The NHS has had historically low levels of capital investment. Compared to similarly advanced economies, this country’s capital investment has been very low. On average, a person living in the UK has missed out on almost £2,000 since 1975 – the equivalent of over £100 billion overall.

Though they were bad deals, private finance initiatives (PFI) were the only mechanism that brought enough capital into the health system. However, PFI specifically has turned out to be a bad deal – and will eventually cost almost £80 billion for just £13 billion of assets. This report reveals that £55 billion of this debt is still outstanding – representing a huge burden on tight NHS resources if the government does not take action.

This report recommends a new settlement to fund capital and support transformation totalling £5.6 billion per year – an 80 per cent uplift. The PFI legacy must also be urgently addressed, through a ‘right to enfranchisement’ for the NHS, which would bring those that represent bad deals back into public ownership.