Recommendation 14

ICSs must contend with the legacy of an increasingly decrepit NHS estate and infrastructure. The NAO’s report highlights that the cost of the work needed to bring the NHS estate back up to scratch has increased from just under £5 billion in 2015–16 to an eye-watering £9 billion by 2020–21, of which £4.5 billion was assessed as high or significant risk repairs.44 We have previously reported on capital expenditure pressures in the NHS and the Department’s ongoing failure to publish a capital funding strategy, which was originally due in 2019.45 The situation is exacerbated by the limited pots of capital funding in the NHS, and long delays to decision making for existing capital programmes. We highlighted the example of the Queen Elizabeth hospital in King’s Lynn, which currently has 3,000 timber and steel supports holding up a cracked aerated concrete roof.46 Staff and patients at the hospital have been waiting many years for a decision on whether they will be included in the government’s new hospitals programme, and we were told they must now wait until later this year for a decision that was most recently expected in spring.47