Governance of Capital Investment and the Infrastructure Risks to Delivery of Safe, Sustainable Care

Time: 11:25 am - 11:50 am


The NHS currently faces complex challenges in its ability to deliver current and long-term service demand. These challenges come in several forms from vacancies, growing waiting lists, aging buildings, and infrastructure at its capacity limits.
Estate infrastructure poses a serious concern to many NHS trusts, with backlogs for building repair mounting, proposed new infrastructure to drive down waiting lists, as well as the ability to maintain or replace infrastructure severely hampered due to a legacy of under-investment.
In this environment, the governance and investment decisions for NHS Trusts need to be strategically targeted to align clinical & system priorities, estate risk & safety standards, as well as estate infrastructure capacity and alignment to long-term Net Zero targets.
Governance of capital investment is critical in providing clear organisational structure, effective decision‐making, and control processes ensuring viable and affordable investments. These processes face competing investment priorities; however, these processes can be problematic, with risk to infrastructure not prioritised against new or expanded services. Estates’ risk may not be acknowledged or considered within developments, or risks may be reduced for political purposes, with subsequent impacts on the viability and affordability of the capital investments. These sorts of failures of governance extended into planning for Net Zero targets, where investment in new green technologies may fail to acknowledge the required infrastructure to support them.
Governance has a significant influence on investment decisions, NHS Trusts need a coordinated governance structure to reduce risks, ensuring viability and affordability, particularly in large complex investments.
NHS trusts need to ensure they are appropriately prioritising estate investment, ensuring risks are understood across the organisation’s governance, the investments required to support service expansion & delivery are factored into the business cases as well as ensuring PFI providers are meeting their requirements in terms of estate investment.


  • Mark Page ICS Associate Director for Estates & Net Zero - Norfolk & Waveney ICB

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