Conclusion 5

The NHS has still not published a capital funding strategy to support the NHS Long Term Plan. The Department had planned to announce its capital strategy to support the Plan in the autumn 2019 Spending Review. However, a one-year spending round was delivered given the government’s focus on exiting the EU, with a full spending review postponed to 2020. At October 2019, trusts reported an estimated total backlog maintenance cost to restore their estate to an appropriate standard of £6.5 billion, of which £1.1 billion was high-risk, indicating that not doing the maintenance meant an increased risk of harm to patients. NHSE&I recognises the issue of the growing backlog and accepts that improved capital investment is vital. In October 2019, the Department published the Health Infrastructure Plan which announced 40 new hospital projects and associated funding. During the COVID-19 crisis, implementation of the NHS Long Term Plan was halted and capital expenditure requests from trusts were required to be clearly linked to delivery of the COVID-19 response. The crisis has also demonstrated the potential of, and the need to, invest further in IT and digital services. Recommendation: The Department and NHSE&I should identify a capital strategy and provide clear guidance to local partnerships, that supports the NHS NHS capital expenditure and financial management 7 Long Term Plan, including expectations on how backlog maintenance costs will be addressed alongside competing priorities for digital investment and the Health Infrastructure Programme.