NHS Capital Spending

Helen Maguire Excerpts

Wednesday 4th March 2026 Westminster Hall

[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.