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.
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