CHP Thought leadership: The NHS needs to make smart choices

With limited budgets and high demand for healthcare, the NHS faces hard choices as highlighted by the HSJ recently.  At a time of heightened scrutiny, it is critical that spending decisions deliver greater productivity and benefit for patients and staff.  In a recent Financial Times interview Richard Meddings, Chair of NHS England, highlighted how investment in more staff has not delivered the anticipated productivity gains, hampered by the lack of capital investment.  The HSJ also highlighted that the NHS currently faces a trade-off in relation to capital spend versus more staff. Whilst we recognise that short term imperatives often drive decision making, there is wide recognition that the lack of capital spend negatively impacts NHS productivity.  Investing in the environment for staff to work and care to be provided, over and above more staff is a hard decision but at CHP we would argue that this is a smart decision. The long-term benefits of the right capital investment can support productive working. This will enable more patient care to be provided, supporting the workforce to achieve higher productivity which ultimately provides the best outcome. 

We have seen this through our capital programme where investment to create sustainable space for patient care across the LIFT estate brings significant benefits to staff and patients.  The investment in capital to create Community Diagnostics Centres (CDCs) in our buildings for instance has delivered over 300,000 additional tests, checks and scans in almost two years.  A significant amount of capital has been spent on building alterations to house specialist medical equipment, such as CT and MRI scanners.  These state-of-the-art CDCs provide a great environment for staff to work in as well as providing patient care, and we have received great feedback from staff and patients that support this.

The HSJ also highlighted that tension exists with capital spend on existing estate versus building new.  We believe that the NHS needs to make smarter choices to make limited budgets go further.  As part of a system wide approach the NHS should make best use of its existing high-quality estate.  The NHS already pays for the LIFT estate, a portfolio of modern, multi-use health facilities which has the capacity to support more services in community-based locations.  By using these assets fully, the NHS would benefit massively in productivity gains.  It would seem an obvious choice, and with targeted capital investment to progress with further adaptations at pace this would improve the utilisation and optimisation of these buildings further, increasing productivity and realising the staff and patient benefits sooner. This is why we are making this a priority in our forward plans.

Hospital versus primary care is a perennial capital investment trade off also highlighted by the HSJ.  While the state of NHS hospitals grabs much of the public attention, the state of the primary care estate must not be forgotten.  Recent data showed one fifth of GP premises pre-date 1948.  Furthermore, the lack of investment in the primary care estate is detrimentally impacting on the delivery of the long-term workforce plan for primary care.  Not good if you consider that 90% of first contact with the NHS occurs outside of hospitals. We know the primary care estate comes with its own challenges and hard funding choices. It is also clear that the long-standing alternative of third-party development in primary care is no longer a real viable option. However, as experience shows us smart, targeted investment in the primary care estate through greater utilisation and optimisation of core assets, such as the LIFT portfolio, the NHS can support productivity in primary care and enable the delivery of the long-term workforce plan for primary care.  The capital investment required here is minor compared to the cost of new builds, and the speed to enable service delivery through adaptation much faster, and this represents better VFM for the taxpayer. Surely then, this is a smart decision rather than a hard one.

Find out how we are supporting the NHS with its productivity challenge through greater utilisation and optimisation of our buildings.


Wendy Farrington-Chadd


Community Health Partnerships

Contact your CHP Regional Director

Article orginally published on CHP LinkedIn: 16  May 2024

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