NHS Confederation’s recent report on capital efficiency has put the current NHS capital regime under the spotlight. They call for urgent reform to enhance productivity and support economic growth. The report is well considered and makes practical recommendations across five main areas:
- Streamline Approvals: The current capital approval process is slow and involves too many overlapping approvers, leading to increased costs and complexity. The report suggests devolving more decision-making to the system level to address this issue.
- Longer-Term Funding and Planning: Short-term capital allocations hinder strategic planning and the execution of long-term projects. The report recommends implementing longer-term funding cycles with more flexibility on capital spending limits.
- Local System Empowerment: Local systems need more capacity and control over their budgets and assets. This includes identifying and recycling assets, which the current setup does not adequately support.
- Cross-Boundary Capital Flows: Improving the movement of capital across Integrated Care System (ICS) boundaries is essential. The report suggests changes to facilitate better capital flow, ensuring investments follow patient needs across different regions.
- Private Investment: To meet the 2% annual productivity challenge set by NHS England, the report advocates for enabling systems to raise private investment. This approach aims to bridge the gap in capital funding and support the NHS’s long-term workforce plan.
The report also recognises Community Health Partnerships (CHP) pivotal role within the system given CHP’s expertise in the LIFT (Local Improvement Finance Trust) estate. Through our well established LIFTCo Boards, comprising of CHP Regional Directors and local representatives, CHP are well placed in working locally to identify and support local initiatives.
Our national role in the management and direction of the LIFT portfolio as we move to securing the future is also recognised, an area which is a key priority across CHP.
While NHS Capital Regime reform is much needed, it should not distract from what is possible and deliverable now with current assets.
Hospital to community shift taking place now
The NHS should act now to better utilise our existing high-quality, well-maintained community-based health facilities. There is capacity and opportunity in existing assets to shift hospital services out into communities. The LIFT estate is made up of over 300 health centres purposefully developed to support community-based care.
Unlocking estate solutions
Integrated Care Boards (ICBs) were created to take a holistic approach to transform health and care in local areas. A whole system approach underpinned by partnership working is crucial to how the NHS moves forward and makes strategic decisions on critical infrastructure. ICS infrastructure strategies are a good starting point to understanding the range of assets available in local systems and the opportunities to unlock NHS estate challenges.
Optimising the use of existing high-quality assets as part of a strategic approach to health infrastructure is key. It is quicker to deliver and demonstrates better value for money. In the short-term, simple moves and changes or restacking buildings by considering patient flows can support the shift out of hospital and the co-location of a range of services in neighbourhoods. Existing spaces can also be adapted and repurposed, for instance by converting administrative to clinical space facilitated by small capital investments. This can also support the move of services out of hospital or from unfit for purpose buildings that can then be disposed of – generating a capital receipt for reinvestment locally.
These infrastructure solutions can be delivered in the short to medium term and can unlock estate challenges for the NHS – there are opportunities to act now to improve care for patients and communities.
Wendy Farrington-Chadd
CEO
Community Health Partnerships
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