That this House has considered NHS capital spending.
It is a pleasure to serve under your chairship, Mr Western. I am grateful to have secured this debate on NHS capital spending. This subject goes right to the heart of how the NHS functions, and yet it is not discussed enough in this place. I had a look through some ministerial statements and questions in preparation for this debate, and I found that we often talk about staffing, specific illnesses, waiting times and other operational performance issues, but the simple truth is that all these challenges will be much more difficult to deal with until we improve NHS buildings, equipment and technical infrastructure. I get it: it feels much more impactful and immediate to talk about lifting nurses’ pay or commissioning a new medicine, and those things are important. But however arduous the process, or however far beyond our electoral terms the output of capital investment may be, it is vital for the long-term healthcare of our constituents that we fight for these slow returners, too.
My hon. Friend is starting to make a compelling point. In my local area, Stepping Hill hospital has a reported repairs backlog of £138 million. That means, in practice, that only four of the 14 lifts are working, staff are having to physically take meals upstairs to patients, and family members with a mobility issue cannot visit their relatives on higher floors. Does he agree that, while we are talking about bricks and mortar, we are also talking about people and their quality of life?
I am grateful for the point my hon. Friend made, and I will come to make very similar points about the impact that maintenance backlogs are having.
It is partly because of the slow payoff of capital investment that we are in this mess. The last Conservative Government completely undermined the NHS’s future by overpromising, underdelivering and sacrificing long-term investment to plug holes in their mismanagement of the public finances. While capital underspends being plundered for revenue black holes is not a total innovation, it did accelerate under the Conservatives, with the most acute period seeing more than £4 billion raided from the capital budget in the five years up to 2019 to cover deficits in day-to-day spending. I note that that was prior to the pandemic, when operational pressures were clearly stress-tested to the limits, and I have no doubt that that under-investment left us more exposed than we otherwise would have been during that period.
The outfall is staggering. If we had simply matched existing levels of capital spend, more than £30 billion of additional capital would have flowed into the NHS. Instead, we watched buildings decay, equipment age, diagnostics fall behind and maintenance backlogs soar.
Medical devices and equipment are increasingly becoming pressure points as trusts rely on ageing, life-expired kit. Torbay and South Devon NHS foundation trust has had fantastic results in bowel surgery from a free trial of a robotic surgery system that it was offered, but it cannot afford to buy the system because it has to replace other equipment that is on its last legs. Does my hon. Friend agree that the Minister should set out how the Government will ensure that NHS capital policy supports not just buildings and maintenance backlogs, but clinical equipment and the technology needed to deliver safe, high-quality, innovative care for patients?
My hon. Friend makes an excellent point: this is about not just buildings, but equipment and digital and technical infrastructure, all of which are crucial to getting the NHS to operate in the way it should. She also highlights how we need to upgrade ageing equipment to a very basic level, let alone take advantage of all the opportunities that the latest innovations in new equipment could provide us with, if we were able to purchase those.
I mentioned that maintenance backlogs are soaring. They have doubled from around £6 billion in 2015 to over £13 billion in 2024. The critical thing to stress is that it did not have to be this way. The UK invested around a third less in health capital during the 2010s than other comparable nations. According to OECD data, the UK has 10 CT scanners per 1,000 people compared with an average of nearly 20 per 1,000 across Europe. We have 8.5 MRI scanners per 1,000, compared with an average of 12 per 1,000 across other EU nations, and our bed capacity is pitiful. We operate at around 2.4 per 1,000 people, compared with an OECD average of 4.4. The issue has not only been a lack of money; it has also been a lack of certainty and flexibility.
The approvals process for capital bids is slow and cumbersome. Even when capital is available, trusts often receive final sign-off so late in the year that they physically cannot begin procurement, get survey work done and start construction in time. The money therefore goes unspent not because of poor planning locally, but because the system itself creates delay.
On that point, my local authority is currently sitting on £50 million of developer funds that it was paid, but those funds are not being spent in the local community because there is not the total money needed to invest in health, infrastructure, schools and other things. Does the hon. Member agree that that is something we must look at, to make sure that money set aside for development is spent with urgency in our communities?
The hon. Gentleman highlights the complexity in putting together large capital projects. Funding is not often from one source. It is from multiple sources, and everybody providing the capital needs to have greater flexibility for the schemes to become deliverable, or the funds end up getting clawed back and put elsewhere, as has been done in the past.
The yearly cycle that I speak about is important because, in the past, capital departmental expenditure limits rules—Treasury CDEL rules—have meant that any unspent capital must be returned to the Treasury at the year end. Not being able to carry it forward punishes good financial management, prevents multi-year planning and leaves trusts scrambling to spend money before deadlines, rather than investing it strategically. The result is a system where underspends exist at the same time as record levels of urgent capital need. Trusts want to invest and start work, but the system ties their hands.
The effect of all that has not been abstract. The buildings maintenance backlog includes high-risk failures: operating theatres closed due to ventilation problems, leaks near electrical systems, sewerage failures and outdated wards where modern clinical standards simply cannot be delivered. A 2022 British Medical Association survey found that 43% of doctors reported that building conditions negatively impacted patient care.
My hon. Friend is giving a powerful and important speech. Half the residents in my constituency are served by Basingstoke hospital, which was included in the now infamous promise of 40 new hospitals by 2030. Now it seems completion could be as late as 2046. The delay means another 20 years of spending taxpayers’ money on a building with leaking windows, exposed wiring, an uninsulated roof and countless other physical problems, with a bill that goes up and up every year to maintain that crumbling building. Does my hon. Friend agree that asking taxpayers to pay twice is a waste of public money, and Basingstoke hospital and others should have their rebuilds brought forward?
I do agree with my hon. Friend. I will come on to the new hospitals programme, as my constituency stands to benefit from it, too—if it comes soon enough. In the meantime, as she says, we are paying twice to pay for the repairs and patchwork, and never keeping up with the investment we need.
Ageing diagnostic equipment also means fewer scans, longer waits and more delayed diagnosis. Last year I had the pleasure of visiting my local hospital’s nuclear medicine unit, where I was shown a new machine that was driving down diagnosis times from hours to minutes. Obviously that is a fantastic sign of good capital investment, but when I spoke to the trust I was shocked to discover it is one of the only hospitals in the country with that particular piece of kit, and I thought to myself how much more productive the NHS would be if such equipment was rolled out routinely across the country as soon as it became available.
Then there is the infamy of poor IT systems. More than 13.5 million clinical working hours are lost every year due to poor IT. We have all heard shocking stories of hospitals running on Windows operating systems that we were talking to a paperclip on 20 years ago. As the age of artificial intelligence promises to transform the workplace, it would be great if the NHS could catch up with the last decade or so.
I recently met an AI developer who thinks they have come up with a solution to the elective surgery booking system. His system auto-calls patients and offers them a choice of appointment, making hundreds of calls in just minutes. They say it beats the old system on two counts. Patients usually receive a date by post without a choice, but the trial in the midlands saw “did not attend” numbers drop by 50%, which they put down to patient choice in the appointment time, and delivery was guaranteed because they had answered the phone. Think of the potential productivity gains if such technology was picked up at scale.
I am based on the outskirts of Nottingham, and already this year we have had three critical incidents at Queen’s medical centre, which is the main hospital in the city. They have all been based around A&E, and they were all the exact situation that the hon. Member describes. A&E has capacity for 350 patients, but it has routinely been seeing over 500. Does he agree that, in addition to the pressures he describes, there is a reputational risk to the NHS when such incidents are being declared because of physical capacity issues?
I agree with the hon. Gentleman, and I am sure that, like me, he hears constituents say that they do not want to attend their local A&E because they do not trust that they will be seen in time. I am sure that the figures he is describing are an undercount of the people who should be in there. Like me, he will have received emails about corridor care for some time. I had hoped that corridor care was a peak crisis moment and that it would subside, but it has become the norm and that is extremely worrying. It is not acceptable for patients, it is not fair on staff, and it is not a sustainable way to run our NHS.
If the Government are to reconsider which schemes should be in which waves of the new hospital programme, let me assure the Minister that my local trust is ready to go. Plans have been drawn up, land has been secured, and teams can move at pace. We need this, we want this, and we are ready. If that is not possible, but other pots of capital to be reallocated still remain, I make a separate plea: extend St Helier’s emergency department now. That is a smaller ask than delivering a whole new building, but it will make a big difference. The only thing more full than the corridors at my local hospital right now is my inbox, which is filling up with constituents describing their traumatic experiences.
St Helier hospital emergency department sees around 250 patients a day, with routine overcrowding leading to the trust being placed into national oversight measures. Kirsty, one of my constituents, was left anxiously waiting for her 83-year-old mum to be seen, witnessing elderly patients crying, vomiting, screaming and walking around in severe pain in the corridors. The father-in-law of Muhammad, another constituent, waited over 13 hours only to return home without seeing a doctor at all. Others have shared deeply personal details of their stories; their conditions were explained to them alongside countless others in the same corridor. It is undignified, unjust and unsafe.
I congratulate the hon. Member on securing the debate. To summarise what he is saying, we need to better spend the money that is currently being deployed in the NHS. Does he agree that this has to be the underpinning feature going forward? More and more money has been poured into the NHS; we all think it is a fantastic organisation and praise those who work in it, but we need to spend that money better and modernise the monolith that is the NHS.
I agree with the hon. Gentleman, who hits on one of the central points of this debate. We can continue to pour money into the operational side of the NHS, but if we do not get the capital expenditure right and improve the equipment, systems and buildings, we will always be pouring good money after bad.
I know that PPP is fraught with political risk, particularly for a Labour Government who are scarred by what happened in the past, but I urge them to look at the National Audit Office’s report and the experience of others internationally. They should also listen to the NHS Confederation, which is pushing them to go further and experiment with different financial models for delivering the infrastructure that we need at scale.
NHS capital has been insufficient, uncertain and inflexible for far too long. The new Government have good intentions to improve on all three, but now is the first moment at which we can start to look at their delivery. After what I have outlined today, I would like to put several questions to the Minister. Will she update us on the current level of capital underspend under this Government? Where in the system is the underspend occurring, and what is being done about it? Will the Government allow trusts to carry forward any unspent capital to future years? Will that exist beyond the current spending review period? What assessment has the Department made of the delivery of the new hospital programme, and will any schemes be reconsidered for movement between the waves? Will the Minister outline whether the Government plan to reform the capital allocation system to allow multi-year planning and reinvestment of trust surpluses permanently?
The NHS cannot function without modern, safe and efficient infrastructure. No Government can deliver improvements in performance or productivity without addressing the capital crisis at the heart of our system. I urge the Minister to use this moment to reset the capital regime and put it on a footing that prioritises long-term investment, accelerates delivery and gives patients and staff the facilities they need and deserve.
The White House in Harrow, thanks to NHS capital money, will shortly become even better than its American namesake. I pay tribute to the hon. Member for Carshalton and Wallington (Bobby Dean) for the way in which he introduced the debate. I agree very much that levels of capital investment into the NHS do not get the attention that they deserve in this place. He is certainly right about the impact on NHS capital spending of the austerity over the previous 14 years of Conservative health administrations. He rightly referenced the shameful spectacle of Conversative Health Secretary after Conservative Health Secretary handing back capital moneys to the Treasury at the end of March. My hon. Friend the Minister will be pleased to know that I have a solution to that problem if she faces it this year.
The White House, which is located at Harrow college, close to Harrow-on-the-Hill station, is set to become one of Harrow’s neighbourhood care centres thanks to NHS capital. NHS capital is allowing the local NHS to convert the White House, which is part of the college at the moment, into a new, expanded GP surgery and care centre. It will offer two opportunities for students enrolled at the college to begin a career in health and social care. Crucially, it will create a hub for care services that can keep people out of hospital and, in particular, out of accident and emergency queues.
The White House is set to be one of a number of new neighbourhood care centres, including Belmont health centre, Alexandra Avenue health and social care in Rayner’s Lane in my constituency and the Pinn medical centre in Pinner. This planned expansion of primary care over the next two years, using NHS capital moneys, builds on a recent significant increase in the number of GP surgery appointments. The nightmare of having to get an appointment to see a GP once lines open at 8 am is beginning to ease, but much more progress still needs to be made. GP appointments in Harrow have increased substantially since July 2024. Just under 120,000 appointments took place that month, but by October last year the total number of appointments each month had risen to more than 145,000—a 22% increase. For face-to-face appointments in particular, there had been a 30% increase.
I expect speeches to be around five minutes so that we can get everyone in. Please be respectful to colleagues.
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I have explained a little about the past state of NHS capital spending and will now turn to where the Government are today. Part of the reason for this debate is to find out where the Government think they are. It is worth saying that the Government’s stated intention has been a step in the right direction. There has been more certainty, more money and more flexibility. After the initial one-year capital settlement for 2025-26, with assurances that things would continue, the spending review confirmed capital budgets through to 2029-30. Those decisions will provide some stability, though it is still uncertain whether the Treasury clawback system remains in place on an annual basis or over the spending review period.
There was a substantial uplift of money in the year 1 allocations, but that is followed by a relatively flat commitment going forward, albeit at a higher level due to the initial uplift. I do not think we should be churlish about that—an increase in investment is inarguably good—but equally, we should not kid ourselves that investment is now at the required level. It does not fully address the inadequacy of past investment, nor does it bring it in line with international comparators. The King’s Fund has described the failure to reverse the historical underfunding by the previous Conservative Government as “extremely disappointing”. The NHS Confederation is asking for the commitment over the spending period to be doubled in real terms, from £3.1 billion to £6.4 billion.
There has also been greater flexibility, with Treasury approval now only required for capital projects in excess of £300 million, up from the previous, pitiful £50 million. The new delegated authority will cut out layers of bureaucracy and speed up delivery on the ground for ward refurbishments and equipment purchases. It will not address issues inherited in the largest NHS capital schemes, however, which brings me on to the new hospitals programme.
The programme was imagined by former Prime Minister Boris Johnson—I say “imagined”, because for some time the only place it existed was in his imagination. Conservative leaflets in my patch were emblazoned with a promise that the money had been secured for a new hospital building that would be delivered by 2024. I am sure that experience holds true for many in this room. When 2024 came, hardly a brick had been laid across the country. When the new Government came in, they told us no money had ever been allocated for those schemes.
The programme was reset by this Government, with an updated timetable and revised waves of projects. My local hospital’s building was put into the second wave, meaning that work will not begin until the 2030s, which was a bitter disappointment. Since the announcement of delay, things have gone a little quiet overall. A year or so on from the announcement, people are wondering how the programme is getting on. There are rumours that are some in the first wave are not keeping pace and could already be underspending allocations. Mostly, that is put down to the adaptation period of the hospital 2.0 model, an attempt to homogenise design across the country that is broadly welcome.
Any delays will spark questions about what will happen to that allocated spend. Hospitals such as mine will want to be at the front of the queue for any reallocation, if such an opportunity should arise. I have already mentioned my local hospital, but there is no clearer case of capital neglect than St Helier hospital in my constituency. It is as old as the NHS itself, overcrowded and cramped, and the specialist emergency care functions are simply not up to modern-day clinical standards.
Let me be clear: staff at St Helier are working heroically and patients are safe, but they are in a building that is not designed for 21st-century emergency care, with patients routinely treated in corridors. Key recommendations for improving service delivery simply cannot be implemented because there is physically not enough space. Despite tens of millions having been spent on basic repairs in recent years, the building is deteriorating faster than the trust can fix it.
The new hospital programme promised to resolve many of those issues with a new building for emergency and maternity care but, with that delay well into the 2030s, my constituents are left facing another decade of care in a building that is visibly past its lifespan.
The trust has come up with a plan. It believes that it can redesign the existing estate, creating a new urgent treatment centre and expanding the same-day emergency care service. By doing so, it would dramatically increase the number of patients it can see. The urgent treatment centre would be able to handle up to 30% of patients—up from 14%—and SDEC could get to 20%, up from 8%. That would prevent unnecessary overnight stays, free up hospital beds, speed up ambulance transfers, and reduce delays for patients needing hospital admission. The plan would also address £15 million of the trust’s ageing estates backlog. It is immediately deliverable; the trust believes that work can begin as early as autumn 2026. It would make an incredible difference, so I ask the Minister to make use of any influence she has over the matter to help the proposal get over the line.
Before I conclude, let me raise one further point about NHS capital expenditure that I suspect will not make me popular, but that I believe is right. The Government have tentatively re-entered the world of public-private partnership models with their announcement of neighbourhood health centres late last year. We all know how disastrous that model of financing was in the past, with the long-term costs to the taxpayer far outweighing the short-term benefits. Britain was among the first in the world to pilot such a scheme, and it failed fast.
It must be said, however, that other nations have learnt the lessons of our failures and successfully delivered social infrastructure at scale, on budget and on time. Indeed, I believe that is one of the reasons why we have fallen behind so badly. As a member of the Treasury Committee, I recently guested on a Public Accounts Committee inquiry into PPP, which concluded that if we get procurement, contract management, and the risk allocation of projects right, then we can massively accelerate the delivery of infrastructure in our country in a way that delivers real value for money for the taxpayer.
I welcome the difference that NHS capital allocated to Harrow will make for primary care in the coming years. The funding for GP Direct, a surgery currently based in west Harrow, to expand and offer more and better primary care services, and for a neighbourhood healthcare centre located at the Alexandra Avenue clinic, is set to make even more of a qualitative difference to primary care services in my constituency.
However, I hope to make the case to the Minister for the allocation of further NHS capital investment at Northwick Park hospital. Waiting lists are beginning to come down at Northwick Park, but, again, there is much more to do. To help maintain that progress, Northwick Park needs a new 36-bed critical care unit, with space for further expansion. A series of NHS and independent assessments of critical care across north-west London have identified a shortage of critical care beds, particularly on the Northwick Park site. The existing intensive care unit there has a series of problems that compromise the current delivery of critical care. It is not co-located with other key NHS services on site, such as the emergency department or operating theatres. It is outdated, noisy, cramped and unfit for purpose for patients and families facing critical illness—or, worse, potential end of life.
The trust has put together a proposal for a new UK-leading exemplar intensive care unit that provides additional critical care beds and a new CT scanner, which would embed modern standards of patient experience and family support. The proposal is for a 36-bed unit and allows for a potential future expansion for a further 24 critical care beds. The new unit that is immediately proposed allows for 30 of the 36 beds to replace existing critical care beds that are located in other parts of Northwick Park hospital, which will free up extra bed space and, in turn, help to alleviate pressures on other parts of the hospital, notably in accident and emergency. It will also play a useful role in helping to prevent the cancellation of elective operations.
The recommended bed occupancy for critical care beds is set at 85%, according to the National Institute for Health and Care Excellence. Northwick Park has been consistently above that level for some time. The hospital has one of the busiest A&E departments in the country, receiving an average of 90 ambulances a day, rising to 140 on its busiest days. Critical care admissions are also up by more than 16% since 2018-19, and more than 80% of admissions to the trust are at Northwick Park hospital. It is worth reflecting on the experience of covid. Northwick Park was the first hospital during the covid pandemic to declare a critical incident, as the number of intensive care beds simply ran out.
An expansion in critical care beds at Northwick Park needs funding. It needs funding to improve services now, but also to better prepare north-west London for future health emergencies. The bid for funding is strongly supported by the trust board and, I understand, by the local integrated care board as well. I hope that the Minister, her Health colleagues and the Treasury will support it, and that the Minister will commit to doing all she can to give it a strong push.
Work on cancer care services is also taking place in the London North West University NHS trust. Northwick Park already sees more than 50,000 people with suspected cancer each year, and diagnoses more than 3,000 cases. However, too many cancer cases have to be dealt with outside of our area, and the quality of the experience for those being treated for cancer could be significantly improved with further investment. I hope that the Minister will duly make sure that Northwick Park is flagged up early for further investment as part of the national cancer plan.