NHS Capital Guidance 2026–27 to 2029–30: In Summary

The guidance sits alongside wider NHS planning requirements, including the medium-term planning framework, emerging strategic commissioning priorities, and clearer expectations around the roles and responsibilities of Integrated Care Boards (ICBs). Together, these frameworks signal a shift towards longer-term, system-led decision-making across health and social care.

ICBs are expected to take a stronger coordinating role in capital planning across their systems. Rather than organisations developing plans in isolation, the guidance encourages systems to agree shared priorities and take a collective view of risk, affordability and impact.

This reflects the wider direction set out in the ICB Model Blueprint on-system leadership and accountability, with ICBs acting as coordinators across providers, places and partners. Capital planning is positioned as a system responsibility, aligned with both operational delivery, longer-term transformation and a support pillar for integrated care.

Affordability is a central theme throughout the guidance. Systems are expected to be realistic about what can be delivered within available capital limits and to avoid over-committing funding before schemes are fully assured.

Capital proposals will need to be clearly prioritised and supported by robust business cases. These should show how investment addresses safety or estate risks, improves service delivery, or enables longer-term change. There is also a clear expectation that the ongoing revenue and workforce implications of capital schemes are understood from the outset.

This focus on financial discipline reflects the wider capital settlement set out in the recent NHS spending review. While £44 billion of capital funding has been confirmed over a 4-year period, capital remains constrained and largely pre-allocated, reinforcing the need for systems to make careful, evidence-based choices about investment.

The capital guidance is explicitly shaped by the government’s 10-Year Plan and its three shifts: hospital to community, analogue to digital, and sickness to prevention. In practice, this has clear implications for how capital will be prioritised.

Hospital to community – neighbourhood health services:

• £426 million over four years via the Utilisation and Modernisation Fund.
• Up to half expected to support 40–50 neighbourhood health centres this Parliament.
• Focus on refurbishment and better use of existing estate, with a longer-term ambition for a centre in every community.

Analogue to digital – technology and productivity:

• A technology and productivity ringfence of around £1 billion per year.
• Supporting priorities such as a single patient record, the NHS App, AI-enabled services and automation.
• Digital proposals expected to account for both capital and ongoing revenue impact.

Sickness to prevention – safe and resilient estates:

• At least £64 billion committed over the next decade to maintaining the health estate.
• £6.75 billion Estates Safety Fund over nine years.
• £1.6 billion for RAAC eradication, alongside sustained investment through the New Hospital Programme.

Increasing capital flexibility over time:

• • Delegated capital limits increased to £300 million.
  • Greater freedom for high-performing providers to reinvest surpluses.
  • Continued exploration of alternative financing models, including public-private partnerships.

There is a clear expectation of stronger governance and oversight of capital programmes. Systems should have transparent decision-making processes and clear criteria for assessing and prioritising schemes.

Capital plans are expected to be reviewed regularly, with flexibility to adjust or pause projects where delivery risks emerge or priorities change. This reflects a move away from static capital plans towards more active programme management over time.

The guidance reinforces that capital planning should align with wider NHS planning cycles, including multi-year operational planning and the longer-term strategic commissioning framework. Capital investment is expected to support agreed service models and population needs, rather than responding only to immediate operational pressures.

In practice, the guidance is likely to result in fewer but more tightly managed capital schemes, with stronger scrutiny of affordability, delivery and ongoing impact. Phased investment and regular review are expected to become the norm, with capital decisions increasingly shaped by evidence of what delivers long-term value.