Author: Bev Evans
Published 27 February 2020

The efficiency and productivity of the NHS is once again in the spotlight as systems fail to meet targets. Leaders across the NHS have pronounced that the system is “capital-starved” which is a factor behind the declining performance. The decline in investment of capital has been front of mind for many years; NHS figureheads have been demanding a capital settlement to go towards supporting performance improvements.

In July 2016, NHS England chief, Simon Stevens was calling for a ‘70th birthday infrastructure fund’[1] to boost capital within the NHS.

In June 2019, Lord David Prior, NHS England’s chair, spoke at an event hosted by the Cambridge Health Network, he asked for a £50bn bond; and is quoted saying “if we were to come up to the OECD average – the average, not a demanding place to be – we would need between £3bn and 5bn per year extra on capita ….[the lack of capital] is far too few MRI and CT scanners … 43% of NHS buildings are over 30 years old and 18% pre-date the founding of the NHS In 1948”.[2]

Throughout the 2019 elections, capital funding was a hot topic; Boris Johnson pledged to build 40 new hospitals by 2030 but refused to specify how much they would cost, where they would be or where the money would come from. Mr Johnson went on to name six NHS trusts that will share £2.7bn of funding, to totally rebuild existing acute hospitals by 2025 and confirmed a further £100m of seed money for 21 trusts in England, to work up detailed plans for similar projects.

Focusing on future demand and capacity requirements

Ben Zaranko, research economist, IFS, said: “there is no such thing as a ‘typical’ hospital and the cost will depend on their size, location, technical specification, the degree to which they are refurbishments versus new builds and a huge number of other factors.”

The focus needs to be on these “other factors” so that the NHS can ensure that the services are fit for the future. The Long Term Plan (LTP) published by NHS England and Improvement stated that the NHS would “make better use of capital investment and its existing assets to drive transformation.”

Recently, we have experienced first-hand working with NHS systems, that the focus is often the hospital building, square meterage, the number of beds and footprint. Too often the questions of what will be provided, where, how and by whom are afterthoughts, yet these should be the questions that should be addressed first.

At CF, we use our combined healthcare expertise and analytical skills to place a firm focus on the overall clinical strategy. This is then converted into a model of care, developed and agreed with the clinicians who will need to work differently to deliver the service transformation.

The NHS has a chequered past in rightsizing hospitals. We know with a growing elderly population that the best bed is often at home, with the right care around them. The capital investment is welcomed but must be alongside investment in developing the out of hospital provision at scale to truly deliver integrated care.

The NHS should use this opportunity to move from focusing on simply rebuilding the structure of NHS buildings, to one which strengthens the imperative to develop and begin delivering a clinical services strategy. When done this way, new flexible hospital design and construction becomes the ultimate enabler for maximising service transformation, safety and quality, service users’ experiences and support future change, rather than become an impediment to further change…