News / Report exposes poor level of capital funding in NHS

The report from the King’s Fund said that capital investment in the NHS amounted to just 0.33% percent of the UK’s GDP in 2019 compared with the average of 0.48%. This was below countries such as Austria (0.67), the United States (0.65), Sweden and Denmark (0.6), and Australia (0.56). The UK’s capital spend rose to 0.43% in 2020, the first year of Covid, but this reflected both an increase in Covid related expenditure and a reduction in GDP. The King’s Fund said that while the differences sound small, ‘they reflect substantial underinvestment’.

The report – How does the NHS compare to the healthcare systems of other countries? – said that the UK’s healthcare capital investment had been ‘consistently below the average of comparable countries for nearly 20 years’. It highlighted estimates that an extra £2.5bn of spending would have been needed to bring capital spending in England up to the average of comparable countries in 2019.

The low level of capital funding has contributed to rising maintenance problems with NHS buildings and reduced investment in equipment. The report said the UK has fewer CT and MRI scanners – 16.1 per million head of population in 2019 – than any of the 19 countries examined. The US has five times as many scanners per person and Germany has four times as many. While there is no ‘right level of diagnostic equipment, too few scanners can lead to longer waiting times, and there have been recent moves to improve diagnostic infrastructure in the NHS.

The NHS also has fewer hospital beds – 2.5 per 1000 – compared with the average 3.2 per 1,000 across all the countries examined. Combined with a high occupancy rate of 88%, this points to a shortage of beds across the NHS in England – although the number of beds that can be operated is closely associated with the number of available clinical staff, another area where the NHS suffers by comparison.

The report found that the UK has very low levels of clinical staff, including doctors and nurses, but roughly average overall spending on healthcare after large increases were made during the Covid-19 pandemic. Spending per person was below average, while spending as a percentage of GDP has been above average since the Covid-19 pandemic.

‘The pressures of the Covid-19 pandemic on our health service compounded the consequences of more than a decade of squeezed investment in staff, equipment and wider services,’ said Siva Anandaciva (pictured), King’s Fund chief analyst. ‘Working to improve our existing health system while providing it with the adequate resources, political support and long-term planning it desperately needs would give the NHS the best chance of delivering the timely, high-quality care and outcomes it is capable of.’

Miriam Deakin, the director of policy and strategy at NHS Providers, shared the concerns raised in the report: ‘Every bit of the NHS is under strain, including hospital, ambulance, mental health and community services, with record demand for urgent and emergency care.’ She said the report’s findings ‘back our call for more investment to improve NHS performance, capital funding to upgrade buildings and the publication of the government’s long-awaited NHS workforce plan to boost staff numbers’.

Layla McCay, director of policy at the NHS Confederation, also backed calls for more funding: ‘We need to see sustained capital investment and this report reinforces just how far behind the NHS has fallen.’