The Independent Healthcare Providers Network (IHPN) and Future Health have today launched a new report setting out policy opportunities for increasing the use of Public Private Partnerships (PPPs) to support the transformation of healthcare services.

With public spending – including on health and care services – likely to be severely restricted in the coming years, PPPs will play an integral role in supporting the modernisation of NHS services.

The report highlights how partnerships can go beyond ‘bricks and mortar’, by demonstrating how independent healthcare providers have partnered with the NHS to provide packages of investment, bringing capital investment alongside staffing and equipment to:

• Create additional lines of investment, enabling NHS providers to utilise their capital allocations to undertake a more diverse range of capital projects
• Utilise the expertise and capacity of the independent healthcare sector to couple estates development & management with clinical services -enabling the delivery of a broader range of services for the NHS

Based on an assessment of the current challenges and opportunities associated with the current capital regime, this report makes the following recommendations:

1. HM Treasury should update Green Book guidance, to clarify the off–balance sheet capital investment mechanisms available to senior NHS leaders to stimulate PPPs – particularly those which enable the independent sector to provide finance and deliver services on an ongoing basis.

• Updated guidance should refer to schemes, encompassing primary and community as well as secondary and tertiary care where NHS providers have already entered effective, ongoing partnership with the independent healthcare sector to work within the current accounting rules.

2. To create a forum for leadership and enable ongoing partnership between Government, the NHS and the independent healthcare sector a National Strategic Council for Healthcare Infrastructure should be established.

• Its membership should include representatives from HM Treasury, DHSC, the NHS and the independent healthcare sector to enhance collaboration on the enablers of PPPs. Its work should align to the Government’s stated priorities in the Ten Year Health Plan.
• In conjunction, DHSC should publish a dedicated set of guidelines for how the NHS will use PPPs, with a focus on an expansion of independent sector led services to tackle waiting times for elective care and diagnostics.

3. The Government should collaborate with the independent healthcare sector to develop a dedicated Neighbourhood Health Capital Fund.

• To avoid the usual difficulties in the existing capital system and to move at pace, a separate and dedicated Neighbourhood Health Capital Fund should be established. Such a Fund would allow the Government to set out the strategic objectives, requirements and levels of investment needed from capital investment into neighbourhood health. The primary aim of the Fund would be to raise private capital investment, but it could also be supplemented by central funds to support the overall capital requirements of the neighbourhood health programme.
• The development of the Fund will also create opportunities for independent sector delivery of some clinical services within these new neighbourhood health facilities, which can be delivered within the bounds of the Provider Selection Regime.
• Alongside this, the National Health Service (General Medical Services Premises Costs) Directions 2024 should be amended in tandem, so that they are supportive of private capital investment into the NHS primary care estate and to enable alignment to the Government’s vision.

4. Enhancing accountability for delivering on NHS capital priorities

• The Government will need to follow through on its Ten Year Health Plan aims of speeding up capital programme processes. As part of this it should introduce a new indicator in the NHS Oversight Framework that tracks the performance of NHS organisations on their delivery of capital projects. Such transparency can be used to identify organisations that are struggling with capital builds, identify blocks to progress and work on solutions to these challenges.

5. Increasing PPPs to support elective recovery

• NHS England should publish a set of guidelines for how the Government’s commitments in the Ten Year Infrastructure Strategy for more PPPs will be translated into building more capacity to deliver elective recovery. Learning should be taken from those NHS and independent sector organisations who have already been able to make such arrangements work within the current accounting rules.

The report features case studies of effective partnership across primary and community care, diagnostics, electives and cancer care.

[1] https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england

[2] https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf

[3] https://www.gov.uk/government/publications/spending-review-2025-document/spending-review-2025-html