The NHS requires a long-term infrastructure investment plan (this piece is published in Prospect’s new policy supplement)by Anita Charlesworth / March 20, 2020 / Leave a comment
Play a word association game with the term “infrastructure” and it’s a fair bet that the NHS will not be the first thing that springs to mind. The remit of the National Infrastructure Commission, which advises the government, covers transport, energy, water and sewerage, flood defences, digital and communications and waste. Indeed, infrastructure investments in the March Budget included boosts for roads and flood defences.
The Budget was a clear signal of intent. Quite rightly, a package of support was announced to help the country cope with the coronavirus outbreak—now an all-consuming threat. While welcome investment in England’s hospitals was also reaffirmed, this fell short of what is needed. The NHS is as much a crucial part of Britain’s infrastructure as the rail and road network, and the health service’s own infrastructure is in a pretty sorry state.
Compared to other developed countries, the UK spends much less on healthcare capital, which includes spending on new buildings, equipment and IT, maintenance and research and development. Just 0.3 per cent of GDP goes on health infrastructure compared with an average of 0.5 per cent in similar industrial countries. The impact of this lower investment is felt daily in the physical capacity of our services. The UK has just 2.5 hospital beds per 1,000 of the population—13 per cent fewer than in 2010 and less than two-thirds the average of the EU14 group of countries that joined the EU before the 2004 expansion.
Beyond its buildings and beds, access to diagnostic equipment is also low by international standards. The UK has fewer MRI and CT scanners per head than comparable countries; and less than a quarter of the number in Germany.
Through the last decade of austerity, the NHS prioritised day-to-day spending pressures and capital investment budgets were raided. Pressures on government capital funding have been compounded by changing attitudes to private finance. Over recent decades major infrastructure projects in the NHS were largely funded by the Private Finance Initiative (PFI) rather than public sector capital investment. Use of PFI declined sharply after 2010 and in 2018 was formally discontinued. This had a significant impact. Between 1999 and 2010, PFI funded 101 completed projects providing around £1bn a year of extra infrastructure investment for the NHS.