Recommendation 5

The NHS estate is in an increasingly decrepit condition, but the Department seems unable to make timely decisions to address these problems. The NAO report found that the cost of tackling outstanding maintenance work on the NHS estate has now reached £9 billion, up from £5 billion seven years ago. Alongside this, there are long delays in making decisions on capital programmes. For example, staff and patients at the Queen Elizabeth hospital in King’s Lynn have been waiting for years for a decision, now expected later this year, about whether it will be part of the new hospitals programme. At present the hospital has 3,000 timber and steel supports holding up a cracked aerated concrete roof. The Department has set an aspiration that Integrated Care Boards within ICSs can retain the proceeds of any asset sales, but it is not clear whether they will be able to retain the full value of proceeds given wider pressures on public sector budgets. The Department has still not published its long-term strategy for capital, despite telling us in September 2020 that it would be published in Autumn 2020, and in June this year that it would be published in Autumn 2022. It now tells us it expects to publish in early 2023. Recommendation: The Department and NHS England should ensure the capital strategy is published in early 2023. This strategy should set out an analysis of need and plans to address this. The Department and NHS England should also provide an annual progress update against the strategy, to include progress on nationally determined commitments and priorities, such as the New Hospital Plan, and system-wide ICS-led issues such as addressing the backlog of maintenance work. The progress update should also include details of when the Department and NHS England expect to make decisions that affect current and potential capital projects, to enable ICSs to plan with more certainty.