The NHS estate is one of the health service’s most important assets. From hospitals and community facilities to administrative buildings, the environments in which care is delivered have a direct impact on patient safety, staff wellbeing and operational performance. Yet our research suggests many organisations are struggling to maintain their estates in the face of increasing financial and operational pressures.
In March 2026, we surveyed 77 NHS estate leaders to understand the challenges, priorities and opportunities shaping estate maintenance across the NHS. These findings highlight the scale of the challenge many organisations face. Estates teams are being asked to maintain increasingly complex buildings and infrastructure while working within constrained budgets and responding to growing service demands.
In our new guide, Maintaining the NHS Estate, we help you tackle some of the key challenges raised.
As outlined in NHS Property Services’ NHS Guide to Estate Funding, estates teams should not simply wait for capital funding to be approved. The period between identifying a need and securing investment can be used productively to strengthen the case for funding while improving the performance of the existing estate.
Delivering the ambitions of the Government’s 10 Year Health Plan will depend not only on investment, but also on how effectively organisations use the buildings and spaces they already have. Future models of care will require more flexible community facilities, spaces that can adapt to changing demand, and estates that support integrated, digital and sustainable healthcare delivery.
Start by understanding how buildings are performing
While capital funding remains essential for major transformation, approval processes can be lengthy. In the meantime, estates teams can take practical steps to optimise existing assets, reduce costs and unlock value.
NHSPS’ Estate Optimisation Guide encourages organisations to take a strategic, data-led approach to understanding estate demand and supply. By reviewing how space is being used, engaging stakeholders and considering a range of options for improvement, organisations can make better use of their estate today while preparing for future investment.
1. Review how space is being used
Start by understanding how buildings are performing.
Many estates contain areas that are underused, poorly configured or no longer aligned with service needs. Reviewing utilisation data and occupancy patterns can help identify opportunities to repurpose, consolidate or better manage space.
Establishing a clear picture of current usage ensures future investment is targeted where it will deliver the greatest benefit. As outlined in the recently published 10-year capital plan, the upgrading and repurposing of existing estate continues to be a key priority, and NHSPS, alongside the Department of Health, will capitalise on opportunities to unlock improved utilisation, co-location (physical and digital, driven by our investment in technology to ensure systems are interconnected) and service integration in existing buildings.
2. Improve utilisation before investing in new space
Before seeking additional accommodation, consider whether existing space can work harder across the core and flex parts of your estate, as well as the current role the familiarity of the estate and NHS play, as an anchor institution for placemaking in the local community.
Better booking systems, occupancy data and service planning can often increase capacity without significant capital expenditure. Small operational changes can help organisations accommodate growing demand, improve patient access and make more efficient use of existing facilities.
Demonstrating that current space has been fully optimised can also strengthen future business cases, with robust schedules of accommodation.
3. Generate income and reduce unnecessary costs
Revenue generation and estate optimisation often go hand in hand.
Vacant or flexible space may provide opportunities for shared use with partners across the health and care system, creating income while supporting collaboration. At the same time, reducing or releasing underused space can reduce backlog maintenance, energy and operational costs and free up disposals for capital reinvestment.
Even modest improvements can deliver financial benefits while organisations await capital decisions.
4. Explore alternative funding routes
Central capital funding is not the only option available.
Estates teams should consider alternative approaches such as developer contributions, lease renegotiations, internal funding sources, property disposal and reinvestment, or third-party development solutions. Exploring these routes early can help to unlock projects more quickly and reduce reliance on future capital allocations or to potentially create a blended funding solution.
5. Prepare a strong business case now
One of the most valuable uses of the waiting period is developing a robust case for investment, especially a strategic case and options appraisal.
This means gathering utilisation and demand data, assessing feasibility and deliverability, aligning proposals with organisational priorities and engaging stakeholders early. Clinical, operational, finance and estates colleagues should all be involved in shaping proposals from the outset.
Organisations that complete this groundwork in advance are often better placed to secure funding and move quickly when opportunities arise.
Making the most of the waiting period
Rather than viewing the time before capital approval as a delay, estates teams should see it as an opportunity to optimise existing assets and build a stronger foundation for future investment.
By understanding demand, reviewing utilisation, reducing avoidable costs and identifying opportunities to generate value, organisations can improve estate performance today while preparing for tomorrow’s transformation.
As organisations plan for future models of care, this also means maturing the estate so that buildings, systems and data can support the shift towards smarter, more connected healthcare environments.
The focus should not only be on the capital required for change, but also on how to get the maximum value from the estate already in place.
Taking these steps now can help keep services functional, efficient and adaptable, while creating a stronger evidence base for future funding decisions.
