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Exclusive: NHS England to take control of investment spending

NHS England is drawing up plans to centralise control of spending on estates and information technology in the health service, including proposals to sign off spending by bodies over which it has no formal power.

A document seen by HSJ says plans to establish a central “project appraisal unit” are at an advanced stage.

The unit’s job will be to evaluate business cases for spending on infrastructure and assets by NHS England, clinical commissioning groups, NHS Property Services Ltd, Community Health Partnerships, and even NHS providers.

The unit will be led by Peter Brazel, former head of strategic investment at NHS London.

According to the document, which was produced by NHS England to accompany a presentation, the unit will focus on “both capital and revenue” business case proposals for:

  • healthcare facilities and clinical equipment;
  • administrative facilities and non-clinical equipment;
  • both clinical and non-clinical information systems.

It effectively means that NHS England plans to oversee investments made by NHS Property Services. This is despite the fact that the company’s sole shareholder is the health secretary, and it is not formally accountable to NHS England.

NHS England is also proposing to review business cases for property transactions and disposals, and “significant provider trust investments [for] new capital infrastructure that has long term revenue resource implications”.

A spokeswoman for NHS England said examples of this included private finance initatives and service reconfigurations. The oversight applies both to NHS trusts and foundation trusts.

The move to assure NHS provider business cases is a further indication NHS England plans to oversee organisations which are not formally accountable to it. The document sets out lines of communication between the NHS Trust Development Authority and NHS England for business case approval.

The spokeswoman said NHS England wants to approve business cases which commit it to spending, or commissioning commitments.

NHS England has a total capital budget of £200m.

HSJ has also learned that NHS England’s funding allocation to the property company will be split into two ringfenced pots.

One, called “landlord capital”, is for the maintenance of the property company’s estates portfolio.

NHS Property Services says its assets are worth around £3.6bn – a lower figure than the £5bn set out by the Department of Health a year ago. It says the difference is due to the decision to transfer some former primary care trust assets to Community Health Partnerships. However it is unclear why the new figure has only just come to light, as the decision to split former PCT assets in that way was made in 2012.

The landlord capital fund, for maintaining the NHS Property Services estate, is worth £125m, but the company says this is not subject to the oversight of NHS England.

The other, called “customer capital”, will be to support commissioning decisions. For example, customer capital could fund the move of a service from a hospital setting into the community, or the setting up of a telehealth service to replace a building-based one.

NHS Property Services Ltd has refused to tell HSJ how much its customer capital fund is worth, although NHS England has confirmed it will oversee this budget.

HSJ understands the separation of capital funding in this way is intended to ensure NHS Property Services does not leave NHS England or CCGs unable to fund service change by over-spending on maintenance.

Readers' comments (15)

  • Roy Lilley

    I'm pleased this is not top-down

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  • Next step- Big Brother extends into the buy to let market. Maybe Nicholson could be re-hired as handyman- bet he looks lovely in a pair of overalls.

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  • A unified strategic approach to use of the estate does make logical sense. However, that ball was dropped with the decision to allow providers to choose to take on bits of the PCT estate, rather than everything going to NHS Property Services. As with many other aspects of the recent reforms, the ideological tensions (centralist vs local, state vs market, however you see it) will be left to play out through disputes between rival power bases, and - I guess - their lawyers. Another win for those guys...

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  • I'd be interested to understand what level of fact checking goes into these articles, as some of this information is completely inaccurate!

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  • So forget local decisions and freedoms, forget competition and choice, it's total command and control from the centre. Why do we need CCGs? and what's the point of becoming an FT? Who's going to innovate in this environment?

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  • Hello anon 12.53 - we check our stories extensively, and where possible upload source material (see the pdf attached on the right hand side). If there are any particular points you'd like to raise you can contact me directly: david.williams@emap.com

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  • As a CCG that has experienced total frustration from the inability to progress any of the estate developments "inherited" from the PCT, it is nice to see that NHSE has woken up to the problem. Sadly rather than support the CCGs with a sensible approach to local management it has created another monolithic dinosaur!

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  • Does not sound quite like Peter Brazel has described to us. I will believe what I see when NHSE guidance is issued to us.

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  • So the dead hand of central control extends into more of the NHS. What happened to "we want to free the NHS from central control"? "local decision-making"? "CCGs know their local area best"???? THis has Nicholson the Controller written all over it

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  • More coherent strategic investment brought to you by the same people as NPfIT. Can't wait to see the results!!!!

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  • NPfIT, LIFT, PFI, can't wait for the next success.

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  • Today gave a presentation on topics like patient safety and medical leadership to 20 consultants from all over the country gathered in Manchester. I was shocked at negative comments about NHS, how demoralised these wonderful consultants are, their comments about how NHS meant only for mediocre, no one cares for patient safety, no one listens in our Trust about patient safety, their comments about their Trust leaders, their Trust Board was simply shocking. Not even one had any good things to say about any of their Board Leaders! Can NHS really improve? Do we have true leaders in our NHS? Why such an intelligent, hard working group of senior NHS doctors are so demoralised? Is anyone in NHS Leadership academy, FMLM, College, BMA, DOH or even NHS Employers are listening to this tragic status of our NHS? I am really saddened after 30 years working in the NHS.

    All leaders must have a feedback from those who are affected by their leadership. It is only when our staff feel valued, involved, engaged then only they provide good quality care for their patients. I feel sorry for the NHS and for our patients. It is sad that not even one had any good things to say about NHS!

    NHS England must get NHS Leadership right and if not we will not change our NHS and there will be more and more Mid-Stafford!

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  • Umesh I gave a talk today to 20 managers, osme clinical some not.

    I was shocked at negative comments about NHS, how demoralised these wonderful staff were, their comments about how NHS meant only for mediocre, many of the clinicans appear not to care for patient safety, none listens in our Trust about patient safety, their comments about the Trust conultants and other clinical leaders was simply shocking. Not even one had any good things to say about any of the consultants! Can NHS really improve? Do we have true leaders in our NHS? Why such an intelligent, hard working group of senior managers are so demoralised? Is anyone in NHS Leadership academy, FMLM, College, BMA, DOH or even NHS Employers are listening to this tragic status of our NHS? I am really saddened after 25 years working in the NHS.

    The answer is to stop the blaming managers or doctors or policy makers or politicians and to do what we say about patients safety and care being paramount and for clinical and non- clinical leaders to work together to make this happen.


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  • Come on Roy "not top down" really, in the real world?

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  • "NHS England has a total capital budget of £200m".

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