Safety fears escalate as squeeze on NHS capital continues


The Chief Executive of NHS Providers, Chris Hopson, has hit back at further cuts to the capital spending plans of NHS Trusts, saying patient safety is increasingly at risk and the situation needs urgent attention. “England’s 226 hospital, mental health, community and ambulance Trusts fear patients’ safety is at risk because they’ve been told to cut their 2019/20 capital spending to comply with Treasury spending rules and all NHS frontline capital spending has been paused until this cut is delivered.

“Over many years of austerity, Trusts have had to hold back from buying new scanners, replacing ageing wards, repairing leaking roofs and purchasing new ambulances. They’ve scrimped, saved, patched up and made do. But we’ve now reached a crisis point."


A recent briefing from the Health Foundation (‘Failing to Capitalise’) emphasised the seriousness of the situation. It found that between 2010/11 and 2017/18, capital spending by the DHSC declined in real terms from £5.8bn to £5.3bn, a fall of 7%, which is mostly explained by capital to revenue transfers by the Department. Capital spending by NHS Trusts fell by 21% in same period – from £3.9bn to £3.1bn. 


In addition to the capital to revenue transfers, the Health Foundation briefing also reported a significant increase in capital from sales – over £400m in 2017/18 compared with £175m in 2010/11. However, it states that although sales of capital are supposed to be re-invested, this has not been the case, “with significant amounts of money from sales of land being used for the revenue budget.”


There has been a commitment by the government to put an end to capital to revenue transfers by the end of this year. However, last month HSJ reported that the spending increase for the Long Term Plan is to be partly funded by an additional raid on capital budgets. In addition to the £250m agreed as part of the 2015 spending review, a further £221m has been agreed to fund part of the first year of the long-term settlement for the NHS.


Lack of capital funding starting to bite

The Labour Party has also published research to underpin the extent of the maintenance problems being faced by hospitals across England. 170 Trusts responded to the Freedom of Information request, revealing that 76 Trusts had experienced incidents as a result of estates and infrastructure failures in 2018/19. Problems included sewage and water leaking on to hospital wards, broken lifts and ceilings collapsing. Some incidents have affected patient care, often leading to the cancellation of appointments and leaving patients waiting longer for vital treatment.


Chris Hopson has seen examples of this lack of capital funding at first hand.

“In the last year I’ve visited a Trust that has had multiple floods because of crumbling pipework. A Trust that’s had to close its intensive care unit within an hour and move it to the other end of the hospital due to torrents of water running down the walls all because it couldn’t get the capital to repair a leaking roof. A Trust that’s had to cancel vital cancer diagnostic appointments because they’re trying to extend the life of their oldest scanner. A mental health Trust that was looking after seriously ill patients on wards built in the 40s - the 1840s.

“A number of Trusts have told me that they are worried they are running an unacceptable fire hazard risk. And several have said they don’t have the capital to comply with the terms of formal Care Quality Commission enforcement notices.


“What’s worse is that some of these Trusts have the cash in the bank to pay for this work. They’re ready to sign contracts to get this vital work started right now. But they’re now being told they have to pause this work and cut their plans by 20% so that the Department of Health and Social Care can meet its arbitrary Treasury capital spending target.


“The money is there to be spent. Patient safety is clearly at risk. But everything’s on hold. Politicians need to focus on and sort the very real problems facing the NHS today - this can’t wait. Quickly increasing the 2019/20 NHS’s capital spending limit is the obvious answer."

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