Health Infrastructure Plan

Lord Lansley Excerpts

Monday 30th September 2019 Lords Chamber

[Lord Bethell]

My Lords, the noble Lord raises an important question about how infrastructure spending is approved and green lit. He is quite right that today’s announcement sees the final green light given to six hospitals and a further 21 projects—some of which are multisite projects—are on the runway but are not 100% green lit. That is because their plans are not yet ready, but there is a full intent by the Government to work with the trusts involved to develop those plans to final proposals and to have the money available to finance those plans in their current form. It has been publicly put out by NHS England that the rough current estimated cost of those projects is around £10 billion and that that money is put aside and allocated for those projects, as long as they meet the requirements of infrastructure scrutiny.

[Lord Lansley (Con)]

My Lords, I welcome what my noble friend said from the Dispatch Box in repeating the Statement. I say that as one who became Secretary of State in 2010. Although the noble Baroness, Lady Thornton, seemed to think that I had a large capital budget, it did not seem like it at the time. It was consistently underspent, because the spending of many of the trusts was determined by their resource. Capital and resource have to travel hand in hand. What is really important, as I hope my noble friend will confirm, is the commitment to future increases in resources for the NHS. The revenue alongside the capital is really important. It got to the point where, as we know, capital was raided to support revenue. Now we have a capital budget that will be supported by increases in the revenue budget.

If the noble Baroness, Lady Pinnock, had spent 10 years visiting hospitals as I did as shadow Secretary of State and then as Secretary of State, she would not ask, “How do you know which hospitals need rebuilding?” I stood in many of these hospitals, such as Epsom and St Helier, and looked at them. Why not Huddersfield Royal Infirmary? I went to Huddersfield and the truth is that it has never agreed what it wants to build, whether at Huddersfield or elsewhere. Some decisions have to be made before putting forward a capital project.

May I ask my noble friend a key question? We are abandoning PFI. The largest capital building programme that Labour talked about is a bit of an own goal, because it was all PFI and that is no good, but we must not throw the baby out with the bathwater. What was proven before the PFI project was extended and went wrong was that fixed-priced contracts deliver greater efficiency and that the NHS is not necessarily very good at building new hospitals. Can we make sure that we get some really good fixed-price contracts for these projects? They are funded through PDC and land sales, which is great, but can we make sure the NHS brings in additional expertise to make sure we have good designs and cost-effective delivery? In my experience, that was not available within the NHS. We do want not to go back to the days when every hospital invents for itself how to build a hospital. We want to go beyond that.

[Lord Bethell]

My noble friend makes powerful points. His point on income over capital is extremely well met. If it were the case that the income of the NHS had been driven down last year and we plonked a large amount of capital on top there would be a really big problem, but this capital announcement is on top of a record cash increase up to £33.9 billion a year by 2023-24 to the NHS budget. It feels, to the Government at least, that this is the right balance between income and capital.

However, the implementation of this infrastructure plan is definitely challenging and it is worth stepping back and thinking about how we will implement a massive step change in the capital infrastructure of our hospitals. The Government are aware of two areas where there is a need to focus resources. The first, as I referred to earlier, is on the actual design and planning of hospitals to ensure that they are to the highest standards and take into account the long-term needs of the community. Secondly, as my noble friend mentioned, NHS trusts will need greater capability in the management of contracts and the building of the hospitals. We will put aside money and expertise to ensure that those resources are in place.