Conclusion

Capital investment is essential to deliver the 10-year health plan and Government’s mission for the NHS, including modernising care, improve productivity, and deliver better patient outcomes.

Without investment, the NHS will continue to place an increasing burden on its staff and operate from outdated facilities with outdated technology. A modern healthcare system deserves modern levels of investment.

For this reason, the DHSC should set a trajectory to increase the capital share of health spending annually, with the aim of dedicating 10% of the overall budget to capital investment by 2035. This could transform the NHS with more capacity, modern facilities, cutting-edge devices, labour-saving technologies, and the most advanced digital tools.

The NHS and DHSC have many levers to achieve this and improve investment in the NHS. They can change the balance of capital and revenue funding, provide new FTs with greater freedoms to invest, reform the flows of capital charges, and unlock embedded value from the NHS asset base.

With government support, even more change is possible. This could enable local authorities to invest with the NHS to revitalise high streets, develop the NHS’s own investment facility to drive productivity, and help the NHS make best us of all appropriate funding sources for infrastructure (including alternative financing sources).

This change can happen quickly. Many of the changes discussed here can be implemented by NHS and DHSC alone – all the proposed changes could be delivered by 2035, and many of them before the end of this Parliament.

Supported by a clear capital strategy, robust guidance and practical support for trusts, the NHS can secure the investment it needs to deliver its strategy, improve care and drive productivity.