Exclusive: NHS pleas for covid upgrade funds went unmet ahead of second wave

HSJ examined bids worth £567m made by local NHS trusts for capital to regional and national chiefs, who must then seek permission from the Department of Health and Social Care and the Treasury.

Of that total, about £335m of bids had been rejected or gone unanswered — covering a wide range of improvements such as extra beds, modular surgical theatres, and critical care equipment.

HSJ understands it is likely that while in some cases trusts will have gone without the facilities they needed altogether, in other cases they went ahead and bought it despite not having approval. In the latter cases, trusts may now be left with their own financial headache if government and national NHS officials decide they will not pay for it retrospectively.

HSJ’s analysis is based on information provided by 138 English trusts. Eighty trusts in England did not respond to HSJ’s freedom of information request — meaning a conservative estimate would put the national figure of rebuffed bids at around half a billion pounds.

The bids cover the period from March to November. But HSJ’s analysis found that most of the bids which were still unapproved last month were submitted in early summer, after the first wave, and were aimed at preparing for major covid outbreaks during autumn and winter. It means dozens of trusts approached the second wave and winter without formal approval to spend the cash they had asked for.

Trusts were told in guidance published in May the “turnaround time following receipt in the national covid-19 capital team from regional team will be seven calendar days”. But despite the Chancellor’s assurance in the spring that the NHS would get “whatever it needs”, and with many firms having won huge contracts for covid services like testing, consultancy, and protective equipment, HSJ was told the Treasury has been assessing trusts’ bids “line by line”.

NHS England said that as of 4 December it had approved bids worth £509m and it was continuing “to work with the Department of Health and Social Care to consider the outstanding applications”.

However, one finance director told HSJ: “It’s all a bit of a national joke [and] disaster, to be honest. I don’t know any director of finance who says all of my requests have arrived now…

“For our trust, [our bids] meet the criteria of kit and estates works we needed to do to be covid ready. I don’t think it was a big-wish list of fanciful items, it was stuff that locally we determined we absolutely needed to be put in place.”

The director said they were not aware of anybody having a significantly better ratio than 20:80 for “approved” to “not approved”.

HSJ’s analysis suggests around 60 per cent of bids which required approval had gone unanswered at the point the information was provided to us (between September and November).

To calculate this, we removed bids which were not expected to require prior approval (during the peak), and removed £3.4m of bids for ventilators (thought to have been rejected after the government said it would procure ventilators centrally). 

HSJ has been told by senior NHS finance staff that the delays in approval mean equipment worth huge sums may have been bought by trusts “at risk”, ahead of approval. If it is later rejected, this could place local and regional capital budgets under strain, as it would have to be funded from other pots.

One finance director told us: “The guidance and processes were confusing and changed too often. In the heat of wave 1, it was very hard to keep track of the rules. Less than £250k, more than £250k, prospective, retrospective, stop orders, don’t stop orders, ask for loan stock, directly, through the critical care network… Capital processes have definitely been the shakiest and from our point of view, the riskiest.”

HSJ highlighted delays to capital funding in June, after senior managers across the country said they hadn’t received cash despite government pledges.

At the time NHSE said that “all phase two and three bids are being considered, with decisions being announced shortly” while the Treasury stated they were “not aware of any (bids) currently awaiting HMT approval” and reiterated Rishi Sunak’s claim that “the NHS will get whatever it needs in support of the coronavirus response”.

An NHS England spokesman said: “Actually, since the start of the pandemic, £509m of capital bids from NHS organisations have been approved, including the vast majority of those urgent bids received during the peak of wave one. 

“We continue to work with the Department of Health and Social Care to consider the outstanding applications.”

A DHSC spokesman said: ”We are committed to reimbursing the NHS for unavoidable covid-19 capital costs as quickly as possible, while making sure the appropriate checks have been carried out.

“While in some instances we, and NHS England and Improvement, have returned claims where further confirmation is required to confirm they are related to covid-19, we remain clear that if any potential cashflow issues arise they will be immediately addressed.”