The NHS faces a £14 billion repair backlog, but health leaders say global private investment models could be the key to modern, world-class facilities
The NHS is battling a £14 billion infrastructure backlog, with crumbling hospitals and outdated facilities putting pressure on patient care. Now, health leaders are calling for bold solutions: looking beyond the UK to proven private investment models from around the world. By adopting international approaches to funding and upgrading healthcare estates, the NHS could unlock billions in capital, modernise its infrastructure, and deliver safer, more efficient care for the future.
Increasing capital investment and decreasing infrastructure issues
A new report from the NHS Confederation highlights seven global public-private partnership (PPP) models that have been successfully used overseas—and could now be adopted in England to unlock billions in capital investment, tackle the NHS’s £14 billion infrastructure backlog, and modernise healthcare facilities.
The NHS estate is in disrepair; years of no capital investment have taken their toll. Crumbling, dilapidated buildings are unsafe for patients and staff, stifling the NHS from tackling waiting lists effectively.
The NHS Confederation warns that without private capital investment to build modern healthcare facilities, the NHS will be unable to deliver the government’s promise to reduce waiting times.
The Chancellor is expected to decide in the autumn budget whether to approve a new wave of public-private partnerships (PPPs) in England, enabling healthcare leaders to build neighbourhood health centres central to the government’s Ten-Year Health Plan. The NHS Confederation, however, is urging the government to go further—allowing PPP models to fund hospitals and wider NHS services, potentially unlocking billions for the country’s healthcare infrastructure.
Public-private partnerships: The future of the NHS?
The report – Towards a new co-investment model: what is next for NHS public-private partnerships? – found that new private investment could be the solution to the NHS infrastructure issues and outlines a set of recommendations to bring value for money for the taxpayer and the NHS, including:
- Developing a framework that sets the parameters for systems and trusts to build their own PPP models to meet their local circumstances best;
- The Treasury should devise a process to ensure trusts have a suitable method for requesting building changes should the original investor sell their stake.
- Exploring the use of contract models from overseas where contract disputes have been minimal
The new report highlighted that many major new hospital builds would not have been possible without private investment, and very few projects have been built with just public funding. Furthermore, privately paid projects are typically delivered on time and within budget, and public projects often face delays and funding constraints.
Matthew Taylor, chief executive of the NHS Confederation, said: “The NHS has suffered from chronic, decades-long underfunding by successive governments in its estate and infrastructure. The result is a £14 billion maintenance backlog that hampers the delivery of safe and timely patient care. In some hospitals, as much as one day every week of staff time is wasted due to failing estate.
“To ensure the NHS can deliver on the ambitions of the government’s Ten-Year Health Plan, more capital investment is crucial. Private investment is one of the only ways to invest the capital sums needed to ensure quality 21st-century healthcare facilities.
“This is not about resurrecting the old private finance initiatives (PFI) model but building a new model fit for the future, that learns from our own experiences and other countries. While there are justified criticisms of PFI, our report shows that we can learn the lessons and reap the benefits.
“We welcome the government’s commitment to considering a new public-private partnership (PPP) model for the NHS’s neighbourhood health centres at the forthcoming Budget, but we need it to go much further and promise the same to hospital trusts and other parts of the NHS.”
