Roll up your sleeves…

Training Primary Care NHS GPs Roll up your sleeves...

It’s Monday, are you ready?

The best way to get ready for Monday, is to start on Friday… but it’s a bit late for that!

You could make a list of the stuff you are looking forward to this week; cheer yourself up.

You could make someone happy. Take them a cuppa builder’s, put it on their desk and say;

‘I didn’t get a chance to say this on Friday but thanks for what you did last week’.

Hot-tip; don’t try and do everything on a Monday just be sure to do the job you least want to do… get it out of the way.

Roll up your sleeves.

The rest of the week is clean-clear-to-flag-town.

I feel it is my duty to send a cheery word or whistle a happy tune on a Monday but this morning I’m going to follow my own advice; get the job I least want to do, out of the way.

I’ve been putting it off but I’ve been wanting to have a conversation about ‘the money thing’. Not the usual; ‘we ain’t got enuff’.

No, I want to speak about a particular aspect of ‘the money thing’. Capital.

Don’t confuse it with the so-called ‘extra’ funding that started in April and rises to £20.5bn in 2023/24. This money is for front-line NHS services… revenue.

Capital is super-important. It is lack of capital investment that is driving the estates department into insomnia.

Repairs and renewals; the NHS maintenance backlog has doubled from £1.5bn in 2014/15 to £3bn last year.

Capital can fix repairs and renewals, buys IT systems, scanning and imaging equipment.

Improving productivity can’t be done without a major investment in the management of patients and treatments by the use of technology.

The lack of imaging and scanning technology, creates queues, delays treatments, frustrates staff and who knows… puts lives at risk.

The Health Foundation tells us;

‘… if capital funding were to be increased in line with the OECD average… [it] would require an additional £3.5bn … for the NHS in England, on top of the current capital budget in 2018/19, rising to £4.1bn by 2023/24.

Alongside this, an end to the regular transfers from capital to revenue budgets… so that NHS trusts can invest and plan for the future.’

The current system of capital funding is complex, convoluted and to most of us… impenetrable and as transparent as a black-bin-liner.

Hence the confusion over this year’s capital. Trusts have asked for £1.8bn on top of last year’s priorities on the basis they agreed to improved control totals. It’s not happened, there’s not enough money.

Thats why; the request from NHSE, to think again.

DH control non-FT trust’s capital. FT’s are a law unto themselves and NHSI. There is no hint that anyone is interested in the fact that we are still a ‘national’ health service and some alignment of priorities is more than sensible.

Financially challenged Trusts have no chance of financing their capital requirements.

Trusts facing enforcement notices for knackered, dangerous plant or buildings, compete for the same global pot as a Trust that would like to build a shiny-new-whatever, gives no hint of planning in a bigger picture.

The clunky allocations model is another legacy of the Lansley Lunacy. Time for it to go.

Then, of course… you have to have some money to allocate. There ain’t


Time to use a dirty word… borrowing. Lord Prior, NHSE chair, back in June, called for a bond issue for a ‘capital starved’ NHS. He’s not wrong.

Borrowing is the cheapest it has been in my lifetime, around 2%.

The NHS can borrow cheaper outside the DH; commercially, pension schemes and sometimes local authorities (as in Newcastle), even hedge funds.

It might create an issue with the interest rate counting against the resource Departmental Expenditure Limit but if it’s cheaper… so what? Find a way. It’s in the taxpayers best interest.

Infrastructure spending is good for the economy, good for employment, good for staff to have new kit-n-caboodle and great for patients who will get treated quicker, safer and in places where the roof doesn’t leak and the sewage pipes don’t drip.

The whole capital allocations system is unfit for purpose.

This week’s to-do list

• Remember we are a National health service

• Create a national, or at least regional, policy on capital planning and prioritisation

• Organise and agree to use some cheap money

…. roll up your sleeves.

Contact Roy – please use this e-address – roy.lilley
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Reproduced at by kind permission of Roy Lilley.