The long term plan set out a vision for an NHS built around preventative and technologically enabled models of care, and charted a path towards financial recovery for NHS trusts and foundation trusts. It also made clear that a new capital settlement will be needed, to realise efficiency gains, to transform and upgrade existing facilities, enhance digital capabilities and expand diagnostic capacity.

The impact of many years of underinvestment in facilities is now obvious to patients, demoralising for staff and of concern to NHS leaders.

The CSR expected to take place in 2020 represents the best opportunity for many years to improve resourcing and reset the rules governing capital in the NHS.

The NHS needs:

  • A multiyear capital settlement, ideally lasting ten years and extended annually.
  • A capital budget in line with comparable economies, roughly doubling the amount available to providers. This will be necessary to reverse the growth in the backlog of maintenance works, and to fund a national building programme on a scale comparable with previous large-scale infrastructure investment schemes.
  • An efficient and effective mechanism for prioritising, accessing and spending NHS capital based on need. This must start with there being enough money available in the system overall, and once there is, should run on the basis that capital spending decisions should wherever possible be devolved to the level where accountability for services sits. Central funding will be needed for large-scale rebuilds and to deal with entrenched problems that place trusts on an unequal footing. Sign-off processes should be streamlined, while systems can add value overseeing investments that affect more than one local provider or sharing decision-making where trusts choose to.

These recommendations are intended to be taken together as a coherent package. We hope that ministers will take the opportunity this year to implement them, thereby putting NHS infrastructure on a sustainable footing and improving the lives of all those who use, and work in, NHS services for the long term.