Since the flurry of main announcements the Department of Health and Social care has published a Health Infrastructure Plan (HIP) as “a new strategic approach to improving our hospitals and infrastructure”.
It offers few surprises. The same gaps and skewed priorities that can be seen in the first round of allocations under the Johnson government run through the HIP.
There are no new resources to tackle the rising bill for backlog maintenance, even though the scale of the problem is referred to on page 9:
“There is significant unmet demand for capital in the system. A key example of this is that the NHS is reporting significantly increasing levels of backlog maintenance, up 37% between 2014-15 and 2017-18 to £6.0bn, with the highest risk category (‘significant’) rising most rapidly.”
But by page 11 this had shifted to a general aspiration for an NHS that “proactively takes steps to maintain assets and reduce backlog maintenance,” and by page 17 the problem has been deftly shuffled back onto the trusts themselves to pull themselves up by their own bootstraps:
“… we expect that local health systems adhere to the following:
“… Taking responsibility for the on-going ‘business as usual’ maintenance of their healthcare estates, ensuring they are sufficiently surveyed, and sensible investment decisions are made and prioritised accordingly.”
Similarly the HIP offers no hope for trust boards, management and staff trying to deliver mental health services in decrepit and unsuitable buildings. It begins with brave words on page 6:
“The HIP is not just about capital to build new hospitals – it is also about capital to modernise mental health facilities, improve primary care and build up our infrastructure in interconnected areas such as public health and social care …”
The same platitudes are repeated on page 14, but the document contains no commitments to any significant investment to make this possible, and it’s clear that the promises, if any, will only come in the future:
“The full shape of the investment programme will be confirmed when the Department for Health and Social Care receives a multiyear capital settlement at the next capital review and will feed into the phases of HIP – and at that point an updated version of this document will be published.”
So these priorities for the NHS are ignored and 93% of the £3.7 billion of new money is focused on the acute hospital sector.
However there are some new aspects to be noted in the HIP, most notably banging the final nail into the coffin of the Private Finance Initiative, a failed Tory policy which the Johnson government is now keen to link to the Blair government, which implemented it with most vigour in the NHS.
The HIP (page 9) has a clear commitment to public funding of any new hospital development:
“The retirement of off-balance sheet government-funded infrastructure (formerly known as “PFI” or PF2) has also removed a significant source of funding from the system, given the majority of new acute provision over the past 20 years has come through PFI. It is therefore clear that public capital funding will be needed to deliver new large hospital replacements in the future.”
Former NHS finance director and analyst Roger Steer, speaking to The Lowdown, pointed out the limitations of the HIP as a strategy:
“While some chosen projects have received good news the reverse of the coin is that the announcements represent years of delay for other projects, equally as urgent and pressing. Projects should be receiving capital and revenue support based on need and the quality of the business case; and shouldn’t be required to wait in a queue for years.
“£2.9bn only represents a proportion of backlog of projects built up over the years and the total bids for capital in the STP plans of 2016 added up to more than £20bn.
“The other word of caution is that the Treasury is not mentioned once. It is clear that this is a hasty announcement that may not have the Treasury’s full backing.
“If the economy nosedives after Brexit we may be back to stop in the stop –go cycle, with capital spending as the first item on the list of cash savings.”
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