NHS Capital Spending

James Naish Excerpts

Wednesday 4th March 2026 Westminster Hall

[Bobby Dean]

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.

[James Naish (Rushcliffe) (Lab)]

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?

[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.

[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.

[James Naish]

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?

[Bobby Dean]

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.

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.

--- Later in debate ---

[Luke Taylor (Sutton and Cheam) (LD)]

Thank you, Mr Western. An MP Josh Taylor—that would be a beast, would it not? It is a pleasure to serve under your chairship. I thank my constituency neighbour and hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for introducing this incredibly important debate. He and I have written op-ed articles for our shared local newspaper in recent weeks, describing our constituents’ despair at the state of emergency care and facilities at St Helier hospital.

When I posted my article on Facebook for local residents to read, somebody commented on my post to say that they were fed up of the endless discussions on the topic, and they rightly pointed out that St Helier has been a totemic issue in Sutton for decades. They angrily demanded action, not words, from us all to get something done about it. The truth is, I could not remotely fault my constituent for their outrage at the imbalance of words and action that they, and everybody in Sutton, have had to live with for far too long. This is what happens when Governments fail to act; people lose faith that the system and their politicians can deliver results. When people hear grand words but see no action, it is no wonder that politicians are the least trusted profession in the UK.

Before I was elected I was an engineer, which is one of the most trusted professions. Then, with the support of more than 16,000 of my constituents, I instantly became a member of one of the least trusted—it is a funny old world, is it not? When the policy area at hand is something so visceral as whether people and their families can go to their local hospital safe in the knowledge that it is equipped to care for them properly, that loss of faith is absolutely corrosive to all faith in politics.

[James Naish]

The Minister will know the health centre I am about to mention. It is in East Leake in my constituency of Rushcliffe, and it has been talked about for over 20 years. It has clinical rooms that are out of action because there has not been the appropriate investment. The hon. Member for Sutton and Cheam (Luke Taylor) represents a relatively affluent part of the country, but does he agree that there is something called building deprivation? The reality is that health centres are not in a good enough condition for our constituents and, irrespective of the relative affluence of an area, we still need to invest in our infrastructure.

[Luke Taylor]

I could not agree more with the hon. Member’s point. When the condition of an asset does not attract staff, particularly in more deprived areas, the challenges will be greater. Those compounding challenges are borne out visibly through the physical asset, and everything becomes much more difficult.

I should not have to be here making points about political faith and delivery—or the economic arguments that have been made by other Members—but I will make the important humane case, based on the experiences of my constituents. I recently did a health survey where residents wrote in and told me their stories. One of them was a woman whose husband spent 54 hours in A&E with sepsis, lying on a trolley in a room so small it could have been a broom cupboard. Another, who is in her late 80s, sat waiting on a chair for 10 hours after a suspected heart attack, while another woman, who was unable to sit on a chair because of her pain, had to lie on the floor crying and wait for several hours.

Almost half of those who responded to the survey said that they had waited for more than four hours in A&E at St Helier hospital. We have the NHS numbers, too: across the Epsom and St Helier trust, 18,600 people waited for more than 12 hours in 2025. That is sickening; it is an example of a system that is not working. “Sickening” is the right word: like thousands of people across Sutton, I am sick to the back teeth with the endless delays that have got us here.

There is another important angle. In almost every one of the stories I was told, there was nothing but deep appreciation for the dedicated staff on the estate, many of whom the respondents credit with saving their lives in spite of—not because of—the conditions that they find themselves in. How can we keep recruiting into the NHS or uphold its public image if these are the conditions that we are expecting staff to work in? This is normally the part of the speech where I talk about the Government’s awful inheritance from the Conservatives, but I do not feel like making that point any more, because the people of Sutton have had enough context-setting and this Government is almost two years old now.

I thank the Minister for her discussions of this topic with me and other colleagues. I feel that we are engaging openly and positively, and I want to make that very clear for the record, but I ask the Government to listen to the pleas of our constituents, and to please provide the money to expand our emergency department. At risk of returning to my point about trust, if we do not fix this, we risk a catastrophe in Sutton that might undermine the faith of my residents and the broader public in the entire model of the NHS.

My speech has been about expanding, refurbishing and fixing St Helier hospital, but there is the separate issue of the real and urgent need for the specialist emergency care hospital that our NHS and residents were promised by the previous Government. We need that too, and we need it quickly. The expansion of our A&E would complement the provision in Sutton, and it needs to be brought forward.