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This Health Service Safety Investigations Body (HSSIB) investigation focuses on how the health needs of people in prison are assessed and the provision of safe living conditions for people in prison who use a wheelchair or have mobility issues. This investigation explored how healthcare provision for a whole prison’s population is assessed and commissioned using health needs assessments. How outdated assessments may present a patient safety risk through mismatched staffing skill mix and services that don’t match the patient’s needs. These risks may result in physical injuries, psychological distress and dignity violations, each of which can impact on patient wellbeing. It looked at challenges related to this approach, cost implications of the current system and ongoing developments. Disability access within prisons is complicated by the original design and purpose of prison buildings. Some of the prison estate dates back as far as 1800, making adaptations and provision for wheelchair users, for example, difficult. The investigation explored the prevalence of this issue, the impact on people in prison and potential areas for improvement. Findings The investigation explored two main themes: health needs assessments and access for physically disabled people within prisons. These themes were identified during the evidence gathering phase for the three previous HSSIB reports in this series. The findings have been separated into these two themes and are listed below: Health needs assessments (HNAs) The current process of developing an HNA for a prison population, which are generally conducted at most every 3 years, means that HNAs are frequently out of date by the time they inform commissioning decisions. There is often a delay in prison healthcare providers being made aware of likely changes to the prison population by HM Prison and Probation Service (HMPPS). This can impact on providers’ ability to ensure the required healthcare provision is in place to serve the new population. Outdated HNAs lead to mismatched healthcare provision, forcing providers to submit business cases for additional services or absorb the financial impact of changes to their services. The business case processes were slow and did not support the needs of a rapidly changing prison population, resulting in services that may pose patient safety risks due to mismatched healthcare services, incorrect staff skill mix requiring retraining, recruitment, and removal/addition of new services. HNAs were commissioned by NHS England regional commissioning teams and did not include social care requirements as this is commissioned by local authorities, which made planning and provision of social care difficult and often resulted in delays in care. In response to limitations in the current HNA process, some regions had introduced alternative approaches, including digital data dashboards and artificial‑intelligence‑enabled tools. Different approaches to assessing healthcare requirements for prison populations contributed to variation in how healthcare services were commissioned and delivered across the prison estate. Stakeholder engagement in assessing prison population health requirements was limited; local authorities and other relevant bodies were rarely consulted, contrary to guidance. Physical disability access Wheelchair users experienced harm and dignity concerns, including injuries from unsafe chair-to-chair transfers and deteriorating mental health caused by being housed in inappropriate accommodation. The number of wheelchair users in prisons is increasing, and many prisons cannot easily accommodate wheelchair users or people with mobility issues. None of the prisons visited had enough wheelchair-accessible cells. In some regions there were none. Accessible cells are sometimes located only on vulnerable prisoner wings, potentially wrongly associating wheelchair users with that cohort of prisoners. The current system for gathering information on the physical accommodation needs of people in prison is ineffective; this can impact on the ability to place people in appropriate accommodation. HSSIB makes the following safety recommendations HSSIB recommends that HM Prison and Probation Service, in collaboration with the Department of Health and Social Care, formalises arrangements for alerting healthcare commissioners and providers to changes in prison populations likely to impact on healthcare provision requirements. This is to ensure that healthcare commissioners and providers can plan for changes to healthcare services that are necessary to meet the changing needs of the prison population. HSSIB recommends that the Department of Health and Social Care works with local authorities to redesign how the health and social care needs of prisons’ populations are assessed. This is to ensure that appropriate services are commissioned to meet the needs of people in prison and prevent possible delays in care. HSSIB recommends that HM Prison and Probation Service reviews and amends its information gathering processes for accommodation requirements for wheelchair users and people with mobility issues, to identify and mitigate risks for people whose accommodation does not meet their needs. This is to enable and support the effective identification of appropriate prison accommodation for these groups.

The NHS has around 1,500 hospitals in England, of which around 210 provide emergency care. Where hospitals are older or in deteriorating condition, there may be significant risks to patient and staff safety and high maintenance costs. In 2020, following years of under-investment, the Department of Health & Social Care (DHSC) committed to build 40 new hospitals by 2030 through the New Hospital Programme (NHP). Hospitals in the programme will be built to a standard design with the aims of increasing cost-effectiveness and quality, and utilising the construction industry in a more coordinated way. Hospital construction had previously been funded centrally but designed and delivered locally by NHS trusts. The NHP is a joint endeavour between DHSC and NHS England (NHSE) to coordinate schemes centrally instead. DHSC has overall responsibility for the NHP and NHSE is responsible for its delivery. Following the July 2024 general election, the new government carried out an internal review of the NHP and announced a new implementation plan in January 2025. This report provides an update on progress on our 2023 report and whether the programme is now deliverable under the new plan, it: sets out the history of the programme, the new implementation plan announced in January 2025 and what the programme aims to achieve examines the progress that has been made towards building new hospitals examines how DHSC is managing risks to delivery, including the extent that the new plan addresses issues raised in our 2023 report and by the Public Accounts Committee.

The UK spends significantly less on capital, such as buildings and equipment, than most other Organisation for Economic Co-operation and Development (OECD) countries. This may contribute to its poor performance on outcomes compared with similar countries.  This Health Foundation report analyses trends in the capital budget, comparing the UK with international averages. Using annual data from all NHS trusts in England. It then focuses on trends in the capital spending of NHS trusts to analyse where money has been spent and where there are areas of need. It then analyses the implications of recent capital spending, with a specific focus on NHS trusts’ maintenance backlog. The report concludes with a discussion of the trends in capital spending and capital levels, and implications and recommendations for future health care funding.

The NHS in England has around 1,500 hospitals, where most emergency and elective care is carried out. The hospital estate contains many old buildings and its condition has been deteriorating. In response, in 2020, the government announced the New Hospital Programme (NHP) and committed to build 40 new hospitals by 2030. This report shows the key findings and progress made. Responding to the National Audit Office (NAO) report on the New Hospitals Programme, Matthew Taylor, chief executive of the NHS Confederation said: “Members will be concerned by the delays to many parts of the New Hospitals Programme, as this report from the National Audit Office reveals. Especially as some trusts are having to find additional money to tackle ongoing maintenance issues such as new roofs, when they were led to believe they would be moving to a new site or given funds to build something new as part of this programme. This is adding more pressure on finance departments whose budgets are already stretched to the limit. “Our members tell us that the maintenance backlog continues to be a significant challenge, impacting productivity and their ability to deliver the transformation required, hindering their progress in reducing the elective backlog and rendering some areas as unusable."

This year marks the NHS's 75th anniversary, and is an important moment to look back at where the service has come from, consider where it stands today and to look forward to how it needs to change to meet future needs. This report from the NHS Assembly draws on the feedback of thousands of people who have contributed to a rapid process of engagement with patients, staff and partners. It aims to help the NHS, nationally and locally, plan how to respond to long term opportunities and challenges. It sets out what is most valuable about the NHS, what most needs to change, and what is needed for the NHS to continue fulfilling its fundamental mission in a new context. The report identifies three key 'shifts' that will help the NHS adapt to the current needs of the population: Preventing ill health. Shifting funding to evidence-based measures to prevent and manage coronary heart disease and other causes of poor health, such as smoking and obesity. Working far more effectively with others to reach those at greatest risk and using NHS insights to advocate for effective action in tackling the wider determinants of health. Personalisation and participation. Ensuring people have control in planning their own care, supported by a continuity of relationship with clinical teams and an NHS accountability framework giving greater priority to patients’ experience and voice, particularly those who have been marginalised historically. Co-ordinated care, closer to home. Accelerating plans to strengthen general practice, wider primary care and community services in every neighbourhood. Universalising much better care for those with complex needs and frailty based on community teams and hospital at home services, supported by outreach from hospitals.

This report explores why capital investment is key to boosting productivity and transforming long-term care. Key points It is a worldwide experience that as society ages, becomes wealthier and adopts less healthy lifestyles, healthcare becomes more expensive. The UK is no exception. Providing staff with the right tools and space to perform their jobs through capital investment is how to become more productive and to use the resources available most efficiently. However, the UK has invested less in health capital over several decades when compared with comparable nations. The result is a less productive service hampered by, among many other things, Victorian estates, too few diagnostic machines and outdated IT systems that cannot communicate across between hospitals. As the examples in this report demonstrate, NHS leaders across the country continue to invest in novel ways to make the service more productive and have more ideas should the government commit funding. Capital is the number one issue NHS leaders tell us is holding back their progress. To better understand this, we have asked ICS leaders how much they need to meet the NHS Long Term Workforce Plan’s ambitious productivity targets. NHS leaders are calling on all political parties to commit to a £6.4 billion annual capital funding increase for the NHS at next year’s three-year Spending Review. As we enter a general election year, there has never been a more urgent time to set out an ambitious plan to put the NHS on a path to financial sustainability. NHS leaders are committed to working closely with the new government to ensure this money is used as swiftly and effectively as possible.

PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. The 2023 programme is planned for launch in early September 2023. Good environments matter. Every NHS patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. The assessments involve local people (known as patient assessors) going into hospitals as part of teams to assess how the environment supports the provision of clinical care, assessing such things as privacy and dignity, food, cleanliness and general building maintenance and, more recently, the extent to which the environment is able to support the care of those with dementia or with a disability. Recruitment and training of patient assessors is the responsibility of those organisations undertaking assessments. The assessments take place every year, and results are published to help drive improvements in the care environment. The results show how hospitals are performing both nationally and in relation to other hospitals providing similar services.