• NHS Improvement estates boss says trusts’ capital bids need to be “smarter” to get through “nightmarish” approvals process
  • Some doomed bids allowed to hope for too long, says official
  • Huge backlog bill may get bigger, says Sir Robert Naylor

Local NHS organisations have been told they need to submit better business cases for capital schemes, to have a better chance of getting through a “nightmarish” approval process.

NHS Improvement estates boss Simon Corben and Department of Health and Social Care property advisor Sir Robert Naylor both addressed the difficulty of getting applications approved, speaking at a Westminster Health Forum event yesterday.

Mr Corben said “we need to be smarter and cuter in the way we make our case”, adding that there are “only 20 people assessing [capital scheme applications] nationally, we have to make it easier for them”.

He said NHS Improvement would help make the case for investments but sometimes the applications made basic oversights, like not taking account of VAT. 

Mr Corben also said that in some cases applications were “allowed to go far too far down the line when the system knows [they] won’t be granted”.

Capital funds have been heavily constrained in recent years, and regularly raided to prop up revenue budgets.

Sir Robert told delegates at the event that the system, and political approval, made it difficult to get schemes off the ground.

The former University College London Hospitals Foundation Trust chief executive said the NHS went through phases of localism and centralisation and “we are probably at the highest point of centralisation”.

He said: “To get capital schemes through now is a labyrinthine nightmare. When you address this… the blame comes back to you. They say your business case isn’t good enough, do it again. And by then there’s a change of government.”

The conference heard that a delayed review of backlog maintenance in the NHS was due to be released soon.

The most recent estimate of the cost of maintenance due is £5bn, but Sir Robert suggested the true figure may be higher, based on more recent collections.

Mr Corben said the NHS had a “huge amount of infrastructure that is well beyond its sell by date” and “hospitals out there that are simply not fit for purpose”.

“We need to make a step change and a credible case to make sure that we [deal with] that,” he said. “We have got to put an end to short-termism. We simply can’t move the dial in 10 years, we need to get into a rhythm.”

Sir Robert said Imperial College Healthcare Trust was responsible for between £1.3bn and £1.5bn of the total national backlog maintenance – and said “something big has to be done” at the trust.

Imperial’s estate at St Mary’s Hospital in Paddington is owned by a combination of the trust, its charity and Imperial College London.

Mr Corben gave an example of a hospital in the south of England that had to cancel 90 procedures one morning after a 45-year-old power cable stopped working, highlighting that backlog maintenance was increasingly causing clinical problems.