The new report by the NHS Confederation sets out how the capital regime can be improved to deliver on the Government's missions for health and economic growth.

NHS Confederation chief executive Matthew Taylor said: ‘Across the NHS, staff are having no choice but to treat patients in crumbling buildings and with out-of-date equipment. This is neither safe nor good for productivity. As Lord Darzi highlighted, the NHS has been starved for capital for more than a decade, so it is vital that it is able to maximise the return on every penny it has.

‘But what money there is, is too often held back by red tape – creating delay and cost, undermining taxpayers' value for money. The verdict from NHS leaders is clear: the NHS capital regime is broken.'

NHS leaders have told NHS Confederation the capital approvals processes from local trust and ICB, up through NHS England, the Department of Health and Social Care and the Treasury, is too slow as there are too many duplicative stages, creating delay and adding cost.

The report recommends reducing the number of approval stages projects have to go through – currently at least 19 – as well as giving local health systems greater autonomy over their spending.

NHS England and the Government both have to approve any investments over £50m, but the NHS Confederation believes this should be increased to £100m, allowing projects such as new hospitals, new scanners and artificial intelligence to progress more quickly.

The report, Capital efficiency - how to reform healthcare capital spending, also recommends that ICBs should be allowed to raise additional investment away from Government allocations including via private means, which is not allowed at present.