Chancellor, Rachel Reeves; Chief Secretary to the Treasury, Darren Jones; and Health Secretary, Wes Streeting, attend a Cabinet meeting at 10 Downing Street ahead of today’s Spending Review. Image, Lauren Hurley/No 10 Downing Street

The Chancellor’s long-awaited Spending Review, delivered earlier today, failed to provide additional capital to address the huge maintenance backlog across the NHS estate, with critics claiming the long-term vision to shift care out of hospital settings will be ‘extremely hard to achieve’ within the proposed budgets.

Rachel Reeves’ speech revealed the day-to-day budget for the NHS in England will go up by 3% in real terms on average over the next three years, reaching £226bn by the end of the review period in 2029.

We cannot ignore that today’s flat settlement continues to leave a major shortfall in capital funding and also fails to lift the ban on private investment that is required to boost NHS capital funding

She also pledged to deliver £17bn in = savings over three years by boosting productivity by 2%.

And she said she was increasing the NHS technology budget by almost 50% – and by £10bn – to bring the ‘analogue health system into the digital age’.

But there was no additional money for capital works, making it almost impossible for the NHS to fully address the estimated £13.8bn maintenance backlog.

Critics fear this will lead to further degeneration of the estate and increased health and safety risks for patients and staff.

And they said restrictions on the NHS using private funding to carry out essential repairs would further hinder service improvement.

Commenting on today’s speech, Matthew Taylor, chief executive of the NHS Confederation, said: “Given the difficult state of public finances health leaders will understand that there is only so much vital capital funding to go round.

“But we cannot ignore that today’s flat settlement continues to leave a major shortfall in capital funding and also fails to lift the ban on private investment that is required to boost NHS capital funding.

Decades of under investment mean we must think outside the box when it comes to solving this double whammy of under-strain public finances and an NHS estate in desperate need of renewal

“This needs to be addressed in the upcoming National Infrastructure Strategy and the NHS 10-year plan.

“Only then will the NHS be able to work with the private sector to build new healthcare facilities, including much-mooted neighbourhood health hubs, while also supporting economic growth and local regeneration.”

Daniel Elkeles, chief executive of NHS Providers, added: “With an ambitious 10-year health plan to transform the NHS just weeks away from being unveiled, and tough targets to improve access to care, right now trust leaders will ask whether the funding announced today enables the NHS to deliver everything being asked of it.

“While extra capital investment in NHS technology and digital transformation is long overdue, decades of under investment mean we must think outside the box when it comes to solving this double whammy of under-strain public finances and an NHS estate in desperate need of renewal.

“It’s vital that all options are on the table, including exploring ways of bringing private capital back into the NHS which don’t replicate the costly mistakes of PFI.

“Making these shifts a reality will require upfront investment.

“The Government – and the NHS – will face difficult decisions and tough trade-offs in the coming years.”

Nuffield Trust health think tank senior policy analyst, Sally Gainsbury, told Healthcare Property that spending pressures, including inflation and increased planned treatment capacity, mean the funding announced at the Autumn Budget has been more than wiped out.

With capital funding staying flat in real terms for the rest of the spending review period, it will be difficult for the NHS to invest in the technology and facility upgrades it needs to meet the Government’s ambitious productivity targets

And the Department of Health and Social Care starts the period covered by this Spending Review £1.3bn in the red.

She added: “Compared to the settlements for other departments – from policing to education – the NHS deal looks generous. But seen in the context of all the promises made by the Government to the British people – to drive down waiting lists, shift care closer to home, and rapidly improve tech – and the commitments to meet staff pay demands and rising costs of new drugs, today’s settlement soon melts away.

“[And}, with capital funding staying flat in real terms for the rest of the spending review period, it will be difficult for the NHS to invest in the technology and facility upgrades it needs to meet the Government’s ambitious productivity targets.”