NHS Capital Spending

Alex Brewer Excerpts

Wednesday 4th March 2026 Westminster Hall

[Bobby Dean]

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failures: operating theatres closed due to ventilation problems, leaks near electrical systems, sewerage failures and outdated wards where modern clinical standards simply cannot be delivered.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.

[Alex Brewer (North East Hampshire) (LD)]

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?

[Bobby Dean]

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 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.