A new report from independent charity, The Health Foundation, concludes that ‘a short-termist approach’ has resulted in ‘years of declining and inadequate capital spending for the NHS in England, risking patient care and staff productivity’.
'Failing to capitalise: Capital spending in the NHS' – published on 8 March –argues that the Department of Health and Social Care’s (DHSC’s) ‘vision’ for a world-leading tech and data-driven health service ‘is unrealistic when capital investment is much lower than in comparable countries, and underfunding over the years has left the NHS with an inadequate and ageing IT infrastructure’.
Meanwhile ‘an ageing infrastructure’, and a ‘substantial and growing repairs backlog’, are likely ‘to undermine ambitions to transform the health service’. The report says the DHSC’s capital budget has declined in real terms over the last eight years; NHS Trusts in England have consequently seen a 21% reduction in their capital funding – mostly explained by transfers of money for long-term capital investment over the last five years, ‘to cover the growing day-to-day cost of running the NHS’. The Foundation added: “This year alone, the transfer amounts to £500 million of cancelled or postponed capital investment.”
The UK reportedly spends ‘about half the share of GDP’ on capital investment in the health service compared with similar countries, with the share having fallen significantly since 2009. While capital to revenue transfers have reduced the capital budget, this reduction only accounts for a small portion of the UK’s low capital spending by international standards. The Health Foundation says an extra £3.5 bn annually would be needed to bring capital spending in England up to the OECD average.
Health Foundation-funded research by the University of Birmingham, referenced in the report, saw directors and managers at NHS Trusts reveal ‘serious concerns’ that spending restrictions are impacting service efficiency, and, in several cases, the quality of patient care. The research highlights the impact of equipment shortages and failures, and ‘reliance on ageing diagnostic equipment’.
The authors says the lack of capital funding is ‘storing up problems for the future’ – in the form of a nationwide maintenance backlog in England, which has been rising since 2013/14, and is now valued at over £6 bn. Over half of this comprises ‘high’ and ‘significant’ risk maintenance, with the total backlog ‘now larger than the entire annual DHSC capital budget’.
Anita Charlesworth, director of Research and Economics at the Health Foundation (pictured), said: “Capital investment is not a nice-to-have – failing to carry out repairs and invest in modern equipment and technology puts at risk the quality of patient care. It will also undermine the NHS’s ability to improve and transform care in line with the NHS Long Term Plan.”
One finance director at an acute NHS Trust said: “The age of equipment, and the quality of the estate, definitely impact the care that can be delivered. Highlighting the practical impact of the backlog, meanwhile, an estates director at an ambulance Trust said: “My immediate backlog maintenance risks for the high and significant risks are over £1 million, but if I just tackle them I’m still not going to have a fit-for-purpose estate, because just addressing the high and significant risk items doesn’t do other things, such as repairing rotten windows, and fixing roofs that are starting to leak. It feels like you are constantly playing catch-up.”