The NHS has an extensive and diverse property portfolio - ranging from large hospitals to smaller community facilities - and, increasingly, NHS estate directors are exploring ways to make the most of these properties. But change is painfully slow to come.
The inertia of complex institutions has long been recognised as a challenge the NHS must address, but until the organisation as a whole embraces a shift from ‘minor adjustments’ to ‘ambitious transformation’ the NHS property portfolio will remain an operational burden.
NHS properties are often seen simply as places for healthcare services, but each building or site also holds potential for alternative uses.
While some Trusts could do more to unlock reserves for transformative projects, they all face capital spending limits
To unlock the value in their property portfolio, estate directors need to view these assets not just as healthcare facilities but as economic resources that can boost revenue or be repurposed to meet future needs.
Surface car parking areas can be repurposed; non-essential services can be consolidated off-site to improve patient care; remote clinical spaces can be merged; even rooftops and building facades can generate revenue through renewable energy solutions. But a mindset switch needs to occur across the organisation as a whole before we can make any significant progress.
Embracing a more commercial and flexible mindset doesn’t mean compromising patient care - it simply requires a more entrepreneurial approach to property management.
By being open to new models, NHS estates can become strategic assets rather than operational burdens and this shift in perspective can create opportunities that benefit both the NHS as well as patients.
Fundamentally, many NHS Trusts lack the funding for major development projects, which often drive substantial change
The way we work and treat patients is changing and the NHS is at a juncture where it needs to address broader transformation goals around the impact of and adoption of modern practices like digital and remote work.
This shift has implications for healthcare facilities, such as the need for server rooms, spaces for virtual appointments, and fewer individual offices. If more people receive remote care, it reduces the need for frequent hospital visits and encourages community-based healthcare.
However, this change relies on investing in social and community care rather than just physical infrastructure.
Donna Fitzpatrick, Director of Project, Programme and Portfolio Management at Lexica
Small incremental changes will not suffice
Fundamentally, many NHS Trusts lack the funding for major development projects, which often drive substantial change. Instead, we are seeing a trend toward smaller, lower-cost improvements that, at best, make incremental enhancements or keep buildings functional.
These small investments in boilers, building upgrades, or lighting retrofits do increase efficiency but won’t achieve the substantial infrastructural changes needed to meet the NHS's ambitious net zero carbon goals.
To decarbonise healthcare facilities, we need transformative changes in energy performance, including insulation, heating systems, and renewable energy. A fresh approach to operational performance is essential - the small-scale projects won’t deliver the pace and scale of change required.
To decarbonise healthcare facilities, we need transformative changes in energy performance, including insulation, heating systems, and renewable energy
Given its size, the NHS has the potential to boost the green construction sector and support broader community heat networks. But without sufficient funding for clean energy infrastructure, it will continue making minor adjustments instead of leading the way toward net zero healthcare.
We must shift from a short-term focus on marginal improvements to long-term transformative investments that align NHS hospitals with the UK's carbon commitments. NHS leaders should advocate for sustained, large-scale capital investments specifically focused on sustainability, rather than just maintaining the status quo.
While some NHS Trusts have substantial cash reserves that could be invested in their properties and infrastructure, capital expenditure limits restrict major projects.
It’s time for NHS directors to consider broader operational transformations and explore new opportunities for their properties to support better future health outcomes.
Trusts can only spend predetermined amounts on capital projects, even if they have substantial reserves. The amounts spent are often insufficient to address maintenance needs, let alone cover smaller capital projects.
Currently, 48 Trusts are part of the New Hospital Programme, aiming to secure significant funding, but this may not be enough for transformative healthcare. This approach leaves over 150 other Trusts dealing with an £9bn capital backlog across England. Even with an election on the horizon, there will not be a quick fix for the NHS.
While some Trusts could do more to unlock reserves for transformative projects, they all face capital spending limits. What we need is an organisation-wide mindset shift to drive infrastructure investments.
It’s time for NHS directors to consider broader operational transformations and explore new opportunities for their properties to support better future health outcomes. Until we address the way we think about transformation within the NHS, the changes it so desperately needs simply won’t come.