Last week’s budget gave the NHS’s capital budget, used for infrastructure, a boost of £3.4 billion, but there is a catch. It is all earmarked for technology, digital and AI projects and is dependent on productivity increases – that are almost double anything asked for previously.

Meanwhile, parts of NHS buildings are falling on patients and injuring staff. In a single 24-hour period a ceiling collapsed onto a patient in the intensive care unit at the Royal Alexandra Hospital, Harlow, and a lift failure at the Royal London Hospital, Whitechapel, resulted in a surgeon breaking a leg. 

Matthew Taylor, CEO of the NHS Confederation wrote in the HSJ that although the £3.4 billion is “much-needed and to be welcomed” as well as not beginning until 2025-26, bigger productivity gains “will only be realised if crumbling estates are addressed too; a problem exacerbated by regular raids on the capital budget to fund day-to-day cost pressures.” 

The NHS Confederation calls for an extra £6.4 billion in capital funding a year to repair crumbling estates and invest in the latest digital technology and equipment.

Taylor added that

“Images of new computers sitting in outdated and sometimes dangerous buildings could become a symbol of the failure of joined-up policy.” 

A Health Foundation analysis of the budget funding for the DHSC, found that although the DHSC’s total budget will increase to £192bn in 2024/25, inflation means that, on current plans, this would equate to a small increase of 0.6% in real terms compared with 2023/24 and a real terms reduction in funding compared with 2022/23. 

NHS England’s budget of £164bn has not risen in real terms compared with the previous year. But, when adjusted for a growing and ageing population, it will be 1% lower in 2024/25 compared with the previous year.

There is also a 4.7% decrease in real-term funding for other DHSC spending, including for health care staff education and training and the public health grant in 2024/25 compared to the previous year. 

The only budget that will see growth in real terms is the capital budget, up 13.6% in 2024/25 compared to the previous year. The likelihood that it will continue to be raided for day-to-day pressures, therefore, is high given the lack of budget increases elsewhere. What’s left will be nowhere near enough to address the current maintenance needs.

Massive backlog

In December 2023 government figures showed that England’s NHS backlog of maintenance had rocketed by 13.6% in the last 12 months to a massive £11.6 billion, having almost doubled from £6.5m in 2018/19. 

Two-thirds of the latest backlog is rated “high” or “significant” risk. High risk is defined as “where repairs/replacement must be addressed with urgent priority to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution.” 

A recent article in The Times included incidences such as at one hospital where the property manager has to be called if a patient needs to be admitted at weekends, to check that the floor can take the additional weight and also wards being cut off due to failing lifts. 

An ITV News report in 2023 revealed that nearly half of NHS hospitals in England have been forced to close wards and vital services due to flooding, power cuts and structural problems.  Plus there are now 54 hospitals listed as having faulty concrete. 

New hospitals?

What of the “40 new hospitals” pledge how is that improving infrastructure? Well, the project appears to be hitting yet more problems, with the chaotic nature of the NHP, discussed recently in The Lowdown, set to continue. Including cancellations and delays to projects and rising costs. In July 2021, Natalie Forrest, leader of the NHP, admitted to a conference that the ‘brakes had come on’ for some of the Pathfinder projects, most notably Princess Alexandra (Harlow in Essex), the very hospital where the ceiling collapsed last week.

According to HSJ’s sources, the government’s new hospitals programme (NHP) now requires £26 bn, an extra £4bn, to complete the schemes by the end of the decade. Ministers have so far pledged £22bn to the NHP, but changes to the hospital plans mean that costs have increased. The major change is a proposal to maintain existing bed numbers rather than reduce them. The NHP is reportedly drawing up its full business case, containing a more detailed plan and costing for the programme. 

Now, however, its leadership is leaving with Natalie Forrest, the current head of the NHP, and Saurabh Bhandari, the programme director, both announcing in recent weeks they are leaving the NHP. Natalie Forrest, who was only at NHP on secondment, chose not to apply for the permanent position of senior responsible officer for the NHP at the Department of Health and Social Care, which went out to recruitment in late December.

The government’s focus on IT and AI and getting the waiting lists down (including increasing use of the private sector) could prove very short-sighted. Without safe infrastructure, health care can not take place with the knock-on effect on waiting lists. No AI in the world can replace a physical structure that is safe to work in. 


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