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Capital funding must double for more productive and faster care, NHS Confederation report says

The NHS will not be able to deliver faster and more productive patient care unless capital budgets are nearly doubled to at least £14.1 billion, says a new analysis published in an NHS Confederation report, 'Investing to save. The capital requirement for a more sustainable NHS in England'.

The Confederation says NHS leaders have told it that the next government must boost capital funding by an extra £6.4 bn in all three years of the next Spending Review to help the NHS address its £10.2 billion maintenance backlog, ‘refurbish dilapidated buildings’, upgrade equipment, and ‘turbocharge’ staff productivity. That would take annual NHS capital spending to £14.1 billion, compared with the current level of £7.7 billion. The report says that ‘otherwise the consequence will be long waiting lists and delayed care for patients’. 

NHS leaders have told the Confederation, it says, that local investment in capital spending is their priority for any additional spending on the NHS post- the next general election, and that underinvestment has been ‘the number one issue holding back their progress towards greater productivity’.  Analysis in the report ‘sets out the impact that low levels of capital investment have had over the last decade, including the effect on productivity’, and makes the case for greater funding if the NHS is to meet ‘stretching productivity targets’ of 2 per cent by 2030.

The NHS Confederation said: “Capital budgets continue to be raided, with the latest raid being used to plug the rising deficits in the day-to-day NHS budget caused by strike action and other cost pressures. This was outlined in NHS England’s letter to NHS Chief Executives on 8 November, following the outcome of negotiations between the Treasury and the Department of Health and Social Care ahead of the Autumn Statement.”

Matthew Taylor, the NHS Confederation’s CEO (pictured), said: “Some of our members have parts of their estate barely fit for the 19th century, let alone the 21st, so any future Secretary of State for Health and Social Care must make the NHS’s physical and digital condition a priority if the health service is to reduce backlogs and get productivity levels to where the government want them to be. Lack of capital across different care settings, covering digital and physical infrastructure and mental and physical health, is clearly not just leading to missed opportunities to improve productivity, but actively undermining it, and causing patient safety issues. Health leaders across England have endless ideas about how capital funding could drive large productivity increases.

“Equipping staff with the right tools, and allowing them to operate in safe, modern, optimised environments will improve efficiency, meaning an increase to the capital budget will help limit the need for growth in revenue spend, relieve pressure on wider NHS finances and services, and put the NHS on the path to longer-term financial sustainability. This will require a significant increase to the NHS capital budget to make up for years of under-resourcing and repeated raids on capital that has left much of the estate broken.”

Investing to save: The capital requirement for a more sustainable NHS in England, looks at where the NHS is using capital investment to drive productivity, and makes the case for greater funding if the NHS is to meet stretching productivity targets of 2 per cent by 2030.


The report also outlines examples of capital projects which have been ‘transformational’ for patient care and productivity, along with what its claims are ‘numerous case studies of proposed cost-effective, forward-thinking developments delayed, hindered, or scrapped due to the lack of initial funding needed to get them off the ground’.

One of many examples of the positive impact capital allocation can have has been in West Kent, where Maidstone and Tunbridge Wells NHS Trust’s investment in a digital bed management system has seen an 86% reduction in A&E bed allocation time, reduced discharge delays, released 2,300 hours of ward staff time each month, and is saving £2.7 m annually. Beds in the hospital and community are coordinated centrally, enabling the Trust to re-direct incoming ambulances between hospitals to minimise handover delays and waiting times.

The NHS Confederation added: “Leaders across the country have many ideas on how to transform care and increase productivity should funding allow, as the report shows. However, issues in accessing capital funding, with often labyrinthine processes, and lack of funds, are delaying innovative plans for transformation. The NHS still doesn’t have a capital strategy, and the next government must boost capital funding if the health service is to meet stretching productivity targets and become more financially sustainable.”

Up until the pandemic, Investing to save, says, the NHS had been making good progress in improving productivity. However, its analysis finds that – ‘despite the clear links between capital and productivity’ – the UK has consistently spent less money on capital investment than comparable countries for over half a century, resulting in healthcare productivity increasing at an average of 0.9 per cent annually over the past 25 years.

The report says: “Minimal levels of capital investment mean the NHS now has the sixth lowest number of CT and MRI scanners per million people of the OECD countries. In the 10 years to 2019, meanwhile, Health Foundation analysis suggests that had England matched the EU14 OECD average for healthcare capital spending, another £33 bn in capital would have been spent. The NHS Confederation adds: “Instead, we have leaking roofs, broken lifts, and outdated IT systems waiting to be fixed, the cost of which will be roughly a third of the New Hospital Programme. This is in addition to the 42 hospitals that have reinforced autoclaved aerated concrete that urgently needs replacing.”



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