanfair PG primary care centre and health and well-being hubs, as well as addressing infrastructure at Wrexham Maelor and the Ablett mental health unit.

How many properties? About 70% of buildings are more than 30 years old.

What is the backlog? £101.6m is high or significant risk out of a total amount estimated at £130.7m

Where are the problems? A "significant proportion" of the estate is over-crowded and not suitable for the function it performs

What is it doing? £37m neonatal facility and £93m planned operating theatres, haematology and polytrauma wards and cell therapy, with the proposed major trauma centre on the horizon. In the long term, the health board is already looking at replacing the University Hospital of Wales, which opened in 1971, in 10 years' time.

How many properties? It has three district general hospitals and 46 other sites, including community hospitals, health centres and clinics. There are far fewer pre-1948 buildings - less than 3% - compared to more than 25% in 2002.

What is the backlog? There has been a considerable reduction in its high-risk and significant risk backlog - it now stands at £5.19m - although this depends on Prince Charles Hospital improvements being completed.

In 2017-18, the overall backlog was £15.9m. Things have changed in the last few months, however, when the health board took over Bridgend's health services - and buildings.

Where are the problems? It inherited a £25m maintenance backlog - half of it high risk and significant risk - when it took over Bridgend's health services, including Princess of Wales Hospital. Some primary care facilities are in poor condition. Tonteg, Pontypridd's cottage hospital and health centre and Ystrad clinic will be sold in the future.

What is it doing? £36.2m improvements at Prince Charles and a new £7m specialist palliative care unit is being built in partnership with Macmillan at Royal Glamorgan.

How many properties? More than 240 buildings, including four general hospitals and eight community hospitals.

What is the backlog? Its significant risk backlog is put at £39.9m out of a £59m total.

Where are the problems? Buildings are said to be deteriorating and auditors have called for risk assessments and actions to be prioritised to replace them. Refurbishing Glangwili in Carmarthen - the oldest of the region's main hospitals - to keep it up to standards would be expensive.

What is it doing? An estates strategy will be part of its shake-up in services, with the future of some hospital buildings inevitably controversial. On the horizon is the proposal for a new general hospital - including an A&E unit - somewhere near the Carmarthenshire-Pembrokeshire border. The 40-year-old Withybush Hospital in Haverfordwest would lose its status as a round-the-clock general hospital. A long-awaited new health centre for Tregaron is being planned.

How many properties? Although the only county with no general hospital, Powys has problems among its network of nine smaller hospitals - 42% of its buildings pre-date the NHS - the highest proportion in Wales.

What is the backlog? There is £20.3m of high risk and significant risk work, out of £36.5m. One audit had only 58% of buildings rated as being of a reasonable standard, the worst in Wales.

Where are the problems? "The care provided is compromised due to the health board's estate being noncompliant and not fit for purpose."

What is it doing? It has set up an estates compliance group aimed at addressing ongoing issues. Priorities for Machynlleth/Bro Ddyfi - a £7.8m upgrade - and Ystradgynlais community hospitals and a dialysis unit expansion at Llandrindod Wells are planned.

How many properties? It has four major hospitals and six community facilities - although since April when the old Abertawe Bro Morgannwg health board was abolished, it is no longer responsible for Bridgend.

What is the backlog? £2.1m in the high and significant risk categories out of a £14.5m total.

Where are the problems? They include electrical capacity and old engineering systems at Morriston Hospital and cladding at Singleton. But there is only enough money to meet statutory guidelines and not to tackle the backlog.

What is it doing? It has business cases for £60m worth of improvements over 10 years at its three main hospitals, a £9.7m upgrade of Singleton neonatal centre and it is looking to open a health and wellbeing centre in Swansea city centre

The small cancer specialist hospital Velindrein Cardiff - a separate trust - has £786,000 of significant or high risk maintenance out of a £2.2m backlog.

The Welsh Ambulance Services NHS Trust runs 113 buildings, with a £9.1m high and significant risk backlog out of £13.6m work identified - there have been recent refurbishments to centres in St Asaph and Swansea.