To what extent do you agree with the following statements?
Many community sector leaders said that their capital needs were not well understood or recognised either at a system or a national level. To fulfil the government's ambitious three shifts, there must be a change in the way capital funding is distributed to and accessed by the community sector. Our respondents said that, with current investment levels, their organisation would not have the right amount of funding to deliver the government's shifts around treatment to prevention, analogue to digital and hospital to community.
Alongside this, the current regime governing how the NHS shares out and spends its capital budget is, as Lord Darzi described, 'dysfunctional', and the Hewitt Review has also advocated for its wholesale reform. Providers, too, have identified many flaws in the system: long delays in releasing funds, the duplication of different allocation and approval processes, and inflexible rules on how and when capital can be spent.
This includes the Department of Health and Social Care (DHSC) CDEL, which enables HM Treasury to include NHS trusts’ assets on the public sector’s balance sheet. However, the rule still applies even if the funds to make such investments are available locally and no additional investment is required from the centre.
As a result, providers can struggle to manage year-to-year budgets, with the requirement to use capital funds within annual limits often resulting in investment that does not reflect original plans or priorities. The Hewitt Review also called for flexibility so providers can use capital more efficiently, including across system borders, in order to support population need.
Acute hospitals have been prioritised for the limited resources available, with high-profile initiatives such as the New Hospital Programme largely inaccessible to community providers. As a result, the capital needs of the community sector have continually been overlooked.
“CDEL is a limitation... national capital pots are usually aimed at acutes and never facilitate system working...”
Survey respondent