My Lords, the amendments in this group, so ably introduced by the noble Lord, Lord Crisp, aim to restrict the powers of the Secretary of State to limit the capital spending of NHS foundation trusts and to ask for the reinstatement of the 2019 agreement. It is important to note that these amendments do not remove the powers as a whole but tighten them to avoid changes by the Secretary of State to funding that would delay capital works which are needed and urgent on health and safety grounds.
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The current capital spending backlog is £9.2 billion, half of which is deemed to be high or significant risk, which is why it is shocking that, in October last year, the Government announced additional service funding for the NHS but did not include a capital settlement. Last summer, the NHS Confederation surveyed members, and found that 96% of healthcare leaders feared that
they would not receive enough capital money at the forthcoming spending review. The NHS Confederation rightly says that capital investment drives productivity improvements and that insufficient funding is likely to hamper the Government’s plans for the NHS. When NHS England, the Department for Health and Social Care, or Ministers have the ability to backtrack, delay or even cancel capital expenditure, conditions deteriorate, and sometimes there are serious incidents.
My town of Watford, in south-west Hertfordshire, has seen the impact of this capricious behaviour all too well. Twenty years ago, a reconfiguration plan was launched at West Herts Hospitals NHS Trust for a much-needed new hospital, which would replace three older hospitals in Watford, St Albans and Hemel Hempstead with a completely new one, which it was eventually agreed would be in Watford. Given the debate that we have just had on configuration, it is interesting that the councils, CCGs and other stakeholders worked closely and cross-party with the trust, with a new vision for hospital provision in our region. About 15 years ago, capital expenditure approval was given, and preparatory work on site clearing and new road access was all done by 2015, mostly funded by local councils. Since then, the department, Ministers and NHSE have stop-started capital funding for the next stages, with good news always coming in the run-up to a general election—ironic, really, given that in our community there is total cross-party support for the new hospital. The anger about further delays is cross-party too, definitely blaming the centre, whether that is Ministers or the NHS.
Under the 2010 configuration, the NHS capital expenditure plan lists said that the new hospital should have been completed this year. It has been taken off the list and put back on again three times in the last two years. Indeed, it is one of the 40 so-called new hospitals that this Government have announced as a new proposal on a regular basis, much to the bemusement, and sometimes amusement, of local residents.
In April 2020, the hospital had to declare a critical incident, as its oxygen infrastructure collapsed in the first wave of the pandemic. Because of the delays, the hospital had been begging for an oxygen system upgrade for years, warning that any bad winter would cause the oxygen system to fail. It was denied, because the new hospital was just around the corner. As a result of that, an emergency oxygen upgrade was put in place, but the new hospital is now 20 years overdue, and the building is creaking. The Department of Health now says that likely completion of the new hospital will be in 2028, assuming no further delays. What else will fail before then? This is not a foundation trust; it is a hospital trust, and it is still not protected from that behaviour.
These amendments would ensure that the stop-start model—removing permission and then reinstating permission—that many trusts such as Watford General Hospital face over years would be less capricious. It would give foundation trusts more assurance to long-term planning, avoid the high level of emergency repairs and need for temporary provision, and, above all, be a more transparent and fairer way to deliver
capital expenditure. Without the 2019 agreement, we risk putting foundation trusts back in the parlous stop-start model.