Ahead of the Spring Budget on 6 March, NHS Providers has submitted our representation to the Treasury setting out the details of our immediate and long-term asks to the government. Our representation was submitted to the Treasury ahead of the 24 January deadline.

The key messages from our submission are as follows:

• Trusts’ budgets are significantly overstretched. After over a year of higher than projected levels of inflation, compounded by more than £2bn of disruption caused by industrial action, and rising demand for care, government must act now to ensure trusts are adequately funded for managing the financial pressures they have faced this year so that they can continue to focus on providing high quality patient care.
• The long-term financial sustainability of the NHS is dependent on investment in wider public services, which heavily influence the determinants of an individual’s health. Government should ensure multi-year public sector budgets act to improve the population’s health and support economic productivity. This includes increasing the public health grant, which will deliver value for the taxpayer in the long term, reforming social care and ensuring due investment in critical public services which shape health outcomes from birth – such as education, transport, and housing.
• Trust leaders are keen to continue engaging with HM Treasury to better understand and improve NHS productivity, and NHS Providers is pleased to be working with trust leaders and NHS England to ensure productivity measures are appropriate for today’s care settings including in mental health and community settings. However, sustainable productivity growth depends on key enablers, notably capital investment in infrastructure and digital technologies, that require sufficient central funding, and/or access for trusts to new routes to funding.
• Capital investment must be prioritised to address the record-high maintenance backlog and halt the deterioration of the NHS estate. Investment is required across acute, specialist, mental health, ambulance and community services.
• Government needs to explore options for widening access to strategic capital investment so that trusts who missed out on the New Hospital Programme (NHP), can still deliver the necessary transformation to their estate. This should be informed by funded projections for bed capacity over the course of the next spending review, including general and acute beds, but also intermediate care, rehabilitation beds and step-down mental health support.
• Trust leaders are concerned by current plans for a freeze on capital departmental expenditure limits (CDEL) from 2024/25 onwards. Trusts would welcome an increase in CDEL to provide them with greater flexibility to invest in their estates without breaching national spending limits.
• Government must support an expansion in primary and community care capacity to improve the flow of patients in and out of hospitals and the ability to step down care to more appropriate, and often less costly settings. Overall, trust leaders tell us this will improve the ‘flow’ of patients within the system, ensure people receive care in the most appropriate setting and have a positive impact on productivity growth across the NHS.
• In order to see sustained performance improvements across the urgent and emergency care pathway, ambulance services need to see long-term investment. One-off, short-term additional funding will not deliver significant performance improvements and does not deliver value for money for patients and service users.
• Trust leaders want to see the government deliver fundamental reform of the adult social care system and a long-term, multi-year settlement to place social care on a sustainable footing ahead of the next spending review.