Source · Select Committees · Public Accounts Committee
Recommendation 40
40
Accepted
DHSC's neglect of long-term NHS sustainability led to a record maintenance backlog.
Conclusion
This committee has highlighted many times in the years since 2016 that DHSC has focused on short-term survival of NHS services, while neglecting long-term sustainability, 78 Qq 49–51 79 Q 94 80 Q 91; C&AG’s Report, para 4.2 81 C&AG’s Report, paras 3.17 and 3.19 82 Q 109 83 Q 109; C&AG’s Report, para 18 84 Qq 109, 110 85 C&AG’s Report, para 18 86 Q 110; C&AG’s Report, para 18 87 Q 110 20 The New Hospital Programme and has criticised DHSC’s lack of long-term planning for capital investment.88 A key aspect of this has been the diversion of the NHS’s planned capital funding to meet daytoday funding pressures: DHSC diverted £4.3 billion of capital funding in this way from 2014–15 to 2018–19.89 Under-investment in the NHS estate partly caused the record maintenance backlog of £10.2 billion in 2021–22, which was twice as high as in 2013–14.90 In February 2023, we again warned about the increasingly decrepit condition of much of the NHS estate, the escalating maintenance backlog, and how DHSC seemed unable to make timely decisions to address these problems.91 This Committee has also reported before that Accounting Officers only rarely flag concerns they have about value for money using the formal mechanism of seeking a ministerial direction, which would alert Parliament to high-risk decisions.92
Government Response Summary
The government states it is providing record capital funding to the NHS and that decisions to switch capital budgets are only made in exceptional circumstances, following usual processes for Ministerial advice and HM Treasury approval. It commits to providing more certainty for NHS capital through rolling investment programmes, implying the recommendation is already implemented through ongoing work.
Government Response
Accepted
HM Government
Accepted
8.1 The government agrees with the Committee’s recommendation. Recommendation implemented 8.2 The government recognises the importance of capital investment in the NHS and the role it plays in an effective and productive healthcare system. The department is providing the NHS with record amounts of capital, including £12 billion of operational capital between 2022-23 and 2024-25 to address the most pressing priorities. 8.3 The decision to switch capital budgets to revenue is only made in exceptional circumstances. When such switches are enacted, capital programmes with forecasted underspends are prioritised for a switch rather than proactively delaying programmes. The department also enacts some adjustments where, to meet the same programme aims, the currency of spend has changed from capital to revenue. 8.4 Although the government agrees with the Committee’s recommendation in principle, it is right that the department regularly assesses its priorities so that budgets are targeted effectively. Therefore, the government suggests that the usual processes when advising Ministers of the impact of financial decisions, including switching of capital budgets, continue to be followed. The department will continue to make these considerations clear as part of Ministerial advice, with any switches then being approved by HM Treasury. 8.5 Looking forward, the government is committed to providing more certainty for NHS capital through rolling programmes of investment in NHS infrastructure.