NHS capital – a system in distress?

Debbie Paterson

23 October 2018


This paper has been written in response to members’ concerns that the current capital regime is not working – providers are struggling to finance capital expenditure from internally generated resources or from borrowing, the system is complicated, cumbersome and feels combative.

The paper sets out how the current system was developed and now works before setting out the characteristics a new capital regime should have.  Finally, the paper sets out some possible solutions to the problems identified.

The paper also considers the unintended consequence of the recent focus on achieving control totals that is the lack of management review of the balance sheet. It sets out some of the consequences of this as a precursor to further work on best practice in board reporting.


NHS capital – a system in distress?

October 2018 (PDF 381KB)

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