Senedd election promises collide with the harsh reality of ageing hospitals, fire safety concerns and a maintenance crisis stretching across the country
WALES’ NHS is facing a repair and maintenance crisis of almost £1bn, with some of the country’s biggest hospitals burdened by ageing buildings, serious safety concerns and growing pressure on already stretched budgets.
New figures covering 210 NHS sites show that the backlog of work classed as high risk or significant risk has now reached £917m — up 71% in just four years.
The data, published for 2024-25 by NHS Wales Shared Services Partnership, shows more than £616m of the total relates to serious problems at 12 of Wales’ 13 main hospitals.
Ysbyty Gwynedd has the biggest backlog of high and significant risk repairs at £110.5m, followed closely by University Hospital of Wales in Cardiff, where the figure stands at £106.8m.
The scale of the problem is not just financial. Three hospitals — Bronglais, Prince Philip and Ysbyty Gwynedd — have 40% or more of their space rated as not fire safety compliant. At Ysbyty Gwynedd, 35% of space is also not regarded as health and safety compliant.
Aging estate
The figures highlight the deep-rooted problem of an ageing NHS estate across Wales.
More than 30 NHS sites have buildings where over half the estate predates the creation of the NHS in 1948. Another 17 sites, including University Hospital of Wales and Bronglais Hospital, are mainly made up of buildings between 50 and 60 years old.
Only one major hospital in Wales — the Grange Hospital near Cwmbran — is said to have no maintenance backlog. But even that project, which cost £350m, was first proposed in 2004 and only opened during the Covid pandemic, showing how long major hospital developments can take.
When the wider risk-adjusted backlog is considered across all NHS buildings in Wales, focusing on problems where safety may be at risk, the total cost rises to more than £1bn.
The largest overall figure is in the Betsi Cadwaladr health board area, where the backlog stands at nearly £278m.
Despite the Grange being one of the newest hospitals in Wales, Aneurin Bevan health board still faces a backlog of almost £233m, much of it linked to older sites including the Royal Gwent and Nevill Hall hospitals.
In Hywel Dda, where hopes of a new west Wales hospital remain some way off, the total backlog has reached £221m. Among the worst affected sites is Glangwili Hospital in Carmarthen, where high and significant risk repairs and maintenance amount to £82m.
West Wales pressure
FOR west Wales, the figures are especially troubling.
Hywel Dda residents have already faced years of uncertainty over the future of hospital services, and the scale of the maintenance bill raises fresh questions about how long ageing buildings can continue to serve local communities safely and effectively.
Bronglais Hospital is among the sites with major fire safety compliance concerns, while Glangwili carries one of the largest repair backlogs in the region.
The growing cost of patching up older hospitals will inevitably intensify the political argument over whether ministers should prioritise maintaining existing buildings or push ahead with long-promised new developments.
The chair of Cardiff and Vale health board recently acknowledged that the age and condition of University Hospital of Wales was affecting morale and efficiency, describing the quality and upkeep of buildings as an ongoing concern.
Expert warning
Mark Dayan, a policy analyst at the Nuffield Trust, said Wales had a worryingly large maintenance backlog by any standard.
He warned that poor infrastructure could directly affect the way care is delivered, making it harder for the NHS to reorganise services, improve patient flow or create safe, modern working environments.
The issue is not unique to Wales. NHS England is facing its own enormous repair backlog, estimated at £16bn. But in Wales, where budgets are tighter and hospital plans often move slowly, the pressure is especially acute.
Election battleground
WITH the Senedd election set for Thursday, May 7, parties are offering different solutions to the growing crisis.
Labour has pledged a £4bn Hospitals of the Future fund, promising new hospitals including replacements for Wrexham Maelor Hospital and University Hospital of Wales, as well as a major development in west Wales.
Plaid Cymru says Labour’s sums do not add up, and argues urgent high-risk repairs should come first.
Reform UK says the Welsh Government should concentrate its capital budget on clearing the maintenance backlog rather than making promises on multiple new hospitals.
The Conservatives say they would declare a health emergency and expand capacity through new community hospitals, diagnostic centres and surgical hubs.
The Liberal Democrats say they would upgrade the worst parts of the NHS estate while backing a replacement for University Hospital of Wales, linking investment to wider reform of social care and community services.
The Green Party has called the backlog a disgrace and says it would launch a multi-year programme to bring NHS facilities up to a safe and modern standard.
Whatever the result in May, the next Welsh Government will inherit a stark reality: before it can deliver a new generation of hospitals, it must first confront the spiralling cost of keeping the current estate from falling further into decline.