Since summer 2019, while the campaign has been running, there has been a series of government announcements about NHS infrastructure. This section outlines the interventions that have been made in recent months that, collectively, demonstrate a welcome acknowledgement from ministers that NHS facilities need investment, and that this is an appropriate public spending priority. While these announcements are welcome, they do not go far enough to address the maintenance backlog within the NHS or allow for sufficient investment in transforming services and introducing new technologies.

  • Hospital upgrades announced: In a speech in Downing Street on 24 July, the day he became prime minister, Boris Johnson announced "20 new hospital upgrades". These will span acute, mental health and primary care facilities and will cost £850m, to be spent over several years.
  • Urgent repairs and upgrades for 2019/20: An additional £1bn was made available for urgent infrastructure repairs and upgrades in 2019/20. This has mainly been funded from trust reserves, which are sourced mainly from surpluses in previous years.
  • Spending round: The September spending round increased the 2020/21 CDEL from £6.8bn to £7.1bn, and promised: "The Department for Health and Social Care will receive a new multiyear capital settlement at the next capital review. This will look to deliver a smarter, more strategic long-term approach to the country's health infrastructure, with investment focused on local areas where the need is greatest. The plan will include capital to build new hospitals, modernise diagnostics and technology, and help eradicate current critical safety issues in the NHS estate."
  • Legislative change proposed: Following the publication of the long term plan, NHS England and Improvement consulted on a set of supporting plans for legislative change. In September 2019, after extensive consultation with the wider health sector, including NHS Providers, a narrow "reserve power" limiting foundation trust capital spending was proposed. Under existing law, foundation trusts are free to set their own capital budgets.
  • Further investment announced: Later in September, ministers announced a further round of investment. This comprised, £200m for MRI and CT scanners, £2.7bn for six large scale hospital rebuilds, to take place between 2020 and 2025, and £100m "seed funding" for a further 21 acute and community trusts to develop business cases for rebuilds between 2025 and 2030.
  • Health infrastructure plan: The September hospital building announcement was accompanied by a health infrastructure plan (HIP). This document, published by DHSC on 30 September sets out why the existing capital system in the health service is currently not fit for purpose, and outlines a new set of arrangements for approving capital spending. This includes an enhanced role for STPs/ICSs, including system-wide capital spending envelopes, a commitment to a "five-year rolling programme" of infrastructure investment, and a streamlined sign-off process, including a new national joint approvals committee.