HSJ’s expert briefing on NHS finances, savings and efforts to get the health service back in the black. This week by correspondent Nick Carding.

Although Boris Johnson has mournfully seen his plans for a Halloween Brexit crumble, one early achievement has been to lay some solid foundations for vital new NHS buildings.

Since picking up the keys to 10 Downing Street in late July, Mr Johnson has made two announcements of major capital schemes for the NHS - the vast majority of which went to providers.

First up were the 20 hospital upgrades (worth £853m) in August, and last month the government’s Health Infrastructure Plan committed to delivering a further 40 schemes — six of which will alone cost £2.7bn.

Seen in tandem with the four waves of capital funding (worth £2.3bn) for schemes put forward by sustainability and transformation partnerships in 2017 and 2018, Mr Johnson’s arrival in Downing Street has completed a hat-trick of major NHS capital allocations worth around £5.8bn in total.

But not everyone is celebrating.

Missing out

Of that £5.8bn pot, Kent and Medway STP’s providers were allocated just £7.5m.

Salt was rubbed into those wounds by Mr Johnson himself in late September when he mistakenly said a new hospital would be built in Canterbury, only for the Department of Health and Social Care to clarify this was not the case.

It was a sloppy error for the PM to make, given the disagreements locally over the proposals to reconfigure acute services in East Kent - which are set to cost hundreds of millions of pounds. Of course, it is precisely this local uncertainty which will have been an important factor in the decision-makers prioritising other projects.

Whatever the reason for Kent and Medway’s omission from the allocations, the reconfiguration plans clearly face an uncertain future. However, James Lee, the STP’s estates lead, told HSJ the STP had secured just under £20m in funding from the capital waves in 2018 for its clinical commissioning groups which would be spent on developing local care hubs in four towns. 

Moving westwards, (and barring some small allocations for screening equipment and winter pressures) South East London STP received £10.5m, Coventry and Warwickshire STP was given £9.4m and Bristol, North Somerset and South Gloucestershire had to make do with £11.1m - all relating to providers only. 

Schemes put forward by these STPs included: work on the Evelina London Children’s Hospital; an expanded emergency department and new theatres at University Hospitals Coventry and Warwickshire Trust; and a new heat and power unit at University Hospitals Bristol Foundation Trust.

These four STPs appear to have been placed at the back of the queue — although BNSSG’s list of capital schemes was a lot smaller than the other three. 

A spokesman for South East London STP said it has a ”prioritised capital investment pipeline of 37 schemes”. 

“Many schemes are being funded through provider self-generated capital and the Estates Technology and Transformation Fund,” he added. 

The mental health sector can also feel hard done by, after being earmarked with just 8 per cent of the £5.8bn, when the sector employs around 14 per cent of the NHS workforce and consumes 11 per cent of the revenue budget.

Other major schemes that remain in limbo include the relocation of Liverpool Women’s Hospital to the new Royal Liverpool Hospital site (£100m); and building a new women and children’s hospital in Birmingham (£450m).

Election time

It will be interesting to see if these areas and projects feature in the election campaign, as the politial parties prepare for a race to the top on public spending.

Through Mr Johnson’s 20 “hospital upgrades” and the Health Infrastructure Plan, the Conservatives have already got the ball rolling.

There was room in both tranches for cash to be earmarked for University Hospitals of North Midlands Trust and University Hospitals of Morecambe Bay FT, which serve two of the five most marginal constituencies in the UK (Newcastle under Lyme and Barrow in Furness respectively).

Article updated at 5.36pm on November 4 to include comment from South East London STP. 

The HSJ Strategic Estates Forum, now in its third year, takes place in London on 12 March 2020. This is a high level strategic forum that brings together estates directors, sustainability and transformation partnership estates leads and trust board leaders responsible for the estates function who are developing strategic plans for their organisations and local health economies. The focus of the forum is on issues such as availability of and access to capital, tackling backlog maintenance, utilisation of the estate and role of technology in infrastructure development. The forum builds on the Naylor Report and highly anticipated 2019 Spending Review. Register your place at this free to attend event on our website: https://strategicestates.hsj.co.uk/register-your-interest-2020