CAPITAL PROGRAMMES
What the data shows: readiness across the programme The findings from the programme director survey are striking. Approximately 75 per cent of NHP programmes reported that they were unclear on the specific operational changes needed to deliver their business case assumptions. More significantly still, not one programme surveyed was actively tracking transformation metrics alongside construction milestones. In a programme that places considerable emphasis on standardised design, governance, and construction efficiency, transformation – the very thing that determines whether a new hospital delivers the outcomes it was built for – remains largely unmonitored and unassured at programme level. This finding has direct and immediate relevance for estates and programme leaders. The Gateway Review process, which provides structured independent assurance at key decision points in capital programmes, does not currently require transformation readiness to be evidenced with the same rigour as construction or financial milestones. The research argues compellingly that this must change.
Implications for programme leaders The research sets out a four-stage framework for embedding transformation within capital programmes, which translates directly into a set of practical imperatives for those leading NHP schemes and analogous capital investments: 1. Reframe and quantify the ambition. Programme leaders must understand and explicitly quantify the transformation gap – the gap between where their organisation is today and where it needs to be on opening day. This requires honest, evidence-based
analysis of current performance against business case assumptions, and a clear articulation of the risk if the gap is not closed. Too often, the research found, this analysis is either not conducted or its conclusions are not translated into funded action plans.
2. Create real confidence through early action. Transformation trajectories must be mapped to specific projects and milestones, not left as abstract commitments. Investment cases for transformation must be developed and secured separately from the capital case. Pilot and test-and-learn programmes should begin years before opening, treating go-live as the final validation of a well-tested model rather than the first real test of an untested one.
Royal Liverpool University Hospital.
August 2026 Health Estate Journal 59
Matt Livey Architectural Photography, NBBJ and HKS
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