NHS Capital Spending

Wednesday 4th March 2026 Westminster Hall

00:00

[Bobby Dean (Carshalton and Wallington) (LD)]

I beg to move,

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.

[Lisa Smart (Hazel Grove) (LD)]

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?

[Bobby Dean]

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.

[Caroline Voaden (South Devon) (LD)]

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?

[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.

[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.

[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.

[Mr Gregory Campbell (East Londonderry) (DUP)]

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.

[Bobby Dean]

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.

[Several hon. Members rose—]

[Matt Western (in the Chair)]

Order. I remind Members that they must bob if they wish to be called in the debate. I first call Gareth Thomas, who will be followed by Steve Darling.

09:51

[Gareth Thomas (Harrow West) (Lab/Co-op)]

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 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.

[Matt Western (in the Chair)]

I expect speeches to be around five minutes so that we can get everyone in. Please be respectful to colleagues.

10:00

[Steve Darling (Torbay) (LD)]

What a pleasure it is to serve under you as chairman, Mr Western. I congratulate my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) on securing this important debate. Sorting out Torbay hospital, the hospital that serves my constituency as well as the constituents of my hon. Friends the Members for South Devon (Caroline Voaden) and for Newton Abbot (Martin Wrigley), is my No. 1 priority as the Member of Parliament for Torbay.

I knew that the hospital was in a difficult place prior to my election, but as I began to immerse myself in the challenges facing it, I was shocked. I was shocked by what was effectively wanton vandalism—corporate vandalism, even—undertaken by the previous Conservative Government by making promises that they just could not keep. The vandalism—the fact that they chose not to invest—made it much harder to invest in the longer term and actually made it more costly. It is that old proverb: a stitch in time saves nine.

In Torbay we face some massive challenges. We have seen more than 700 sewage leaks at our hospital. These sewage leaks do not just happen in the corridors; they happen in clinical areas and affect wards where patients are. There have to be deep cleans, and there are delays for patients in getting on to lists and, most importantly, delays in supporting people who need medical interventions.

We heard from my colleague, my hon. Friend the Member for Carshalton and Wallington, that delays are occurring because of poor ventilation, and we have heard about the impacts—indeed, there have been very significant impacts in Torbay hospital. However, approaching the hospital, someone might think that the seventh cavalry was coming over the horizon—the tower block is wrapped in scaffolding, so it must be being sorted. However, the reality is that the £1 million scaffolding is there purely to stop bits of the building falling off and braining staff and members of the public as they go past. Having to spend so much of our NHS money just maintaining a crumbling building is not good. The Torbay and South Devon NHS foundation trust has some bids in with the Minister around the challenges in the tower block; I am sure she is considering those at the moment and I hope she will look upon them kindly.

I also want to reflect on what works well in Torbay hospital. I recently visited and saw some really exciting changes. There are millions of pounds-worth of investment in the emergency department, for example, which is really welcome. The daytime operations area, where people come in for a short period in the hospital, is calm and businesslike, which is what we want during hospital visits, but that is very different from other parts of the hospital, particularly for those people who suffer from cancer, for whom the offer is chaotic and situated all over the estate. Cancer sufferers deserve a better experience.

We have seen investment in the endoscopy unit, and 90% of patients are being seen within five weeks, which is a massive improvement. However, looking at the estate of Torbay hospital as a whole, 85% of it is not up to standard. The £350 million investment supports only half of the hospital.

We have also seen a toxic change to the spending power of this capital programme. We have seen Brexit, we have seen the pandemic, which has impacted on the spending power of capital programmes, and we have seen the war in Ukraine, which has seen building prices spiral. Some of the management in the hospital field say that, since the pandemic, the spending power of capital programmes has halved, so can the Minister tell us how the Government have taken account of the fact that money is going only half as far as it did historically?

In conclusion, Torbay is one of the most deprived communities in the country and the NHS often picks up the rough end of that. Only recently, a director told me she has patients who believe that living to their 60s is a good span of life. I am sure the Minister agrees that is not the aspiration we should have for our communities. In the south-west we have seen a lack of capital investment, whether in our railways or NHS infrastructure. I hope the Minister will tell us how the Government are planning to invest in the NHS in the south-west and, as my hon. Friend the Member for Carshalton and Wallington asked, what innovation there is to bring forward that investment. Sadly, Torbay has been kicked into the long grass until the mid-2030s. The staff are our most important asset, and they deserve that investment much sooner.

[Matt Western (in the Chair)]

The next speaker will have five minutes. Thereafter, I am afraid I will have to drop to four minutes.

10:05

[Gideon Amos (Taunton and Wellington) (LD)]

It is a pleasure to serve with you in the Chair, Mr Western. I congratulate my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) on securing such an important debate.

The No. 1 issue that I promised during my election campaign that I would focus on and prioritise, if elected, was care in the NHS, specifically Musgrove Park hospital and the dire state of the maternity unit. Of course, the Conservatives did not just promise to help; they promised 40 entirely new hospitals, including one in Taunton. As has been pointed out, there were not 40 of them, many of them were not hospitals and they certainly were not new. According to data from the House of Commons Library, as my hon. Friend the Member for Carshalton and Wallington pointed out, a staggering £4.3 billion of NHS capital spending was cut to cover revenue challenges under the last Conservative Government. It is hardly surprising that their enormous promise turned out to be entirely fictious.

What is the result? In the summer, we have medical staff fainting in the 30° heat in single-storey buildings that were built in world war two, and in the winter, we have holes in the walls and rows of buckets in corridors to catch the water. We even have roof guttering mounted inside the building in several locations to deal with the leaks. I trained as an architect and I was not expecting to see external roof guttering inside hospital rooms.

I genuinely welcome the Government’s increased capital spending for the NHS. Last year, as a result of cross-party campaigns and to the Government’s credit, Taunton and Somerset got a glass-half-full announcement about the hospital programme: it was included in the second wave of funding. Unfortunately that is not until 2033, which is later than is needed. We need action before that. I was delighted to hear the Secretary of State for Health and Social Care being challenged on the radio recently by the redoubtable Emma Britton, the voice of BBC Somerset. He said of the new maternity unit:

“If I can bring forward the timetables of these schemes because we can get not just the money, but the contractors and the suppliers and everything else that is required—the planning to do that—we will do our best to bring forward schemes."

I am working closely with the trust. They have sensible plans that could expedite those projects and get on with the vital planning work that we know needs to happen so far ahead of the project. That could be started next year. Can the Minister meet with me at some point to look realistically at the trust’s proposals to expedite the vital need for a maternity unit in Musgrove Park hospital in Taunton? A meeting was proposed earlier in the year, but got postponed.

I understand the pressure the Minister is under. I know she understands the challenges and has many hospitals to think about, and I genuinely appreciate the work that she is doing. But, given what the Secretary of State told Somerset over the airwaves only a few weeks ago, and given the dire need at Musgrove Park hospital, I urge the Government to make a start on that key project as soon as possible. We know that care and our NHS are the key levers to getting our public services back to where they need to be, to helping people back to work and to boosting our economy. We also know it is the right thing to do for mums and medical staff in Taunton and Wellington.

10:09

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Mr Western. I thank the hon. Member for Carshalton and Wallington (Bobby Dean) for setting the scene incredibly well. Of course, I want to give a Northern Ireland perspective, but I want to put forward two areas where possible savings could be made, and I wonder whether the Minister has had a chance to look at that, collectively or individually.

The hon. Member for Carshalton and Wallington, who set the scene, had 1,000 petition signatures for this debate—well done to him for garnering that interest. Our hospitals are so important and their services are lifesaving, so in terms of our finances they are priority No. 1. It is absolutely no secret that NHS capital spending has a direct impact on patient flow, waiting times and staff morale, and also on the quality of care.

Each year, my colleagues and I listen to the Budget and assess how our block grant can benefit the people of Northern Ireland through our healthcare system. It is clear that we must invest heavily in our facilities as well as our day-to-day spending. In her spring Budget yesterday, I think the Chancellor said that an extra £380 million was coming to Northern Ireland in the block grant. That should hopefully go some way to helping balance the books.

Around two years ago in my constituency of Strangford, our minor injuries unit closed following the opening of an urgent care unit in Ulster hospital. It was one of the most modern acute hospital sites following more than £235 million in capital investment, including in the new emergency facilities, patient accommodation and surgical and research infrastructure. Rather than planning a completely new hospital, the Department of Health has focused on transforming the Ulster into the regional acute hub. That is the right strategy, aligned with wider NHS reconfiguration plans for Northern Ireland.

Furthermore, there are plans for a new maternity hospital at the Royal Victoria hospital in Belfast. That is one of Northern Ireland’s largest capital projects, with more than £100 million already invested. Further investment is also planned for the surgical hubs, elective facilities and rapid diagnostic centres. I am pleased that hospitals in Northern Ireland have witnessed increased capital investment but, in comparison to St Helier hospital, as the hon. Member for Carshalton and Wallington described, it is clear that some hospitals are still struggling drastically, and he underlined that point incredibly well. More needs to be done to ensure that they are fit for purpose.

I have two points on savings, which I put to the Health Minister back home, Mike Nesbitt. A level of middle management has been created, which is not always necessary. I am not saying that people should lose their jobs; I am just looking at how it can be done in a good way to ensure value for money. The second point is about agency staff. Back home—and I understand it is the same over here—agency staff are sometimes employed rather than full-time nurses. That is never cost-effective, because it is better to pay a nurse a good wage than it is to employ agency staff. Those are two thoughts that might be helpful.

NHS capital spending is not a luxury; it is a necessity. It is the foundation of safe buildings, modern equipment, efficient services and dignified patient care. Without sustained investment, we will continue to see rising waiting lists, staff burnout and crumbling infrastructure. The Minister is always very responsive, and we are glad to have her in her place. The hon. Member for Carshalton and Wallington is asking for the Government to commit to sustained strategic capital investment that will secure the future of our NHS and deliver the standard of care that patients and staff both deserve. Those two ideas to save money are worth looking at as well.

[Matt Western (in the Chair)]

I call Josh Taylor—sorry, I got that wrong; I call Luke Taylor.

10:13

[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.

[Matt Western (in the Chair)]

I now call Josh Babarinde.

10:18

[Josh Babarinde (Eastbourne) (LD)]

Thank you, Mr Western. I was half expecting to hear “Luke Babarinde”, but we got there in the end. I thank my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for securing this critical debate.

I will focus my remarks on Eastbourne district general hospital, where I was born. It is at the core of life in Eastbourne. I want to pay tribute to the amazing staff at that hospital, who deliver for the people of Eastbourne and beyond day in, day out. However, over the years we have lost key services at Eastbourne district general hospital to hospitals such as the Conquest in Hastings, forcing Eastbourne residents to travel even further for the care they need. As well as that, our buildings are falling into a state of disrepair. Indeed, the trust has said:

“The age and standard of the current hospital buildings presents challenges for the consistent delivery of safe, effective, responsive and efficient care”.

The half a billion-pound maintenance backlog bill that the trust faces is a financial representation of that.

We were grateful to be included in the new hospital programme by the last Government—I am very sad not to see more representatives of that Government in attendance at this debate—but of course nothing happened under the Johnson Government. Eastbourne was therefore even more grateful to this Government for making a much more serious commitment to include it in the new hospital programme and to fund the DGH through the programme. It is of grave concern to us, however, that we are in the last wave of that programme, which means that investment will not land with us until 2037 at the earliest.

Meanwhile, many of our fears in Eastbourne have materialised. On 6 January, Eastbourne district general hospital suffered a power outage that hit many areas of the hospital. Nurses told me that they were forced to use their iPhone torches to light the way for the several hours that the power cut occurred. Because of that outage, operations were cancelled and our midwifery unit was closed for days. It stemmed from the insufficient power infrastructure that is in need of urgent investment—the very reason, in fact, why Eastbourne district general hospital was included in the new hospital programme full stop.

I have appealed to the Minister and the wider Government numerous times to accelerate that investment to Eastbourne and to bring forward our plans—after all, we were ready to go, but we were asked to pause. If the Government will not do that, however, will the Minister at least meet with the trust and me to discuss accelerating the release of the £42 million needed to replace the failing electricity substation that was responsible for the power cut, to ensure that Eastbourne residents get the consistent care and urgent investment that they need and deserve? I really do appeal to the Minister—if I need to, I will beg her—for that meeting so that we can figure out how to unlock that critical investment.

10:22

[Ian Roome (North Devon) (LD)]

I thank my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for introducing this important debate. I thank the Minister for visiting North Devon district hospital to see the estate for herself and for listening to the passionate pleas from NHS clinicians serving on the frontline.

The hospital is now the third of nine hospitals in wave 3 of the new hospital programme and faces a further 10-year wait for the capital funding it needs. That investment is desperately needed to replace an ancient intensive care unit and operating theatres that are nearly 50 years old. I thank the Government for approving phase 1, building new residences for staff and medical students, which will also recover land for the all-important clinical rebuild. On paper, however, phase 2 is unlikely to begin before 2035.

The cost of keeping these facilities running for another 10 years will be immense. Our hospital has a maintenance backlog of “high” and “critical” grade work of over £40 million, the most per square metre of any hospital in the south-west, higher even than many of the hospitals afflicted by reinforced autoclaved aerated concrete, or RAAC. Our NHS trust worries, as I expect many people in this Chamber worry, that that is simply throwing good money after bad.

In January, the National Audit Office released its update on the new hospital programme, which makes it clear that the current Labour Government have tried to financially rescue a programme that the last Conservative Government had doomed to disaster. However, many of my constituents feel that they have lost out yet again. It is not only that patients in northern Devon are being asked to wait another 10 years for new critical care facilities, but the ever-increasing maintenance costs of keeping their ageing hospital going will demand a bigger and bigger share of NHS funding from the area.

Worse still, the Department of Health and Social Care says that hospitals built to the new hospital 2.0 standard are expected to deliver operational savings. Whose hospitals will really benefit from that approach? When I queried it in a written question, the Minister said on 13 February that trusts and integrated care boards manage budgets, and that the centralised new hospital programme does not redistribute savings. If an NHS trust is lucky enough to receive the capital spending for new facilities sooner rather than later, patients in that community will benefit twice; if not, tough luck.

Furthermore, the estimated cost of the scheme in my area given in the new hospital programme review seems to bear no relation to the bid originally submitted by the trust. The Government will not answer questions on the multi-criteria decision support analysis tool that is being used to score the bids for capital funding under the new hospital programme, nor even answer freedom of information requests to state the name of the provider of the tool. Consequently, we as parliamentarians are unable to scrutinise that detail.

I have some questions for the Minister. First, will the Department explain these cost estimates, because £1.5 billion is a vastly inflated figure, which is far beyond the 50% adjustment stated in the review? That should not delay work on NHS hospitals such as mine in North Devon. The trust is ready to build the next phase now, so if there is any capital available, please bear North Devon in mind. In addition, what else can the Government do in the coming years to avoid entrenching real health inequalities in communities such as mine in North Devon?

10:26

[Clive Jones (Wokingham) (LD)]

It is a pleasure to serve under your chairship, Mr Western, and I thank my hon. Friend the Member for Carshalton and Wallington (Bobby Dean) for securing this extremely important debate.

Let us make no mistake: what we are talking about today is a national scandal. Many parts of our hospitals are falling to pieces. That is not just political rhetoric; it is a statement about genuine risk. Some of my constituents, for example, use Frimley Park hospital, which is primarily built out of RAAC, and it has already lasted for twice as long as it was supposed to. In January, the National Audit Office reported that the most urgent RAAC-related phase of the new hospital programme would be completed at least two years later than originally planned, and could take even longer, despite the pressing safety risks posed by buildings with RAAC. We need to do better.

My hon. Friend spoke eloquently about the challenges with capacity at his local hospital, St Helier. Such hospitals are suffering from many years of Conservative under-investment and neglect. The story is repeated across the country: crumbling buildings; leaky roofs; sewage leaks, in some cases; and equipment faults that delay diagnosis and care. That did not happen in just the last two years, so I hope the Opposition spokesperson, the hon. Member for Hinckley and Bosworth (Dr Evans), will show some contrition for the part that the Conservatives played in there being a lack of capital investment over many years, which allowed those conditions to develop. The promise of 40 new hospitals, which was made by the Conservatives but had nothing at all behind it, will not be forgotten for generations.

Labour is not addressing this crisis with the urgency that it demands. The response has been to delay the new hospital programme even further, which is a staggering miscalculation. It will cost the country billions to keep old—indeed, dying—hospitals on life support, including around £400 million for the Royal Berkshire hospital alone. I draw Members’ attention to my entry in the Register of Members’ Financial Interests, as a governor of that hospital, and a family member works there as well.

The Royal Berkshire staff are hard-working, compassionate people, as are the doctors, nurses and other clinical professionals working across the country. Our NHS staff are truly the best of us. Despite the best efforts of the hospital trust, the conditions they work in are very poor. The building—parts of it almost 200 years old—is quite literally sinking. Cancer patients receive chemotherapy in a children’s ward from 1910. Wards and offices are inadequately ventilated. Parts of the hospital are poorly accessible, and 50 operations were cancelled in 18 months, not due to staff unavailability or incompetence or for medical reasons, but because the building was simply inadequate on the day. Labour’s response has been to make that hospital struggle on for at least another seven years, on top of the Conservatives’ already lengthy delay, at huge cost to both the taxpayer and patient dignity.

It is not a problem confined to the Royal Berkshire hospital. Between 2019 and April 2025, there were at least 5,000 cancellation incidents caused by crumbling infrastructure at our hospitals. These incidents are only recorded when the care of at least five patients is affected, so that is a minimum of 26,000 people who have had vital care delayed or cancelled simply because the hospital was not in an acceptable condition. Once we consider the incidents affecting fewer than five patients, the actual number may well be much higher.

We must also not forget those hospitals that are not part of the new hospital building programme. Yesterday, my staff spoke to an NHS consultant working in accident and emergency at such a hospital, who has asked not to be named. The consultant described an incident this very week where family members had to be moved out of the resuscitation relatives’ room at the hospital because raw sewage was flowing through the room. Simply imagine that: your loved one critically unwell in resuscitation—your whole world turned upside down—and in that moment, you are hurried away from a stream of vile effluent. It is a national disgrace that this is the reality of our NHS today. That happened just this week. There is no new hospital coming for those patients, or for that consultant. The Government must today commit the money needed to maintain our entire hospital estate properly.

Care, of course, starts in the community, before a patient ever reaches a hospital, but we all hear from our constituents that our primary care system is also not coping due to under-investment. In my constituency, we have seen thousands of new homes built in the last 10 years, but no new GP practice to serve those thousands of new residents, and I know that many Members will recognise that problem in their constituencies as well. The investment in facilities is just not keeping up with the reality on the ground. That is why I am fighting for a new GP practice at Arborfield Green, although the sad reality is that the lack of capital investment in this infrastructure and the incredibly complex commissioning rules stand in the way. I hope the Minister will have something to say about investing in primary care as well as hospitals.

Let us not forget the outdated equipment currently in use in our NHS. Data uncovered by the Liberal Democrats has revealed that 80% of hospitals are using outdated X-ray, MRI or radiotherapy equipment. Imaging is critical for the diagnosis of so many medical conditions. NHS England itself says that CT, MRI and X-ray machines need to be replaced every 10 years to be reliable, but 38 out of the 48 trusts that responded to the request for information reported having X-ray machines over that age in active use. Some 21 of them were using MRI machines that were more than 10 years old. Shrewsbury and Telford hospital NHS trust reported an X-ray machine that was 30 years old—older than some Members of this House. It should be a national scandal that lifesaving diagnoses are being left to equipment that we cannot safely rely on. Patients are at risk and staff pushed to breaking point.

I would like to recognise the hard work of my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) on radiotherapy. Like him, I was disappointed to see that the national cancer plan was not more ambitious in its investment in radiotherapy. Anyone who talks to him about this issue will hear about how outdated radiotherapy units are being pushed well beyond their life across the country. We must do better than that for our cancer patients. The national cancer plan, which I called for in this Chamber some 16 months ago, was a welcome step by the Government, but on radio- therapy investment—as with the new hospital programme —Labour has not met the moment.

At this point, I pay tribute to the hon. Member for West Lancashire (Ashley Dalton), who was the Minister who made the national cancer plan happen. I am sorry that she has decided that she needs to stand down from her post. She did a really good job.

The Liberal Democrats would implement a 10-year capital investment programme that allows the NHS to plan for its future, not just its next budget cycle. That would include £10 billion to end the scandal of crumbling hospitals and GP practices, improving outcomes for patients and cutting daily costs for our national health service. We would establish a winter taskforce with a ringfenced £1.5 billion fund to deal with winter pressures, ending the cycle of raiding the capital budget just to cope with the latest predictable emergency. We have said on many occasions how that will be paid for. The question before the Minister today is not whether something needs to be done; we all know what needs to be done—investment on a huge scale—but the question is when. When will the Government deliver?

10:36

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I, too, associate myself with the comments about the hon. Member for West Lancashire (Ashley Dalton) on her stepping down as a Minister. She was a formidable opponent and will be sorely missed. I am sad to see her step back, but she has made the right decision for her, as in this place we should all do.

I thank the hon. Member for Carshalton and Wallington (Bobby Dean) for securing this debate. He was absolutely spot on when he said we do not scrutinise the process of NHS capital spending nearly enough. I was taken by what he said on that point, but less surprised that not many solutions came forward, although that is key to having this debate, because it is hugely technical.

I will use an example from my constituency for both the pros and the cons, the good and bad stories about capital investment. I was elected in 2019 and Hinckley is my biggest town. Healthcare is an important priority for my constituents and talk of improved hospital services there has been ongoing for 30 years now. On the good side, we were lucky enough to be picked to have a community diagnostic centre, a £24 million investment, and I was lucky enough to open it last year. That shows what good can come of capital investment. Under the previous Government, at August 2024, there were 165 similar good news stories of community diagnostic centres being opened across the country, not to mention the 108 surgical hubs that have not been talked about, but that are increasing patients’ ability to be seen and treated quickly, helping to deal with the waiting lists.

I also come with a negative story related to the same hospital. We were looking for a second project, a £10 million day case investment, but unfortunately, despite funding having been secured, delays in the system and difficulties with changing need have meant that that has been cancelled. The NHS papers specifically on that case state:

“The STP Capital business case for the Hinckley Day Case Unit received national approval in March 2024”—

but then struggled. The papers go on to say:

“However, since business case approval there have been further key changes… Changing financial context nationally and local financial challenges… Increased capital costs of the scheme circa £2m compared to that approved by the board… Programme delays resulting in a significantly reduced capital resource”.

They go on to explain that further delays to the programme occurred due to

“Cost pressures that exceeded the STP capital allocation…Since the approval of the STP Capital Business case in 2024, delays can be attributed to…The planning application phasing (considering the contention surrounding the demolition of the Hinckley District Hospital…The delay in submitting the planning application to allow the development of a robust design to address the Local Planning Authority’s concerns”.

We can already see the difficulties in how need is being allocated across Leicestershire and how planning and inflation interfere. That is the process issue at the heart of making these capital decisions.

That leads us to the bigger picture that confronts the Government today. As has been mentioned, funding is important, so what is the best document we can look at to see what the Government are trying to do? The 10-year plan is clear:

“We will continue to use private providers to improve access and reduce waiting times, to return the NHS to its constitutional standards. As we outlined in our Plan for Change, we will not let spare capacity go to waste on ideological grounds. We will continue to make use of private sector capacity to treat NHS patients where it is available, and we will enter discussions with private providers to expand NHS provision in the most disadvantaged areas.”

The Opposition agree with that, but I am not sure that all Government Members will, so I am interested to know whether all the Minister’s hon. Friends are aligned with it. I agree with the concern that the previous Government’s private finance initiatives, which brought in £13 billion of investment for new hospitals, cost the taxpayer more than £80 billion in repayments. We are still paying for that now.

Turning back to the NHS 10-year plan, a section called “Harnessing new investment” states that

“we will learn from previous experience with the Private Finance Initiative…In other cases, however, PFI was a costly mistake which represented poor value for money. Contracts were too complex and lacked proper transparency.

As the government considers new sources and models of private investment, we do so with this experience in mind.”

How do we know that? Where is it set out that the Government have learned this time? In the same section, the Government tell us they will “evolve” their

“infrastructure finance models and…consider the use of Public Private Partnerships…where there is a revenue stream, appropriate risk-transfer can be achieved, and value for money for taxpayers can be secured.”

Those are not small tests; they are the fundamental ones that we must ensure are in place, so my simple question is this: what is different this time? How will we assure value for money, and who will make that decision? How will we see genuine risk transfer being assessed, rather than simply pricing it into decades of payments? How will that work?

The 10-year plan also states:

“We will codevelop this with the National Infrastructure and Service Transformation Authority (NISTA), building on the successful NHS Local Improvement Finance Trust programme, and will look to drive competition in the market to incentivise others, including third party developers, to improve their offer to deliver better services at lower cost to the taxpayer.”

That is great—but LIFT is used only for small practices, so what model will come forward for everything else? The plan states:

“We will engage with the market on this programme and support NISTA in its wider market testing of a new PPP model.”

What is that model? Can we see it? What does it look like?

I note from the Minister’s answers to written questions that 120 neighbourhood health centres will be operated by 2030; 70 will be new buildings, 50 will come from refurbishment and, of those, 80% will be funded through PPPs. However, there are no plans to publish the business case. That raises legitimate questions. Why are the Government hiding this? We have been here before, and the country is nervous about this, so why can we not see what is being brought forward? If a new model is genuinely different, transparency should not be a threat; it should be a strength. Why will Parliament and the public not see it?

[Luke Taylor]

It would be remiss of me not to ask at this point, while the hon. Gentleman is speaking about transparency and funding for hospital projects, about the previous Government’s imagined 40 new hospitals. I invite him to give some transparency as to where the money to fund that hospital programme was supposed to come from and where it ultimately disappeared to. My residents are still suffering from the impact of his Government’s not providing that money. Can he expand on what happened to that money, which never arrived?

[Dr Evans]

I am grateful for the chance to put this on the record. The health infrastructure plan 2019 had the £3.7 billion, which was the seed funding to look into the projects to bring things forward. That also dealt with the first wave—the three hospitals that were brought forward to allow the second and third waves to come on. The hon. Gentleman will also know that, as the Government and the Opposition have stated, all big national infrastructure is done through a series of spending reviews. The money—£20 billion—was committed through those stages on the basis of that plan. The Government throw the same argument back at us when it is convenient for them to say, “We are not increasing defence spending because it needs to come in a spending review.” Both sides are playing politics, but there was money allocated in that plan. I appreciate that the hon. Gentleman was not in Parliament at that time, but he can ask the House of Commons Library to look at it so that he understands it, and he can then pass that on to his constituents to answer that question.

If we have a new model, we in this House need to be able to scrutinise it. GPs’ rents and rates are reimbursed, but there is concern that if we have further PPPs, similar to the previous PFIs, GPs may be on the hook for ongoing premises costs. We must have crystal clear guarantees, so they understand what they are and are not accountable for.

The 10-year plan states:

“We will also work with NISTA to consider the opportunities for health that could be achieved through private financing of revenue-raising assets (such as key worker accommodation and car parks)”.

That will set alarm bells ringing, as it looks like the Government will use key workers, or staff and patients coming into car parks, to generate funds. I would be grateful for clarity about what the Government actually mean by that statement, because this is a contentious issue. People know that we need to have funding coming into the health services, but where will those streams come from and what will they look like? If the 10-year plan is looking at revenue-raising assets, I am keen to understand exactly what that looks like.

Overall, there is a desire in the 10-year plan, which is shared across the House, to improve healthcare. Nobody disagrees with that, but the criticism of the 10-year plan is that there is no delivery chapter. I am grateful to the hon. Member for Carshalton and Wallington for securing this debate so that the Opposition can ask questions about what delivery will actually look like when it comes to improving the health of the nation.

10:47

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Western. I thank colleagues for their kind remarks about my hon. Friend the Member for West Lancashire (Ashley Dalton). We will miss her. She has set a great example, not only by continuing while undergoing cancer treatment but, as hon. Members have said, by recognising that sometimes we need to look after ourselves and prioritise our constituents. No doubt she will be doing that very well, and I look forward to her contributions from the Back Benches.

I congratulate the hon. Member for Carshalton and Wallington (Bobby Dean) on securing this important and timely debate. I hope that my name came up occasionally when he was perusing previous debates on this issue, because I am one of the few Members of Parliament over the past 10 years who has banged on quite a lot about capital. I am delighted to be the Minister, because the sound management of that capital is absolutely crucial to the provision of healthcare for all our constituents. I agree that it does not get enough airtime, and the hon. Gentleman made an excellent speech outlining most of the issues. We have heard a lot of contributions today, and I will try to do justice to this very wide-ranging debate.

Let me remind hon. Members of the problem. I have with me Lord Darzi’s report, which said:

“The NHS has been starved of capital and the capital budget was repeatedly raided to plug holes in day-to-day spending…Some £4.3 billion was raided from capital budgets between 2014-2015 and 2018-2019”.

It said:

“The result has been crumbling buildings”

and

“services were disrupted at 13 hospitals a day in 2022-2023. The backlog maintenance bill now stands at more than £11.6 billion”.

The report also said that the NHS was “in the foothills” of the digital transformation that the rest of the country—indeed, the rest of the world—was undergoing. There was also a shortfall in capital investment.

I kind of admire the hon. Member for Hinckley and Bosworth (Dr Evans) for defending that situation—it is a tough gig—but we all see what happened in our constituencies. I am very proud of the capital investment under the last Labour Government, and I will come back to PFI in a moment.

Reversing that trend and repairing and rebuilding our healthcare estate is a vital part of our ambition to create an NHS fit for the future. That is why we are prioritising the estate to support that task. First, we are prioritising core and safety technology equipment and—this is an important measure introduced by the Chancellor—changing the rules on capital to stop capital-revenue transfer. We are also incentivising the system and streamlining the processes; the hon. Member for Hinckley and Bosworth tells us how terrible the processes were, but his party was in government. We have taken control and used Government to good effect to start streamlining those processes. Part of that is about moving towards making one team of NHS England and the Department of Health—I hope hon. Members will support us in that. We are also building the capacity and capability of the staff in order to develop and do the work we need them to do. That capacity has been completely depleted over the last 14 years.

We have put a lot of information into the system to move things quickly, and I think we are all seeing the benefits of that in our constituencies. We will bring forward a capital plan in the spring to make all of that clearer for the system and for hon. Members.

[Helen Maguire (Epsom and Ewell) (LD)]

The Minister is making an important point about the vital need for capital funding in the NHS. I and a number of colleagues are here in the Chamber because St Helier hospital is falling apart, and unfortunately patients are being affected, but the hospital build programme has been delayed another three years. There has been lots of goodwill in the debate, but we are looking for additional investment in the A&E. I hope the Minister will take that away, and that there might be something about it in a statement soon.

[Karin Smyth]

The Chancellor has made her key decision to put us back on track, announcing in the Budget that capital health spending would increase by £15.2 billion by the end of the spending review period in 2029-30. That funding will be used as intended; in previous years, as we heard, capital funding was diverted to cover day-to-day costs. We have tightened the Treasury rules; we have changed them, because that is what Government can do—who knew! As a result, capital funding will now be fully focused on repairing, upgrading and expanding NHS buildings and facilities to support long-term productivity. This settlement represents record levels of capital investment into healthcare, and it will support the three shifts set out in the 10-year health plan: moving care out of hospitals into the community, replacing outdated systems with modern digital services and focusing on preventing illness rather than just treating it.

Of course, rebuilding NHS infrastructure cannot happen overnight. I assure hon. Members that the Government do understand that long-term certainty over capital funding is needed for the NHS to move from these short-term fixes to more strategic investment. That is another key decision made by the Chancellor. That is why, through the 2025 spending review, we have delivered a four-year capital health settlement, extending to 2029-30. That is backed by a further five years of certainty for estates maintenance funding. I am genuinely grateful to hon. Members for recognising that that is a massive change that we have engineered into the system, and I think we are all seeing the benefit.

That change means there is a £30 billion commitment in capital funding over five years to support the day-to-day maintenance and repair of the estate, with a further five years of funding certainty, as set out in the 10-year plan. For the first time, NHS trusts have also been given multi-year operational capital allocations, with clear funding set out until 2029-30, and indicative funding for a further five years. This is an unprecedented opportunity for local health systems to plan with confidence over a nine-year period, and I continue to encourage all Members to engage with their integrated care boards, which will be prioritising schemes over that period.

Within the £30 billion, the estates safety fund will continue, providing £6.75 billion of investment over the next nine years to target the most critical building repairs, alongside £2 billion to continue supporting NHS England’s RAAC programme across the spending review. Additionally, £21 billion in operational capital over the five-year spending review will empower NHS organisations to invest in local priorities, including hospital infrastructure. It will take time to build up capacity and capability, but this marks the beginning of our rebuilding of an NHS that is fit for the future.

I also assure Members that this Government recognise the pressures faced across the system and are committed to bringing performance standards back to what patients expect. That is why we are investing to expand hospital and emergency care capacity, helping to reduce waiting times and improve care for patients. Over the next four years, there is £1.9 billion for urgent emergency care to support A&E departments, as well as to support ambulance services in reducing handover times.

There is also £1.5 billion for diagnostics, including funding to expand the hours of community diagnostic centres, shifting care from hospital to the community. The hon. Member for Hinckley and Bosworth noted that those centres were started under the previous Government, but we have ensured they have expanded hours and that there are more of them. Crucially, they are not built as add-ons, but are fundamental to the pathways experienced by patients in the system and ensure we have good value for taxpayers’ money.

There is £473 million for mental health services, including for people with learning disabilities and autism. I think we would all agree that the mental health estate needs recognition. There is more than £280 million for community care, supporting services closer to home, and more than £139 million for electives across the next two years. To move away from paper-based systems towards modern digital services, the autumn Budget confirmed £300 million in capital investment in technology, building on the combined revenue and capital investment announced at the spending review of up to £10 billion by 2028-29.

We are transforming healthcare by shifting care out of hospitals and into the community. Over the next four years, we are investing more than £400 million to upgrade primary care buildings and deliver neighbourhood health centres, as part of our commitment to those 250 neighbourhood health centres through the rebuild programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

I will finish these points and answer some of the issues that have been raised.

The first 120 neighbourhood health centres will be operational by 2030 and will, as we have heard, be delivered through a mixture of public and private partnerships. I thank the hon. Member for Carshalton and Wallington for being one of the few to acknowledge that that is difficult—there is some controversy around it—but I am a strong supporter of the previous local improvement finance trust schemes and of the scheme at Southmead hospital in my local area, which was one of the better PFI schemes, and delivered unprecedented levels of care to the people of Bristol, including myself. It is important that we learn the lessons of the past, and we absolutely have, including those in the NAO report. Working with NISTA, as has been outlined, we will continue to pursue this issue and bring forward cases.

I do not want to rehearse the lack of funding for the new hospital programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

No, I will not, because I want to get through my final comments.

We put the new hospital programme on a sustainable footing. I understand that local people across the country were led up the garden path and told something was going to happen. I think we all recognise that the money was not there and that the programme was not on a sustainable footing. We have backed it with the appropriate investment, which is rising to £15 billion over each consecutive five-year wave from 2030, averaging £3 billion a year. The exact profiles of funding will be confirmed at future spending reviews, and that is weighted to ensure that the schemes profiled most are caught in that.

We are progressing wave 1, and I will continue to liaise with hon. Members on progress. My message every week to any NHS trust, to any Member of Parliament, to NHS England and to the team running the new hospital programme is that we need to deliver these hospitals. There is a large queue behind them, and we have heard about some of them today. I also understand that a number of colleagues do not have a hospital being progressed in the scheme. The Government are keen to get on with building these hospitals. As hon. Members have said, a lot of this is about trust and commitment. I want hon. Members and anyone paying attention to know that I am clear about the importance of getting on with this programme, delivering on the ground and ensuring that the programme is robust.

Finally, alongside increased capital funding, we are improving how that funding is managed. As we have heard, the old processes did not work: a local scheme went to the ICB, to the region, to NHS England, to the Department, to the Treasury and back again, with huge amounts of sign-off but no control or accountability, and with no one locally understanding what was happening. We are transforming that, bringing together a team and streamlining the process, ensuring it is well governed. That will ensure that things happen more quickly, and we are already seeing that. With underspends this year, we have got the money out and into schemes already in the system. We are getting more DEXA scanners. That is how we ensure this happens on the ground.

It is up to ICBs to prioritise proposals, and we are working more closely with them to support them to bring things forward. I urge all hon. Members who have spoken today, including my hon. Friend the Member for Harrow West (Gareth Thomas), the hon. Member for Torbay (Steve Darling), my hon. Friend the Member for Rushcliffe (James Naish), the hon. Members for Taunton and Wellington (Gideon Amos), for Sutton and Cheam (Luke Taylor), for Eastbourne (Josh Babarinde) and for North Devon (Ian Roome), to keep working with their local systems on particular schemes. I am happy to keep talking to people.

To the hon. Member for Taunton and Wellington, let me say that I have met NHS England about looking at maternity in the area, which I know is a huge concern, and I am happy to meet him. I will get back to the hon. Member for North Devon about some of the numbers he outlined, which are not familiar to me. On another point that was made, we are ensuring that we are building in contingency for the future, because we live in volatile times.

Motion lapsed (Standing Order No. 10(6)).