News & Updates

A Changing Landscape

A Changing Landscape
The NHS has a huge footprint, with an estate spanning 25 million m2 – that’s equivalent to over 3500 football pitches. We have over 10,000 buildings, including 1,140 hospitals and 7,500 primary care sites.

Much of the NHS estate in England consists of world-leading facilities that enable the NHS to deliver outstanding care for patients.

The NHS estate is critical to the delivery of clinical services and plays a key role in improving patient care. A fit for purpose estate means that we can deliver the kind of modern digitally enabled patient care pathways that we know works best for staff and patients.

But some of our estate is old, in parts significantly older than the NHS itself, and would not meet the demands of a modern health service even if upgraded. This long-term lack of investment in the estate has led to record levels of backlog maintenance across the estate – now estimated to be over £10bn.

Despite this, the NHS is delivering within the capital funding envelope we have, ensuring the NHS uses its resources effectively and maximises value for money.

A number of initiatives have been put in place following the Carter and Naylor Reviews to increase capacity and efficiency such as the New Hospital Programme, the Community Diagnostic Centres programme, the A&E Programme, the Mental Health Dormitories Programme, the RAAC programme, and more recently the Targeted Investment Fund programme. There is a renewed focus on the NHS estate and its workforce – and a recognition that high quality physical infrastructure is key to supporting NHS service delivery.

But we need to look beyond the New Hospital Programme and ensure that as facilities reach their end of life they are replaced by new ones, investing before there is a disruption in services.

Solving issues by strategic planning for the long term

A safe, modern, well-planned and patient-centred estate means we can deliver high-quality services for all and improved value for money for the taxpayer.

By planning NHS infrastructure strategically and using system insights – as we are asking ICBs to do through 10-year system infrastructure strategies – we can make the case for long-term investment in the estate. Doing so can help to address necessary backlog maintenance, support the recovery of our core services, and produce flexible solutions to meet the future needs of patients and staff, while also ensuring the most efficient and productive use of our resources.

Part of this process is categorising all of the buildings in a system into core, flex and tail. This means we know which buildings are fit to deliver modern, joined up healthcare and will continue to deliver services in the long term (core), those which are suitable for now but may not be appropriate for future models of care (flex), or buildings that don’t support current models of care or are poorly located so should be disposed of (tail).

These system infrastructure strategies will feed into a national infrastructure strategy, which we will use to inform national planning and any requests for capital funding at spending reviews.

Systems will be required to refresh their strategies every 5 years as part of the rolling programme, enabling us to have a clear and accurate picture of the current NHS estate and what’s needed to maintain and improve service delivery.

And while we are moving forward with improving the NHS estate, we are also working to improve the reporting process for all centrally funded estates projects, with the roll out of a single national capital reporting tool.

The tool will make the reporting process more efficient and ensure data is consistent and less fragmented.  Regions will have real-time visibility of the status of projects, better ability to align our delivery to high level strategic objectives, and improved quality of delivery through consistent processes and governance. ICSs in London have already had success using this cloud-based platform, specifically configured to report and manage their estates capital projects. Teams in London found the biggest benefit was the time saved collecting, reporting and assuring data.

This is why we are so keen to scale this up nationwide and why NHS England will fund the initial build cost and 10 licences per ICS until March 2025. We’ve already started to work with teams in the East of England and the North East and Yorkshire regions to tailor the national capital reporting tool to local needs and maximise its benefits.

This is a critical time for the NHS estate, and a great opportunity to innovate and reconfigure the NHS estate to make it the best possible environment for staff and patients. By doing so we will be able to deliver patient pathways and care that work better for our patients, our staff and the taxpayer.

Read more about how to develop an NHS Infrastructure Strategy: https://www.england.nhs.uk/publication/guidance-on-developing-a-10-year-infrastructure-strategy/

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