With more than 1,200 hospitals and healthcare facilities and an estimated 8,000 buildings in total, the NHS estate is one of the most complex property portfolios in the world. The estate spans many different facilities, all of which house millions of assets including critical medical equipment and essential building systems.
Every one of these physical assets – from MRI scanners to boilers – plays a role in patient outcomes and hospital performance. This means an effective asset management strategy is more than maintenance – it’s about supporting patient safety and care quality, reducing risk and supporting sustainability initiatives.
That’s a tall order for any estates team, let alone those working within the financial and operational pressures facing the NHS. But asset management is evolving. Advances in smart technology and real-time data are transforming how hospitals manage their estates, helping NHS trusts be even more accurate, efficient, transparent and robust in compliance.
What do we mean by asset management?
Asset management refers to the systems, processes and people responsible for overseeing the acquisition, operation, maintenance and disposal of physical assets. That includes everything from lifts and lighting to medical equipment, HVAC systems, IT infrastructure and the buildings themselves. Again, this underlines the scale of the challenge in the context of the NHS.
Asset management refers to overseeing the acquisition, operation, maintenance and disposal of physical assets
Unlike maintenance, which typically focuses on ensuring assets continue to perform safely and effectively, asset management takes a broader, strategic view. It considers the full lifecycle of each asset, including its cost, condition, risk profile, energy use and role in the hospital’s wider performance. Done well, it supports more informed investment decisions, reduces waste and downtime, and ensures the estate is aligned to clinical needs.
Healthcare in a state of disrepair
The most significant obstacle for effective asset management in healthcare is the NHS estate’s ageing estate – much it in a critical state of disrepair. According to NHS Estates Returns Information Collection (ERIC) data, over 40% of the NHS estate in England was built before 1985 – often with outdated or inefficient building systems.
Recent reports estimate that the NHS’s current maintenance backlog will cost around £13.8 billion to fix. A significant percentage of this number is said to consist of urgent repairs to prevent what the NHS has described as “catastrophic failure or disruption to clinical services”, stretching hospitals to their limit and threatening patient care, serves as a stark reminder of the dangers of inadequate asset management that fails to prioritise regular inspections, good data, as well as robust preventative maintenance and early interventions.
As a result, facilities teams must balance patient safety and compliance with urgent repairs and long-term planning. In many hospitals, visibility over asset condition is limited, and teams are forced to rely on reactive fixes or fixed-term servicing. With many estates, clinical and finance systems poorly integrated, it's not always clear which assets are performing, which are costing more than they should, and where investment will deliver the greatest value.
The skills shortage in facilities and engineering teams only compounds these issues. NHS Property Services has pointed to a lack of pipeline talent in engineering and maintenance, which can make it harder to embed new ways of working or adopt digital tools effectively. Upskilling and retaining talent will be vital to any future-facing asset strategy.
A more holistic approach
The answer lies in a more structured, risk-based and data-driven approach to asset management. At Platinum, we aligned with ISO 55001, the international standard for asset management, an accreditation that ensures we follow a thorough, robust process of assessing asset performance, condition, criticality, and service impact as part of our risk assessments.
A chiller may appear to be in good condition, but if its failure would have catastrophic consequences for the building’s operations – potentially rendering vital medicines ineffective – we assign it a higher risk rating. Based on this risk assessment, we can then recommend digital enhancements, such as real-time current monitoring via IoT or hardwired CT sensors, or vibration analysis applications which help to predict failures before they occur. This approach enables us to intervene proactively, reducing the likelihood of unexpected breakdowns.
On one customer site, we assessed critical assets using the ISO 55001 guidelines and identified that the chillers and pumps were essential to operations. From here, we implemented vibration analysis and current monitoring on the electrical supply to a chiller compressor. Doing this showed us that the maximum current demand for the compressor was 200 amps. Now, if the system detects the current exceeding this threshold, an alert goes to both our team and the client, allowing engineers to investigate before equipment fails.
Crucially, however, technology for technology’s sake. Where assets are considered low risk or low value, digital upgrades are deliberately deprioritised, allowing resources to be focused where they deliver the greatest return. The process is part of a wider 360-degree audit model involving continuous monitoring, reporting, and reassessment.
Still, technology can be transformative in the right places. Equipping assets with sensors and integrating them with building management systems (BMS) allows facilities teams to gather real-time data on usage, condition and performance. This includes factors like vibration, energy consumption, humidity and temperature. Rather than relying solely on time-based schedules, facilities teams can shift towards condition-based or even predictive maintenance strategies.
Maintenance becomes more targeted and efficient. Instead of checking every fan coil unit on a ward every three months, engineers can prioritise the units showing signs of stress or increased wear. This reduces unnecessary servicing, minimises disruption to clinical services, and extends the useful life of critical systems.
Consider an operating theatre, where airflow, humidity and temperature must be carefully controlled to maintain a sterile environment. If ventilation systems fail, patient safety is at risk. But if fan motors are fitted with sensors, subtle changes in their performance – such as increased resistance or higher power draw – can signal a problem before it causes failure. Maintenance can then be planned around clinical schedules or diverted to alternative theatres, preventing delays to care.
The insights gained from smart assets don’t just improve maintenance. They can also inform capital planning. Data on asset utilisation and performance helps estates teams prioritise investment, build more accurate lifecycle models, and provide evidence for business cases. For example, a trust might use sensor data to show that a set of air handling units in a maternity ward are running continuously beyond recommended hours, justifying a targeted upgrade that improves energy efficiency and patient comfort.
Over time, smart asset data can even inform strategic decisions such as ward reconfigurations, refurbishment schedules or where to pilot new services. The richer the data, the more confidently estates leaders can weigh up options and understand the knock-on effects of their decisions.
Aligning with net zero goals
Smart asset management also plays a critical role in delivering on the NHS’s environmental targets. With a commitment to cut emissions by 80% by 2028–32 and reach net zero by 2040, trusts are under increasing pressure to understand – and reduce – the environmental impact of their buildings.
Real-time energy data allows teams to monitor and optimise system performance in line with demand. For example, if a cooling tower is fitted with a sensor that detects a water leak, it can be flagged and resolved quickly, saving thousands of pounds and avoiding significant water waste. Similarly, occupancy sensors in administrative areas can enable demand-based controls reducing HVAC runtimes in unoccupied spaces without compromising patient care.
Even small interventions, like adjusting pump speeds or identifying assets that are running inefficiently, can deliver big results across a large estate. Combined, these measures help hospitals reduce operational costs, meet ESG requirements and demonstrate accountability to regulators and the public. For instance, one NHS trust recently identified inefficient chiller units through energy monitoring, leading to retrofits that saved an estimated £50,000 annually and cut carbon emissions by 120 tonnes.
Incorporating sustainability metrics into asset performance evaluations also helps trusts develop more environmentally responsible procurement strategies. Rather than simply replacing like-for-like, facilities managers can use data to explore alternatives with better lifecycle performance and lower total emissions.
Building a hybrid future
The goal isn’t to scrap existing planned preventative maintenance (PPM) regimes, but to enhance them with greater insight. A hybrid approach – one that blends compliance-led servicing with condition-based strategies – is often the most realistic and effective route for NHS trusts.
However, significant barriers remain. Legacy infrastructure, limited interoperability between systems, and a lack of capital investment all make it difficult to scale smart asset management. But progress is possible. Some trusts are beginning to pilot smart sensors and digital asset registers as part of their wider estate strategies. Others are working with integrated facilities management providers to trial condition-based maintenance models.
A smarter way forward
Ultimately, hospital asset management isn’t just about buildings and equipment – the emphasis must be on the people who rely on them. From safer patient care and more comfortable environments to improved staff productivity and reduced emissions, smart asset strategies offer benefits that go far beyond the plant room.
Embedding a culture of continuous improvement, underpinned by reliable data and empowered teams, will be essential. As patient needs evolve and estate demands increase, a smarter approach to asset management will help ensure the NHS estate remains fit for purpose.