Key Takeaways:

• The lack of capital is making it harder to improve NHS productivity and affects both patient care and staff morale. But there are ways in which trusts and integrated care boards can improve estates, through collaborative working and innovative ways of accessing funding.

• While the pandemic was a difficult time for the NHS in many ways, it had a transformative yet temporary effect on estates planning. The short timescales involved to make major changes in infrastructure led to using frameworks with direct awards or mini competitions.

• An ongoing challenge for the NHS is the government’s tight control of annual capital spending (CDEL) – the departmental spending on investment projects and capital. The limits on this mean that even trusts with money in the bank cannot spend it on capital projects. While there will always be a place for traditional capital projects, this does mean trusts are having to look at different ways of delivering much-needed improvements.