The UK's National Health Service (NHS) is facing a dual crisis, with top experts warning of 'catastrophic' risks to patients from crumbling hospital infrastructure and an alarming surge in patients self-transporting to A&E due to a lack of confidence in ambulance services. A Daily Mail investigation has exposed a ballooning £13.8 billion maintenance backlog across nearly 2,900 NHS facilities, revealing that five sites urgently require at least £100 million in repairs, while the total bill for high-risk issues alone stood at £2.7 billion in 2023/24, nearly triple the £1 billion figure from 2015/16.

Problems plaguing hospitals include burst pipes, crumbling ceilings, broken lifts, and the widespread presence of reinforced autoclaved aerated concrete (RAAC), a structurally weaker material prone to moisture absorption and collapse. Airedale General Hospital in West Yorkshire leads the list of sites needing urgent attention, with £316 million required for 'high risk' issues, part of an overall £340 million repair bill. Other highly affected hospitals include Charing Cross Hospital (£186 million for high risk, £412 million total backlog), St Mary's Hospital (£152 million for high risk, £287 million total), Wycombe Hospital (£139 million), and Croydon University Hospital (£113 million). These 'high risk' issues are defined as repairs necessary to prevent catastrophic failure, major disruption to clinical services, or deficiencies in safety liable to cause serious injury or prosecution, encompassing hazards like fires, floods, electrical issues, and dangerous bacterial infections.

Simultaneously, record numbers of patients are bypassing ambulances and making their own way to A&E, leading to what has been termed an 'Uber ambulance crisis.' NHS England data for 2023/24 shows that 19.5 million attendances (79%) were from people who walked, cycled, or used public/private transport. New analysis from 30 NHS trusts indicates a 14% increase in non-ambulance A&E arrivals since 2019, with a staggering 50% rise in the most severe Category 1 or 2 patients arriving by non-ambulance means. This trend is fueled by long ambulance response times, with the average 7-minute target for life-threatening calls not met for four years, and some callers waiting over 14 minutes. The average response time for Category 2 calls (heart attacks, strokes) was 28 minutes 40 seconds, while Category 3 calls (severe pain) saw waits of 1 hour 40 minutes.

Critics, including Liberal Democrat health spokesperson Helen Morgan and Dennis Reed of Silver Voices, argue that patients have lost faith in the ambulance service, resorting to 'DIY solutions' even in life-threatening situations. The crisis is exacerbated by a lack of hospital beds, which leads to ambulances queuing outside hospitals, further delaying emergency response. The Trust with the largest proportional rise in non-ambulance A&E attendances was Sandwell and West Birmingham, with a 320% increase since 2019.

Both the Labour Party and the Conservative government have outlined plans to address the NHS's challenges. Labour Chancellor Rachel Reeves has vowed to invest £30 billion over the next five years, including a specific £5 billion pot for critical building repairs. The Tories, while in charge, pledged to eradicate RAAC from the NHS estate by 2035 with an extra £700 million and launched the New Hospital Programme (NHP) in 2020, promising 40 'new' (often upgraded) hospitals. However, the NHP has faced criticism for delays and for not delivering on its original scope. Health Secretary Wes Streeting accused the Tories of failing to fund their original NHP plan, describing it as 'built on the shaky foundation of false hope.' Under revised Department of Health and Social Care plans, construction at sites like Charing Cross Hospital won't begin until 2035 at the earliest, with upgrades expected to cost up to £2 billion.

NHS trusts, such as Imperial College Healthcare NHS Trust (running Charing Cross and St Mary's), acknowledge the age of their estates, with some buildings nearly 180 years old, and are investing in risk reduction and improvements while seeking to accelerate redevelopment. Similarly, London North West University Healthcare NHS Trust and Croydon Health Services NHS Trust are undertaking ongoing maintenance but stress the considerable drain on resources and the need for significant investment. Buckinghamshire Healthcare NHS Trust expressed commitment to redeveloping Wycombe Hospital despite its exclusion from the NHP, seeking alternative funding for a phased construction.

A Department of Health and Social Care spokesperson stated that repairing and rebuilding hospitals is a key ambition for a future-fit health service, confirming a funding plan and realistic timetable for NHP schemes. They also highlighted a £450 million investment in urgent and emergency care services, including new ambulances, to improve response times. Despite these efforts, experts like Dr Layla McCay of NHS Confederation estimate an additional £3.3 billion per year is needed over the next three years to tackle the maintenance backlog effectively, underscoring the severe and ongoing challenges facing the nation's health service.