The pressures on the NHS are considerable, but its estate doesn’t need to be one of them. With some strategic thinking, we can unlock the potential of this sizeable asset to improve patient care, and deliver longer-term benefits too, says Wayne Ashton, Healthcare Planning Partner at Ridge

We all know that the NHS estate is vast, sprawling and in need of considerable investment. The latest Estates Return Information from NHS England, highlighted in Lord Darzi’s ‘Independent investigation of the NHS in England’ September 2024, shows a maintenance backlog of £11.6bn. But we could look at it another way: the NHS has an enormous amount of valuable property that it is not using to its full potential.

The current state of many healthcare buildings is a challenge, but it’s also an opportunity to rethink where and how the NHS is delivering care, and whether there’s a better way of doing things. I’ve worked with numerous trusts and health systems to help them use their spaces more effectively. I’ve seen first-hand the benefits that a strategic view can bring – from improving patient care and working conditions for staff, to cutting operational costs and carbon emissions. Ultimately, it’s about releasing capital to create momentum and kick off a chain reaction of positive impacts.

Ultimately, it’s about releasing capital to create momentum and kick off a chain reaction of positive impacts.

Uncovering spare capacity

The first step is to identify what a health system’s estate looks like and how it is used – where is the demand, where is there spare capacity, and how could it be deployed to deliver better care or free up space elsewhere? Once you start moving functions around, that creates a knock-on effect across the whole estate and poor-quality space can then be disposed of or redeveloped to release funds for investment. From a revenue perspective, for every £1 million released from surplus property, you can fund three new GP surgeries.

From a revenue perspective, for every £1 million released from surplus property, you can fund three new GP surgeries.

As an example, one NHS healthcare system had 35 large, health centres constructed under the LIFT public-private partnership programme. Taking a very conservative approach, I calculated that these facilities could accommodate 13 million patient activities each year. At the same time, a different part of the system was using another 500 buildings to deliver primary and community health services, many in converted houses, seeing in the region of 15 million patients a year. Consolidating those functions could theoretically free up an enormous amount of property. Of course, there are many other factors to consider, but this goes to show just how much capacity a typical health system has to play with.

Net Zero

Disposing of inefficient, poorly performing buildings will also help to meet Net Zero targets. NHS England has set a bold, world-leading ambition to deliver a Net Zero health service by 2045. For its estate, it is aiming for an 80% cut in carbon emissions by 2028-32, and for it to reach Net Zero by 2040. This will involve upgrading building fabric and systems at scale, and switching from fossil fuels to electricity so that buildings can run entirely on renewable energy as the grid decarbonises.

To say that this presents an enormous retrofitting challenge is an understatement, especially for an organisation that is already under many other pressures. One welcome shortcut would be to shed the worst-performing assets. This would have the immediate benefit of reducing the carbon footprint, but it would also lower the longer-term investment required.

To say that this presents an enormous retrofitting challenge is an understatement, especially for an organisation that is already under many other pressures. One welcome shortcut would be to shed the worst-performing assets.

Social impact

At the same time, there is a massive opportunity to work with local authorities to rejuvenate town centres. Central locations typically benefit from good public transport links, but in the current economic climate, many local economies are struggling. By relocating healthcare services to high streets, we can help to create self-sustaining communities. It could even be possible to turn the considerable footfall healthcare buildings generate into a commodity, by using it to negotiate more favourable rents.

Central locations typically benefit from good public transport links, but in the current economic climate, many local economies are struggling. By relocating healthcare services to high streets, we can help to create self-sustaining communities.

This is not just about securing better-quality accommodation and making limited funds go further, it’s also a way of using public money to deliver greater public benefits. There is a growing body of evidence on the links between physical and mental health and the places where people live and work. Targeting investment where it will yield the greatest improvement in those environments will quickly begin to pay off. Over the long term, adopting a more holistic strategy will mean fewer patients visiting GP surgeries or Accident & Emergency wards, and alleviate demand on the NHS itself.

The art of the possible

Optimising healthcare estates is the art of the possible. No incoming government could afford to write a blank cheque, and there are many more pressures on the NHS than crumbling buildings. That means it needs to sweat its assets, maximise utilisation rates and take a fresh look at leveraging what it already has. This is about using buildings as a catalyst for change – change that starts incrementally, but could deliver very significant improvements over time.

Find out how Ridge helps NHS organisations unlock the true value of their estates by contacting Wayne Ashton, Healthcare Planning Partner WayneAshton@ridge.co.uk

Wayne and a team from Ridge will be at stand H21 at the Healthcare Estates Conference on 8-9 October 2024 at Manchester Central and would love to connect with any attendees.

Phil Kelly a Partner in Sustainability is presenting “The impacts of the NHS NZC Building Standard” in the Design and Construction Theatre at 2.30pm on 9 October.

Contact any of the team in advance of the Healthcare Estates Conference:

Andrew Bray
Wayne Ashton
Tom Yearsley
Sarah Chipchase
Phil Kelly
Steve Dalton