Future fiscal events
- Trusts welcomed the multi-year capital budget set at the October 2021 Spending Review (SR), following a sustained period of underinvestment since 2014/15. This investment has the potential to improve productivity and performance across health systems.
- Capital budgets must not be raided to fund additional revenue pressures over the period of this SR.
- Policy makers must be cognisant of the productivity improvements that could materialise from an increase in the national capital departmental expenditure limit (CDEL).
Maintenance and utilisation of the estate
- Deteriorating NHS infrastructure and estates risk patient safety and quality of care.
- A greater proportion of capital investment needs to be spent on new assets to generate substantive and recurrent productivity improvements.
- The government must expedite the process of replacing unsafe reinforced autoclaved aerated concrete (RAAC) planks.
- The Department of Health and Social Care (DHSC) should publish its long-term capital strategy, outlining the ambitions for transforming the wider health and care estate, including how it will effectively address the maintenance backlog.
Strategic investment: improving productivity and patient care across the whole system
- The operational ask of the NHS, including national priorities to recover elective and emergency care and improve productivity, cannot be delivered without adequate capital investment.
- Capital investment has not kept pace with rising demand over the last ten years, and the NHS bed base is significantly lower than equivalent OECD countries. Trusts require the right bed capacity, including general and acute beds, but also intermediate care, rehabilitation beds and step-down mental health support.
- Strategic capital investment allocations must be underpinned by a whole-system approach to estate transformation. Mental health and community services have the potential to play a key role in improving productivity and supporting the delivery of the government’s recovery plans.
Transforming the NHS estate
- Digital investment remains a vital enabler to transform delivery, enable full interoperability, improve productivity and reduce the costs of service provision.
- Sufficient capital investment must be provided to meet the ambitions of the New Hospitals Programme. There is also an urgent need to accelerate the programme and enable more trusts already on the scheme to begin construction.
- Capital investment is essential to enable the NHS’s ambition to become the world’s first net zero carbon national health system.
- The government should explore how the NHS can maximise value from land disposal and use the NHS estate more efficiently.
System planning: ensuring appropriate prioritisation
- Integrated care boards (ICBs) now play a significant role in capital planning. The needs of acute, ambulance, community and mental health trusts must be given appropriate consideration as part of the operational capital prioritisation process.
- Foundation trusts need clarity about the extent to which they can spend retained surpluses for capital investment, and any flexibilities that can enable trusts to incur additional capital expenditure without breaching the national CDEL.
- There would be value in enabling systems to become more integral to managing strategic capital investments in future.
- Following the winding down of public private partnerships, policy makers should consider how trusts’ access to strategic capital can be broadened and made more accessible, and how trusts can innovatively partner with communities and industry to increase investment across their estates.