Intended for healthcare professionals


Government’s “new deal” does not erase years of underinvestment in NHS buildings, say leaders

BMJ 2020; 370 doi: (Published 01 July 2020) Cite this as: BMJ 2020;370:m2646

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  1. Gareth Iacobucci
  1. The BMJ

The UK prime minister, Boris Johnson, has promised to accelerate £1.5bn (€1.66bn; $1.86bn) of funding for new buildings in the NHS as part of his “new deal” to help the country recover from covid-19.

He said that the money would accelerate hospital maintenance, eradicating mental health dormitories, enabling hospital building, and improving emergency department capacity.1

Healthcare leaders welcomed the announcement but warned that the government faced an uphill challenge to deliver, given the years of underinvestment that had left NHS trusts with a collective £6.5bn backlog in maintenance costs.

Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, said, “The coronavirus pandemic has underlined the urgency of updating and modernising the NHS estate to provide clean, safe therapeutic environments for patients and for staff. However, it is vital to keep sight of the scale of this challenge. The backlog maintenance bill for the NHS now stands at £6.5bn.”

Anita Charlesworth, director of research and the REAL Centre (Research and Economic Analysis for the Long term) at the Health Foundation, said that the NHS needed “a clear plan for long term investment” because the funding announced by the government “will only go a short way to addressing years of underinvestment.”

Tackling health inequalities

The prime minister promised in his speech in Dudley, West Midlands, that the government would “put its arms around people at a time of crisis” and “build, build, build” to reduce the economic impact of covid-19.

But Charlesworth argued that this promise must include tackling health inequalities. She said, “To level up the country and stop people from falling through the cracks in society, the government will need to go further than pledging new buildings by addressing the factors that have the strongest influence on people’s health and wellbeing: the conditions in which people live.

“This needs to include strengthening the social security system, investing in children’s services, and improving the quality of housing, education, and work for everyone.”

She also highlighted the need to invest in the workforce, a point reiterated by the Royal College of Physicians. Its registrar, Donal O’Donoghue, said, “While new pots of one-off funding are welcome, what the NHS really needs right now is a sustainable funding package to support and grow the NHS workforce.

“We need more doctors, more nurses, the regulation of physician associates, and a culture change that supports flexibility and improves wellbeing for all NHS staff.”


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