Stevens: Old capital process was ‘implicit rationing’

In a thinly-veiled criticism of the previous capital regime, Mr Stevens, chief executive of NHS England and NHS Improvement, told the Commons health and social care committee on Tuesday that “to some extent the process of business plans and local consultations… given how drawn out [that was, it has] almost been an implicit capital rationing mechanism across the NHS.”

Mr Stevens went on to say that the NHS is now in a period when capital investment is “increasing”, and – referring to the process of getting promised cash – he said a lot of delay needs to be taken “out of the system”.

Getting capital projects approved has been a major source of frustration for local NHS leaders in recent years, with the process described as “driving in a fog” by Greater Manchester’s devolution lead Jon Rouse.

Previously, trusts have needed to submit up to three business cases, some of which require approval from different committees within the Department of Health and Social Care, NHS England and NHS Improvement, and the Treasury.

Mr Stevens said measures outlined in the government’s Health Infrastructure Plan would address this, such as streamlining the need to submit strategic, outline and full business cases, restricting the necessary approvals to one central committee, and establishing a team that can help individual areas.

The committee was also told that trust chief executives have criticised a DHSC-led scheme to allow trusts to take over estate owned by NHS Property Services.

Both Mr Stevens and Chris Hopson, chief executive of NHS Providers, said they had been told trusts found the scheme “hard” to use to enable the transfer of ownership.

Mr Stevens said he has asked the estates team at NHSE/I to “see if there’s a way of streamlining that with the support of the Department of Health and Social Care”.

However, Matt Hancock, the secretary of state for health and social care, told the committee there had not been many applications so far. 

Asked about the hospital building announcements by the government last month, Mr Stevens said NHSE/I were “very content” with the schemes that were chosen.

He said the schemes were chosen by:

• Identifying projects submitted by sustainability and transformation partnerships which missed out on funding in 2017 and 2018;
• Identifying parts of the NHS estate that were the oldest or had the biggest operational issues, and
• Identifying (in terms of the six major hospital rebuilds) schemes where enough scoping and design had been carried out to make central chiefs confident they were deliverable within five years.

Mr Stevens also said he would “bat very heavily” for mental health capital investment, citing the need to replace 350 dormitory wards across the NHS.