'Golden opportunites' for the NHS are not straightforward

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A recent Times article saying the NHS could borrow up to £10 billion from hedge funds to repair health service infrastructure and provide specialist care at GP surgeries raises interesting questions.

Jim Mackey, chief executive of NHS Improvement – the organisation that provides financial oversight of NHS trusts, amongst other responsibilities – has been speaking openly about a 'golden opportunity' to raise money from the private sector or local authorities, without needing to look to the chancellor for extra cash.

His motivation is easy to understand.

In 2016/17, HM Treasury and the Department of Health took £1.2 billion off the £4.8 billion capital budget in health and switched it to support revenue spending.

Though this is the biggest cut yet, such transfers are becoming a routine fixture in the financial calendar.

As the recent Naylor Report on NHS Property and Estates makes clear, these combine to mean capital spending as a share of total spending has now fallen below 4%, well below the 6% seen in 2009/10 and low when looking at the historic track record of the NHS.

Though very welcome, the recent announcement in the Budget of extra capital for the NHS was not enough to materially affect this picture.

With private finance initiative slowing down as well, it is no surprise that backlog maintenance is rising, and high-risk backlog maintenance rising very fast indeed (up 69% in one year).

As high-risk backlog maintenance is defined as `where repairs/replacement must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution’ (NHS Digital), this is clearly concerning.

As emerging NHS plans to re-design care are likely to imply at least some additional capital spending as well, the gap between demand and affordability is only likely to grow.

So if the chancellor cannot provide extra cash for the NHS, could the private sector?