Contribution
Lord Darzi’s independent investigation clearly set out the impact that “capital starvation” has had on the NHS in recent years, and the importance of capital spending to fixing the health service. The report highlighted substantial shortfalls in capital investment, combined with a tendency to raid capital budgets to cover in-year spending deficits, so I welcome today’s Liberal Democrat motion, which allows Parliament to highlight how important these issues are to the public. This is the second Liberal Democrat Opposition day, and it is the second time we have debated health and social care. It is because it is a priority for the country that it is a priority for us.
The Health and Social Care Committee has taken a keen interest in the new hospital programme. We have challenged the Government to maintain their capital spending and not fall into the traps of the past, when capital spending was redirected to fund day-to-day spending, so I was pleased to receive confirmation from the Department, and now from the Dispatch Box, that the Chancellor’s changes to the fiscal rules will stop future raids on the capital budget, or CDEL, to fund the day-to-day spending budget, or RDEL. That is hugely welcome. However, although the protection of capital budgets is reassuring, I remain concerned about the lack of transparency around how the funding is allocated by the Treasury.
The charge levelled at the Government is that funding is being funnelled into acute care to tackle waiting lists, at the expense of funding primary care, infrastructure and care in the community. Clearly, on current commitments, we will not see capital funding that is sufficient to meet anything close to the unfunded promises made by the Tories in 2020. Nevertheless, the principle of investing in our hospital infrastructure is good; money will be saved in the long run on maintenance and emergency repairs, as well as providing a better quality of care.
In the policy paper on the plan for implementing the new hospital programme, the Government stated that funding will reach only £3 billion in the early 2030s due to
“other key priorities in health spending, such as funding to enable the Secretary of State’s 3 shifts”.
That is good, but we need transparency around how decisions were made and which projects were chosen. In January, the Secretary of State provided the criteria by which the schemes were scored and funding was allocated, such as site constraints and maturity of planning permission, but it is disappointing that, as I understand it—I am willing to be corrected—the review was conducted without the involvement of the trust teams responsible for delivering the rebuilding programmes. As of last month, no trust with a new hospital programme scheme has been provided with the full details of how it scored specifically against the criteria.
The Health and Social Care Committee has asked how the Department is prioritising schemes and has not received a clear answer, so my question is very simple: in the interests of transparency, will the Secretary of State publish, for every single new hospital programme scheme that was subject to last year’s review, the details and findings of the Department’s assessment of them against each of the criteria that were published alongside his statement in the House of Commons on 20 January 2025? It is the very least that the schemes that felt deprioritised deserve, and we are hearing many examples of those from Members of different parties. I choose to believe that this outcome is inadvertent but, frankly, it just looks a bit shady. We have seen it happen before with the levelling-up money under the previous Government. The Public Accounts Committee, on which I know many Members have served, as have I, has a motto: sunlight is the best disinfectant. If the Government will not publish the detailed assessment, the Minister needs to explain why.
My local area, like so many others, has been affected by this issue. Last year I visited the John Radcliffe hospital, which serves much of Oxfordshire, and I saw at first hand how its capacity to deliver care is being severely constrained by the size and condition of the physical estate. We went to visit the old site of the neonatal intensive care unit, which had to be moved because the staff were worried about the ceiling literally coming down on sick children and on incubators. It was atrocious.
The John Radcliffe hospital wants to be world-leading. It is a specialist tertiary care hospital, which means it is able to perform very specialist surgery, and it wants a new building to do that in. When it put to the Government a bid for £28 million, it was rejected. Instead, it has gone out to seek private financing, and it will now cost the trust £46 million to deliver the exact same building. Would it not have made sense for the Government to allow the trust to borrow from the Government to build it, and then to pay the money back from its own reserves over time? Think what it could have done with that £18 million.