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It seems like conversations about capital have taken on a new tone over the past two years, the time in which NHS England has been allocating capital to integrated care systems.

The ICSs get an assigned amount for their constituent organisations to spend in the year. It constitutes that system’s capital limit, stemming from the Department of Health and Social Care’s delegated expenditure limit – C-DEL – which it is allocated by HM Treasury.

The ICS capital allocations are but one part of the overall NHS England capital budget, with sizeable chunks held by the centre to spend on the new hospital programme as well as smaller, strategically important projects like community diagnostics hubs.

Because how capital is allocated to ICSs is of considerable importance to several parties – from Horse Guards Road to trust boardrooms – NHS England asked Richard Murray at the King’s Fund to look over the methodology used to dish out the money.

It is two years old now and, over the course of multiple roundtables, interviews and workshops with ICS and trust leaders, Mr Murray found it is due an overhaul. The most eye-catching recommendation from his independent review will be for the new method to put less emphasis put on the value of a system’s assets and more on the scale of its maintenance backlog.

But beyond that, there are bigger questions over capital that need answering. The allocations method is, to some extent, tinkering around the edges. Ultimately it is just a way of carving up the pie. The more important question in the future for NHS England will be how to make the pie bigger.

At the moment the allocations to systems is enough to keep the lights on, to address backlog maintenance and do some small-scale but important local estate or diagnostics investments. It is not enough to do the kind of transformative work, like turning a hospital on the patch into an elective cold site, moving services into the community or setting up diagnostics hubs.

The money for that is currently held by NHSE. The time will come when it needs to decide if it wants to actually follow through with the rhetoric and devolve it to the systems or keep all that money centrally.

Gold standard, bronze rollout

Vast swathes of the country are yet to reap the benefits of a successful scheme dubbed ‘gold standard’ by eating disorder patients, HSJ analysis reveals.

Launched with NHSE cash for 18 pilots in November 2020, in the wake of five inquests of women who died with anorexia, the First Episode Rapid Intervention in Eating Disorders programme has been proven to halve the need for intensive treatment.

It is now a year on and just 16 out of more than 54 English mental health trusts have implemented the successful model. Around 24 of 42 ICS areas have limited or no access to FREED, our analysis shows.

Developed by experts at King’s College London, the scheme for 16-25s living with a condition for less than three years helps patients receive contact within 48 hours and treatment within two weeks.

Most services with FREED employ a single part-time champion funded with £30,000 – which leading consultant psychiatrist Agnes Ayton told HSJ “is not sufficient to deliver treatment to everyone who needs it”.

NHSE said it is on track to deliver expanded adult eating disorder services by 2023-24, while networks responsible for scaling up said surging demand had prevented some areas from launching “100 per cent”.