The vast majority of NHS leaders say a shortage of capital funding is holding back their ability to work through record waiting lists, meet targets for improving care and to roll out digital services, polling by the NHS Confederation found.
Polling of NHS leaders found that many fear a combination of 'ageing buildings, run-down estate and outdated computer systems' are risking patient safety.
Among primary care leaders who took part, around 84% said their organisation did not have enough capital funding to enable them to meet the local care backlog.
Nine in 10 primary care leaders said their organisation did not have enough capital funding to 'transform services in line with the NHS long-term plan'. Around 80% said the capital funding shortfall meant they could not deliver services in the most efficient way and therefore increase productivity.
One primary care network clinical director in south-east England said: 'We’re working in a 1950s tin-roof health centre servicing 34,000 patients with no ability to provide fit for purpose 21st century healthcare. Our ability to meet patient expectations and political promises is impossible unless significant investment in infrastructure is made.
'It is like promising the public a safe, effective modern car and when they go to collect it, they find a 1970s Ford Escort, with rusting roof, wheezy engine, designed to take four people, but being required to carry 10, and with no one to service it or drive it.'
Findings from the poll come after widespread warnings from GPs that many practices simply have no room to accommodate staff being recruited through the additional roles reimbursement scheme (ARRS), which the government says will deliver an extra 26,000 staff to support primary care by 2024.
NHS leaders responding to the NHS Confederation poll say capital funding promised by government must be released faster to help healthcare services expand capacity and begin to work through an elective care backlog deepened by the COVID-19 pandemic.
The NHS Confederation warned that in the 10 years to 2020 'capital spending in the NHS has been around half that of other OECD countries' - and that a £9.2bn NHS maintenance bill accumulated over the past decade is also threatening care.
Inflation, meanwhile, is driving up costs for building work - increasing demand for capital investment across the NHS.
NHS Confederation chief executive Matthew Taylor said: 'NHS leaders share the government’s commitment to further boosting NHS efficiency and productivity and are doing all they can to tackle the care backlog that has built up in recent years, but they are being held back in their efforts by a lack of capital funding which is now a major barrier.
'The huge gulf in the NHS’ capital budget combined with a decade-long underinvestment in estate, infrastructure and IT systems has left the NHS with run-down buildings, a major maintenance backlog and limited potential for maximising the use of digital technology.
'The government needs to urgently unlock the capital funding that has already been promised so that work can finally begin up and down the country on new builds as well as addressing the maintenance backlog. The Government then needs to revisit capital funding in the autumn budget to address the shortfall that has been created. We should be ahead of the pack when it comes to the amount we invest in capital compared to other OECD countries rather than lagging behind as we currently are.'
A DHSC spokesperson said: 'This government is investing record sums to upgrade and modernise NHS buildings so staff have the facilities needed to provide world-class care for patients.'
The government said it was 'delivering the biggest hospital building programme in a generation, with a target of 48 hospitals by 2030' - although reports suggest most of the 'new' hospitals are in fact partial rebuilding projects.
The spokesperson added: 'We are also investing £1.7bn until 2025 for over 70 hospital upgrades across England, and in 2020/21 we invested a record £895m in tackling critical infrastructure risk, which included funding for nearly 1,800 urgent maintenance projects across over 170 trusts.'