No more sticking plasters: repairing and transforming the NHS estate

While NHS trust leaders and their staff pull out all the stops to ensure patient safety amid strikes and the ever-growing demand for overstretched services, they have to contend too with huge underlying issues that have caused concern for years. Sir Julian Hartley, chief executive at NHS Providers explores their latest report on the state of capital funding and allocations across the NHS provider sector and explains how trusts can access capital. The report highlights the extent of the dilapidated estate and make the case for strategic capital investment at both the system and national level to drive productivity, improve patient care, and enable much-needed transformation across the NHS.

Capital is one of those fundamental problems and the safety of patients and staff is increasingly at stake.

Trusts welcomed the multi-year capital budget in the October 2021 Spending Review, following sustained underinvestment since 2014/15. Despite this boost, the fact remains that there is not nearly enough ‘give’ within the system to meet rising operational pressures on the capital budget.

In many places the very fabric of the health service, its estate, is coming apart at the seams leaving trusts ill-equipped to do everything that national NHS leaders ask of them. Their efforts to deliver national priorities including greater productivity are hampered by a damaging lack of investment in buildings and facilities.

Our new report, ‘No more sticking plasters: repairing and transforming the NHS estate’, highlights how major, strategic capital investment is vital to enable all trusts – be they acute, mental health, community or ambulance – to improve productivity, operational performance and patient care. Years of underinvestment have led to a significant deterioration in NHS infrastructure, posing huge risks to patient safety, quality of care and efforts to bear down on waiting lists.

It’s not just about bricks and mortar. Investing in capital across the NHS promotes innovation, economic growth, life sciences partnerships and health service ‘anchor institutions’ which are vital community hubs.

More capital investment is needed not least to tackle the maintenance backlog across the NHS which has doubled since 2010/2011, currently standing at a staggering £10.75bn in 2022/23 prices. The total cost to eradicate the highest risk maintenance issues – those which must be urgently addressed to prevent catastrophic failure or major disruption to clinical services- is now over £1.89bn in today’s prices, five times the 2010/11 level.

The operational demands on the NHS, including national priorities to recover elective and emergency care and improve productivity, in turn demand major capital investment. From establishing community diagnostics centres to surgical hubs, additional capital funding announced in the 2021 Spending Review is already making material improvements in enabling systems to ramp up activity and improve patient flow. But we need to go further, faster.

However, sizeable shortfalls in capital funding also risk undermining the NHS’ ambitions to create both a fully digitised estate and the world’s first net zero carbon national health system, as well efforts to increase bed capacity which is significantly lower than in equivalent OECD countries.

The solution? An end to ‘sticking plaster’ quick fixes when what we really need is a clear roadmap for accessing transformative capital spending to modernise the ageing NHS estate.

It’s vital that these pressing capital problems are addressed urgently. One key way to do this is for the government to publish its long-term capital strategy as soon as possible. Trusts which need to replace RAAC planks – unsafe, decades-old reinforced lightweight concrete blocks in ceilings and walls – are still waiting to hear from the government if they will get the necessary funding.

Trusts also need clarity and commitment about the much-delayed New Hospital Programme (NHP) which promises to transform many parts of the NHS estate, improving the delivery of healthcare for patients. Shovels and picks at the ready, trusts in the NHP are poised to start construction but are still waiting for confirmation of funding. Those forced to delay for months have faced spiralling, inflation-driven increases in the cost of building materials far above initial forecasts.

The government should show how trusts are expected to cut the capital maintenance backlog sustainably, mapping out routes for them to access capital for strategic transformation of their estate beyond the NHP.

The NHS, its staff and patients need safe, efficient, reliable buildings and equipment, not wards where crumbling ceilings have to be propped up.

If we don’t build modern, safe settings now where staff can give patients first-class care it will cost the NHS and the public purse dear for years to come.

Further Information:

Check the full report here – www.nhsproviders.org/no-more-sticking-plasters