NHS capital no longer has a process problem. It has a delivery culture problem
The NHS has previously delivered major capital programmes at pace. PFI and ISTCs were not simpler than today’s programmes, nor less controversial. But they operated within a culture that prioritised delivery over optimisation. This article argues that NHS capital now suffers less from excessive formal process than from a deeply embedded assurance culture that slows decision-making, weakens momentum, and makes delivery harder.
We fixed much of the NHS capital process. So why is investment still so hard?
Many of the NHS capital system’s historic bureaucratic problems have actually been addressed. Delegated approval limits have increased, business cases have been simplified, and multi-year planning assumptions are more stable than they once were. Yet capital investment still feels extraordinarily difficult. This article argues that the remaining problem is now less about formal process and more about institutional mistrust, incentives, and a culture that prioritises assurance over delivery.
If I Were an NHS CFO: Preparing for the Return of PPP in Primary & Community Infrastructure
The NHS 10-Year Plan points towards the return of public–private partnerships for primary care, community diagnostics, and neighbourhood health hubs, with acute hospitals excluded. If you are an NHS CFO, the question is whether your organisation is ready to move quickly if a new route of private capital opens. This piece sets out the groundwork: build a complete estate view, align the clinical model with estate decisions, and take priority schemes to a project-ready position.
The Centre’s role in the 10 Year Health Plan
The 10-Year Plan gives Trusts real freedoms – but delivering capital transformation depends on how the centre responds. In this piece, we set out how DHSC and HMT can shift from approval gatekeepers to delivery enablers. We also argue for support for acquirers under the failure regime, and a rescue plan for the most challenged hospitals.
Uneasy lies the head that wears the crown: Capital Strategy After the 10-Year Health Plan
Government’s 10 Year Health Plan doesn’t solve the problems of the acute estate. But for Trust leadership teams willing to think boldly, the keys are there. It’s not a perfect answer, but it’s a better position than we have had for many years.
10 Year Health Plan Promises on Capital: A Turning Point?
Quick reflections on the 10 Year Plan’s impact on the NHS’s Capital Investment challenges.
What does the data say about NHS Capital Allocation?
A new joint report from CF and public sector transaction specialists Burrum River Advisory has highlighted critical issue with the way capital funding is currently allocated across NHS Trusts and how it may be doing more harm than good—undermining system reform, perpetuating inequality, and encouraging short-term fixes over long-term transformation. Amid rising demand, outdated infrastructure, and urgent calls for modernisation, the report offers the in-depth, data-led analysis of how capital allocation interacts with financial performance, estate condition, and system efficiency.
Health on the High Street
The NHS is the anchor institution for most of its communities. What can it do to make more of a positive difference for those communities?
Budget 2024: Capital projects - More checks than balances?
The 2024 Budget brings welcome capital investment to the NHS, but at what price to timely delivery?
Challenges and Solutions for the NHS Estate (CIPFA)
Thoughts and reflections from the CIPFA Roundtable on NHS estates challenges and solutions.
Why the NHS Capital Budget should be £16bn
NHS capital spending is going to enable the kind of transformation the service needs to get on top of its performance challenges. A compelling case can be made for boosting the NHS capital budget to around £16bn annually. Here, I present a variety of methods to estimate the need. None are perfect, but they all come to an uncannily similar number.
New hospitals should be part of our industrial strategy
Healthcare capital needn't just be about infrastructural repair. It can play a strategic role in future UK industrial strategy. The Cambridge Biomedical Campus contributes hugely to the local and national economy, showcasing the potential for the UK to replicate the economic impact from major US health systems. To reach world-class standards, we must invest capital. The good news is that these investments could become self-sustaining through innovations and industry partnerships.
What could a new PFI look like?
The Private Finance Initiative (PFI) was responsible for funding 694 projects across the UK. Initially loved by markets, hated by the left, and the doyenne of the centre, its gloss faded over time. Project failures and continuing bad publicity made it a problem for Government, while project disputes, especially in the NHS, made it unpopular with banks and investors.
And yet, calls to bring it back are increasing in volume. So how do we create a new PFI which is better than the original?