Patient safety at risk as NHS capital budget fails to keep up with demand

01 March 2023

The NHS' efforts to deliver national priorities including elective recovery and improvements in productivity are being put at risk because of a damaging lack of investment in buildings and facilities.

In a new report, No more sticking plasters: repairing and transforming the NHS estate, NHS Providers, which represents every NHS hospital, mental health, community service in England, says major capital investment is crucial to enabling trusts to improve productivity, operational performance, and patient care across all sectors.

But under-investment has had serious knock-on effects across the system, including a significant deterioration in NHS infrastructure, presenting major risks to patient safety, quality of care and efforts to bear down on waiting lists.

The latest data shows the maintenance backlog across the NHS 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 2022/23 prices – an astonishing five times the 2010/11 level.

Significant shortfalls in capital funding also risk undermining efforts to increase much-need bed capacity, which is significantly lower than equivalent OECD countries. They are also getting in the way of efforts to harness digital developments and to curb emissions.

NHS Providers says the government must publish its long-term capital strategy as soon as possible, setting out how it plans to transform the wider health and care estate. Responding to the report, the chief executive of NHS Providers, Sir Julian Hartley said:

"Capital investment in the NHS has simply not kept pace with rising demands on the NHS over the last 10 years.

"Trusts welcomed the multi-year capital budget set at the October 2021 Spending Review and the contribution this will make towards improving productivity and performance after years of under-investment.

"But the fact remains that there is not nearly enough 'give' within the system to meet rising operational pressures on the capital budget.

"This is not just about pounds and pence. It's about ensuring patients have the safe, timely, high quality care they deserve. It's about providing a modern, well equipped therapeutic environment where staff can work efficiently and effectively. And it's about ensuring NHS resources are invested strategically, to meet current and future needs, to improve productivity and prevent waste.

"The government needs to make some major decisions about the growing maintenance backlog as well as the New Hospitals Programme (NHP), which has been beset by delays and indecision over funding.

"These delays are now leading to spiralling, inflation-driven cost increases far above initial forecasts, and it is increasingly questionable whether the £3.7bn set aside for the NHP will meet the demands of all the trusts in the programme.

"Urgent decisions are also needed about replacing RAAC (reinforced autoclaved aerated concrete) planks, which present a major and unjustifiable safety risk.

"We know from the sheer number of applications from trusts to join the NHP that there is an undeniable need to provide trusts and systems with major funding for strategic capital projects. But this need just isn't being met.

"And while digital investment remains a key lever to transform healthcare delivery, improve productivity and reduce the costs of service provision, we have seen how this budget became an early victim of cuts as national leaders had to redirect funds due to the government's failure to fully fund staff pay awards.

"Trusts are committed to delivering integrated, high-quality care but they aren't being given the tools to do this. Strategic investment is vital if we are to transform the delivery of healthcare and modernise the ageing NHS estate."