The NHS treats a million people every 36 hours. In the vast majority of cases, the care they receive is exceptional. But in recent years, the ability of NHS professionals to provide the standard of care they strive and want to deliver has become harder, writes Chris Hopson.
Some of the challenges are widely known: the longest and deepest financial squeeze in NHS history, shortages of doctors and nurses, an ageing population, rapidly growing demand for healthcare, and rising costs of treatment.
The government made an important and welcome commitment last year to increase the NHS’ day-to-day spending to meet these challenges, giving the NHS certainty over that revenue spending until 2023-24. But the capital budget for the NHS’ buildings, equipment and infrastructure remains untouched.
The distinction is important. Paying for more doctors and nurses, newer treatments and more appointments and operations is vital. But what’s the point if NHS staff are trying to deliver care in buildings with leaky roofs and broken plumbing?
If diagnostic tests and scans are being performed with outdated equipment? If patients with serious mental health conditions are being treated on wards built over 175 years ago? If the kit for paramedics is not up to date?
Lack of investment is scandalous
The NHS buildings and equipment budget has been relentlessly squeezed year after year. Over the last five years, we’ve had to transfer nearly £5bn of that money to prop up day-to-day spending.
As a result, the NHS now has a maintenance backlog of £6bn, £3bn of it safety critical. The NHS estate is crumbling and the new NHS long-term plan can’t be delivered because we don’t have the modern equipment the NHS needs.
It’s scandalous that, as a nation, we’re now spending less than half the amount on these items than comparable countries. The impact on patients is tangible and real. Take the number of modern scanners that are so crucial to 21st century medicine as they enable rapid and effective diagnosis of a range of conditions from cancer to heart disease.
Per head of population, we have fewer CT scanners than Slovenia, the Russian Federation, Turkey, and the Czech and Slovak Republics, and less than half the number you’ll find in Latvia, Greece and Iceland. World leading Japan has more than five times the number of CT scanners than the UK does.
Patients at risk
So it’s no surprise that 80 per cent of frontline trust leaders, in a survey we’re releasing today, believe that this continued underinvestment is putting patient safety at risk. Those leaders have deep concerns about the impact of these capital spending constraints on patients’ waiting times, quality of care, and staff wellbeing and recruitment.
Their message is simple – current levels of NHS capital funding are insufficient to allow the NHS to stand still, let alone invest in the transformational technologies required by modern medicine.
The new government has begun to recognise this with its recent, positive decision to scrap the request that all trusts cut back their capital spending plans by 20 per cent this year. It’s also allocated a small amount of extra funding for 20 hospital upgrades over the next five years.
But, as health and social care secretary Matt Hancock made clear, this can only be the start. As we head towards next week’s spending round, with health high on the chancellor’s agenda, it is clear there is a huge amount of catching up to do.
Bring spending into line
That’s why NHS Providers and frontline trust leaders are today launching a campaign to rebuild our NHS and create a 21st century health service with a properly-funded and well-designed system of capital investment.
The campaign is calling for three things. First, we need the government to set a multiyear NHS capital budget, allowing us to plan for the future and transform its services and equipment.
At present, there’s no NHS capital budget for the year after next. If we’ve set the NHS revenue budget till 2023-24, we must set the capital budget for at least the same period. Ideally, we’d match the 10 years of the new NHS long-term plan.
Second, we need the government to bring the NHS’ capital funding into line with comparable countries. We should be aiming to at least double the health service’s current capital spend and sustain that growth for the foreseeable future. Because the NHS is a universal public service, increasing NHS capital budgets has the added benefit of bringing much needed investment and jobs to parts of the country that would otherwise struggle to attract them.
Third, we need the government to ensure the money gets to where it is needed on the frontline, free from the bureaucracy of the present system. Current approvals for new capital projects are so mired in bureaucracy that the last major NHS new build infrastructure project was approved almost half a decade ago.
We know all the government shares these aims, but their warm words now need to be translated into action, because the situation is becoming increasingly urgent. We must see a commitment to address this in the forthcoming Spending Round. We need to rebuild our NHS, and give our doctors and nurses the tools to create the 21st century health service that patients expect and that we can all be proud of.
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