"I think we must consider private capital investment in the NHS."
So said Amanda Pritchard in one of her final interventions as NHS England chief executive, calling for radical thinking on how to fix the crumbling NHS estate. Her comments have certainly provided food for thought.
The sheer scale of the challenge facing NHS buildings and facilities was laid bare with the recent government announcement on the future of the New Hospital Programme (NHP).
A number of trusts were delighted to be given the green light for new hospital building projects last month, but many more face even longer delays for their desperately needed new hospitals.
Interim Chief Executive
This underlined that the NHP is only a partial solution to a much more extensive problem with NHS infrastructure. While the NHS capital budget received a welcome cash injection in the recent Budget, Lord Darzi was right to point out in his recent report that the NHS has been "starved of capital".
Trust leaders' responses to the NHP announcement are testament to that.
A number of trusts were delighted to be given the green light for new hospital building projects last month, but many more face even longer delays for their desperately needed new hospitals – some a decade or even longer. For them, the NHP announcement was a major blow.
We do of course understand why Labour reviewed the NHP. With plans to shift care away from hospitals to the community, questions are rightly being asked about how the health service effectively meets the growing and changing needs of the population.
But with too many NHS buildings and facilities in a terrible condition right now, the big question many trust leaders are asking is: how they will manage the risk to patient and staff safety from buildings across their estate that are becoming increasingly unsafe?
We have urged the government to consider widening access to strategic capital investment and easing restrictions on how much the NHS can spend on capital projects. This would help give NHS productivity a much-needed boost while also supporting essential hospital rebuilds which are critical to transforming services, improving safety, and delivering better quality of care for patients.
Capital investment in the NHS needs urgent reform. As one trust chief executive whose NHP rebuild is unlikely to happen until 2040 said: "We simply cannot wait 15 years for new hospital infrastructure."
This sentiment is echoed by other trusts, whose eye-watering bills for patching up crumbling sites and facilities will continue to mount as delays go on and who aren't getting access to the capital investment they urgently need. Since the announcement, one trust warned that the total cost of delays from when their new hospital was first announced is estimated to be £800m while another has said that every year of delay adds £150m to the cost of a new hospital and keeping the current buildings safe to provide care.
The total cost to eradicate the proportion of the maintenance backlog categorised as 'high risk' is now £2.7bn – over seven times higher than the equivalent figure for a decade ago. Over 100 applications were made from trusts for the final eight spots on the NHP, highlighting again the demand for capital investment is across the NHS.
Another hospital leader whose rebuild is now expected to start between 2037 and 2039 and cost at least £2bn said their current £439mn repairs bill is "desperately needed sooner rather than later". Trusts who are part of the NHP account for more than 40% (£5.7bn) of the near £14bn bill for backlog repairs.
Trusts now face identifying essential works and funding to protect their estate and infrastructure while waiting for their new hospital. A leader said: "We're now going to be throwing good money at bad" while another warned they are now planning and preparing for the "catastrophic" failure of their buildings which could mean moving patient care into temporary buildings.
Given this increasingly challenging predicament, trust leaders are keen for government and national NHS leaders to focus efforts on how they can best support those trusts affected. Alongside wider access to strategic capital investment, there are multiple other options on the table. Temporary facilities could be built on-site to allow unsuitable buildings to be decommissioned and maintain sufficient capacity levels to continue providing high-quality care to patients. The phasing of construction work across each scheme to ensure unsuitable buildings are decommissioned as soon as possible so that work doesn't ground to a halt should also be considered.
We must pursue new and different sources of investment to fund NHS infrastructure.
Interim Chief Executive
With the comprehensive spending review fast approaching, this is an opportune moment for the Treasury to finally rethink its approach.
A 'triple whammy' of insufficient capital allocations, rigid rules which restrict how much trusts can spend on their buildings and huge pressure on public finances means there simply isn't enough money to meet rocketing repair bills and to transform care.
But it doesn't have to be this way.
We must pursue new and different sources of investment to fund NHS infrastructure. Amanda Pritchard's comments have pushed this critical topic back up the agenda. We must not miss this opportunity.
This article was first published by Public Finance.
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