NHS staff have no option but to treat patients in ‘crumbling buildings and with out-of-date equipment’, according to NHS Confederation chief executive Matthew Taylor (pictured).  

Speaking today (11 February) as the NHS Confederation launched a report calling for urgent improvements in how the capital regime is managed, Mr Taylor issued a statement that will resonate with many NHS physiotherapists.

‘Across the NHS, staff are having no choice but to treat patients in crumbling buildings and with out-of-date equipment. This is neither safe nor good for productivity.

‘As Lord Darzi highlighted, the NHS has been starved for capital for more than a decade, so it is vital that it is able to maximise the return on every penny it has.’

Lord Darzi’s 2024 report revealed that the NHS has been starved of capital funding – the money used to purchase or improve public assets, such as buildings, roads, and equipment – for more than decade, leading to a £37 billion shortfall. 

‘Cutting the bureaucratic burden on NHS organisations getting approval to begin new projects is essential to avoid costly delays. Part of this is simplifying the process, but it also requires more autonomy to let local leaders get on and make the decisions’ [Matthew Taylor]

‘Lost’ rehab space

While the Chartered Society of Physiotherapy, for example, has highlighted sporadic cases in which NHS trusts have recently allocated funds to updating buildings and equipment, it has also accused the UK government of ‘backsliding on its commitments around the restoration of rehab space lost during the pandemic’.

Mr Taylor argue that ‘what money there is’ is ‘often held back by red tape’, which creates ‘delay and cost, undermining taxpayers’ value for money. The verdict from NHS leaders is clear: the NHS capital regime is broken’.

Private investment options needed

The report – titled Capital efficiency: how to reform healthcare capital spending report – sets out 16 measures that can help the NHS make the most effective use existing capital funding, including the extra investment promised by the government in the last Budget.

‘Cutting the bureaucratic burden on NHS organisations getting approval to begin new projects is essential to avoid costly delays. Part of this is simplifying the process, but it also requires more autonomy to let local leaders get on and make the decisions that are best for their populations,’ Mr Taylor said.

‘But despite the very welcome increase in capital spending announced in the Autumn Budget, more funding will be needed to address all the issues. One option to bridge this gap is to allow new routes for private investment. This does not mean throwing open the doors to private finance, but creating the environment where the NHS has more options for raising the vital funding it needs to tackle its maintenance backlog and invest in the latest equipment and technologies.’

Key recommendations include

• streamlining approvals and devolving decision-making

• delivering longer funding and planning cycles

• enabling health systems to raise private investment

The report claims that the NHS is being held back from most effectively spending the investment it has been given to repair its estates, purchase vital equipment and build new facilities due to ‘bureaucratic hurdles’ that are slow, unclear and duplicative.

It was published in the wake of the government’s timetable for the New Hospital Programme, with many projects being delayed beyond 2030, the NHS Confederation points out, as well as at a time when the government is considering funding for public services over the next three years through its Comprehensive Spending Review expected in the spring.

Processes are ‘too slow’

Local NHS leaders have told the NHS Confederation that the capital approvals processes from local trust and integrated care board (ICB), up through NHS England, the Department of Health and Social Care and the Treasury, is too slow as there are too many duplicative stages, creating delay and adding cost. 

The report recommends reducing the number of approval stages projects have to go through – currently at least 19 – as well as giving local health systems greater autonomy over their spending.

For example, NHS England and the government both have to approve any investments over £50 million, but the NHS Confederation believes this should be increased to £100 million, allowing projects such as new hospitals, new scanners and artificial intelligence to progress more quickly. 

The report also recommends that ICBs should be allowed to raise additional investment away from government allocations including via private means, which is not allowed at present.

While the £3.1 billion additional capital investment at the Budget 2024 is a much welcome addition, this is still at least £3.3 billion short of the £6.4 billion a year additional capital investment needed to help boost NHS productivity growth to 2 per cent per year.

To access the NHS Confederation report, see: bit.ly/4hOPjM0

To see the CSP’s article, visit: See: https://www.csp.org.uk/news/2023-05-25-government-backsliding-rehab-space-promises-says-csp

The image of Mr Taylor is courtesy of the NHS Confederation