The government needs urgently to start the ‘biggest building programme in the NHS since the Beatles’ to make the NHS fit for the 21st century, NHS Providers has urged. It warned that recent investments fall far short of what is needed especially for mental health, community and ambulance services, as well as the acute hospital sector – and it added that most NHS trust leaders are worried that their trust’s capital investment requirements will not be met.
In Rebuilding our NHS: why it’s time to invest, NHS Providers reported that NHS trust leaders are worried about the impact of inadequate access to capital on frontline services: 94% said restricted funding posed a high or medium risk to patient experience, and 82% said there is a high or medium risk to patient safety. And it pointed out that capital funding restraint is also hampering trusts in their efforts to improve how they run – 97% of trusts reported high or medium risks to transformation programmes, and 95% said there was a high or medium risk to productivity and efficiency initiatives.
NHS Providers said the comprehensive spending review expected this year is ‘the best opportunity for many years to improve resourcing and reset the rules governing capital investment in the NHS’, as it follows prolonged underinvestment in facilities across the English NHS, and comes ‘at a time when the system for allocating capital funding to the frontline is not fit for purpose’.
The report’s authors said: “The impact of many years of underinvestment in facilities is now obvious to patients, demoralising for staff and of concern to NHS leaders.” And they warned that without changes, these problems will continue.
The organisation, which represents NHS hospital, mental health, community and ambulance services, said it welcomed the government’s recent announcements committing to greater investment in infrastructure and facilities in the coming years– but insisted they fall well short of what is needed. It pointed out that many of the buildings in the NHS that now need replacing date from the last and only major national infrastructure programme of the 1960s, which delivered 95 major schemes in its first three years; and it added that more than 100 projects delivered under the private finance initiative (PFI) arrangements in 1997-2015, which was the next-biggest infrastructure programme, are still being paid for. The report concludes: “Even taking into account the second wave of the planned infrastructure spending, covering 40 projects, this is a much more modest ambition than what was achieved under those previous initiatives.”
The report called for three fundamental changes that it said are needed to support the implementation of the NHS Long Term Plan:
- securing a multiyear capital settlement, ideally lasting 10 years and extended annually
- aligning the NHS’s capital budget with comparable economies, meaning funding available to trusts should roughly double – but to rebuild and replace facilities it will also be necessary to fund a national building programme on a scale comparable with the 1960s Hospital Plan, and the investment that took place between 1999-2010
- establishing an efficient and effective mechanism for prioritising, accessing and spending NHS capital based on need.
It added that central funding will be needed to fund large-scale projects, such as rebuilds, that cannot be paid for from surpluses; and that national-level action might be needed to deal with entrenched problems, such as the maintenance backlog.
NHS Providers chief executive Saffron Cordery said: “NHS trusts are suffering from years of under-investment in facilities across the English NHS. The situation is now critical for the great majority of organisations and is directly impacting on patients and staff. The system for allocating capital funding to the frontline is not fit for purpose. This year’s expected comprehensive spending review represents the best opportunity for many years to improve resourcing and reset the rules governing capital in the NHS.”
She added: “It’s time for the biggest building programme in the NHS since the Beatles. This will support the delivery of the long-term plan and provide the opportunity to see tangible improvements to patient safety and staff and patient experience. These include reduced treatment delays due to equipment failure, increased inpatient capacity, expanded diagnostics services, transformed care pathways, more efficient services, and bringing about a fully digitised, technologically enabled service.”