ESTATE MANAGEMENT AND OPTIMISATION
‘Five Step’ approach to repurposing council space
With around 6.5 million people on NHS waiting lists in England, and a limiting factor in reducing this list a lack of space for consultations and procedures, plus a longer-term trend in the NHS and globally towards delivering more healthcare outside hospital settings, Smriti Singh, MD of Symbi Consulting, and Jacqui Baxter, a director at View 10D, argue that repurposing existing vacant local authority properties for healthcare provides a solution which helps both financially challenged councils, and the NHS.
The estate has been identified as a major limiting factor on the ability of the NHS to reduce the current waiting list size of 6.5 million people in England alone. What can we do to provide the right space with so many financial pressures on the public finances as a whole? There are lots of opportunities to create new healthcare facilities in existing buildings, and we need to make sure that the right first steps are taken to ensure unnecessary costs are not incurred. Repurposing existing local council buildings for
healthcare provision undoubtedly has both timeframe and CO2
benefits over new build, but although there is
established experience drawing on HM Treasury’s The Green Book and NHS guidance on building projects for new-build NHS capital projects, the procedure for repurposing is less clear-cut. Of course, starting any building project requires a significant amount of senior management time, with the early stages in particular often very time-consuming and expensive, when there is considerable uncertainty.
Benefits beyond reducing elective waiting lists In this article we analyse the benefits of investing in healthcare in the community (why the benefits go beyond reducing elective waiting lists), and set out our methodology for repurposing office/retail for healthcare. All in all, we believe a compelling case exists for investing in healthcare spaces outside of hospitals. Moreover, we have a clear and structured methodology that enables council and NHS executives to repurpose existing retail/ office spaces with reduced risk and lower cost. Clearly the estate is not the
only challenge facing the NHS. With some 106,000 vacancies (as of late 2024/early 2025), and a significant proportion of temporary staff filling posts, there are other issues, but there remains an urgent need to improve the condition of NHS estates. There are many reasons for this and, as the Darzi report, Independent Investigation of the National Health Service in England, published last
June 2025 Health Estate Journal 31
September, notes, ‘the NHS has been starved of capital’, citing a shortfall of £37 bn. It’s not a simple task to get best value we need to provide for uncertain future needs, while considering how spending should be prioritised on competing short and long-term objectives.
A global shift The Darzi report also highlights an opportunity for health in the community. This global trend towards shifting more healthcare in the community – with better experience for people and more economic sustainability, is well established. It is clear that in the long term we need to transition from a healthcare approach that ‘fixes’ individuals, towards systems which support populations to live well. The Institute of Healthcare Improvement promotes the ‘Triple Aim’ as being the ultimate destination of healthcare systems: (1) Better health for the population; (2) Better experience of care, and (3), Reduced per capita costs. Moving more care out of hospitals is one step toward achieving this. With short-term budget constraints, we need to take cost-effective steps in the right direction of this movement. The NHS Confederation’s 2020 Health on the high
street report is very much in line with a move to a different healthcare system. Turning the strategy into a deliverable plan is currently very much on a localised basis, with some great schemes moving forward. An example of this type of thinking is the Barking Riverside development on the banks
The Barking Riverside development on the banks of the Thames co-locates a waterpark, gym, café, and a range of healthcare and support workers, ‘to help with mental, physical, and financial health’. The photo shows land set aside for the Barking Riverside Health Hub.
Barking Riverside Ltd and Aerial Essex
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