Investing in the NHS: empowering the sector to drive productivity, renewal and growth

The NHS stands at a pivotal moment. The 10-year health plan makes clear that unless the service delivers sustained improvements in productivity, the long-term financial sustainability of the health service will be at risk. Trusts are already working tirelessly to ensure every pound is well-spent and focused on improving outcomes for patients – but they are doing so within facilities that are too often outdated and unfit for purpose. There is broad recognition that the capital regime faces significant challenges and the case for reform is urgent and compelling.

This report, jointly developed by NHS Providers and PA Consulting, sets out both the scale of the challenge and the scale of the opportunity. Years of underinvestment has left NHS infrastructure trailing international peers, yet there are practical, deliverable solutions that can reverse that trend and unlock growth in productivity. By releasing more value from existing assets, reforming the capital regime, scaling proven third-party models, and easing restrictive spending limits, the NHS could unlock billions in additional investment – delivering substantial health, social and economic benefits for patients and communities.

Future-proofing the NHS estate is essential if we are to meet the ambitions of the 10-year health plan. That means moving beyond patching up the NHS estate and instead investing strategically in modern hospitals, community facilities and mental health estates. It means treating capital investment not as an expense, but as a catalyst for improving productivity, stimulating innovation and generating better outcomes for patients.

The real opportunity comes when the NHS and its partners can combine some of these new opportunities to drive local transformation. For example, working with local government, the NHS has a real opportunity to regenerate high streets and provide housing – while securing investment in better care for patients. This is the real opportunity that government can accelerate with the right support.

With the right reforms, this vision is achievable. A streamlined and balanced capital regime, coupled with sustained investment and a shared vision across government and the NHS, will unlock the full potential of our health service. Trusts are ready to play their part. What is needed now is a national strategy for capital investment that matches their ambition – and ensures the NHS is equipped not just for today’s challenges, but for decades to come.

Daniel Elkeles
Chief executive, NHS Providers

Stephen Farrington-Bell
Partner, PA Consulting