Preventing deaths and decay: a capital moment for our NHS
The NHS spends around half what similar countries in the OECD do on buildings and equipment. The result is deaths and decay, both of which can be prevented.
The IPPR’s latest report on international health systems lands with a stark diagnosis: the NHS is not structurally broken, but it is chronically undercapitalised.
The report welcomes public-private investment and calls for a revisit of capital budgets.
Despite rising overall spending, the UK invests around half as much as comparable countries in buildings, equipment and technology. This long-term imbalance has left the NHS with fewer beds, outdated estates and a critical shortage of diagnostic capacity, undermining performance across access, outcomes and productivity.
People are dying earlier as a result.
The NHS’s performance, measured against comparable systems, is sobering. On treatable mortality – deaths from conditions where timely care should prevent a fatal outcome – the NHS is the second-worst performer among the 22 countries analysed, ahead only of the USA.
The report is clear that the solution is not a wholesale shift to an insurance-based system. Instead, the challenge is practical: how to unlock sustained, targeted capital investment.
That conclusion should prompt a renewed focus on one of the most immediate levers available to government, mobilising additional investment through partnerships with the independent sector, while protecting the essence of the NHS and government spending rules.
From diagnosis to delivery: unlocking new investment
This is where public–private partnerships (PPPs) can play a critical role. Modern PPP models: properly structured, transparent, and aligned with public value offer a route to:
Accelerate the replacement and expansion of ageing hospital estate – the New Hospital Programme could be sped up
Unlock investment in diagnostics and digital infrastructure
Spread the cost of major capital programmes over time
Bring innovation and delivery expertise into complex projects
Crucially, this is not about revisiting past models uncritically. It is about learning lessons and deploying new partnership approaches that reflect today’s fiscal realities and clinical needs.
A partnership approach to reform
For the UK’s leading social investors, the priorities are clear:
Establish a stable, credible pipeline of health infrastructure projects
Create policy certainty that welcomes responsible private investment by reducing the adversarial relationship management in some areas
Ensure transparency and accountability to build public trust through New Models of PPPs
Allow extensions of existing PFI schemes in order to fund new wards, equipment and Net Zero projects
The Government has made a good start with expanding investment in Neighbourhood Health Centres, but there are many other opportunities from hospitals to diagnostic equipment that could be accelerated with new partnerships.
The prize is significant. With the right framework, the NHS could unlock billions in additional investment—accelerating modernisation while preserving its founding principles.