Key ask: Greater access to capital funding for the community and primary care sectors, both nationally and through appropriate consideration in integrated care board capital planning processes.

In the last decade, access to capital funding has been very limited for all providers. Amid cuts to public spending, the NHS capital budget was raided between 2014/15 and 2018/19 to support day-to-day revenue spending. While 2021 saw an increase in the capital budget with a multi-year capital funding settlement, the process to access capital has often been very competitive, and the majority of recent investment has been targeted at the acute sector. This includes through the government's New Hospital Programme.

However, investment in community estates is essential to delivering on strategic ambitions to deliver more care in the community, including through greater integration with primary care. Working across organisations in multi-disciplinary teams is often supported by co-location in a physical space, and capital funding for community providers is therefore important in providing an environment that enables collaborative working across sectors.

This is increasingly important given the pressures being felt across the health and care system, especially on urgent and emergency care pathways and in delayed discharges. Further investment in capital estates in the community can also enable the development of modern facilities to deliver integrated care, focused on rehabilitation, reablement and intermediate services. These services play a vital role in keeping people well in the community, including through admission avoidance, and can therefore alleviate pressure in other parts of the health and care system.

Ensuring high-quality integrated care at local level also requires clear ownership models and routes for funding to support community providers and primary care providers to collaborate more effectively on use of estates. At present, community providers often face challenges investing in premises that are jointly run with primary care partners or accommodation rented from other partners. This complexity is amplified by the fact that many community services will operate on multiple, often smaller, sites based in community locations.

For example, if a community provider wants to re-develop a premises that is leased from NHS Property Services but shared with a GP practice, the routes for funding and approval are much more complex than if they were investing in their own buildings, which in turn disincentivises more integrated working across the two sectors. Community providers also tell us that ownership models often mean delays in fixing operational issues day to day. For example, ensuring Wi-Fi access and temperate conditions for patients and staff.

Patricia Hewitt's review into integrated care systems recommended a review into the NHS capital regime, which the government has now accepted, saying it would confirm next steps shortly. We would encourage the review to consider the wider capital funding picture and explore how greater access for community providers (and other sectors like mental health) can support wider strategic ambitions for the health and care system.