ESTATE MANAGEMENT AND OPTIMISATION


Above left: The authors say that their ‘Five Step approach’ provides ‘a low-cost, fast way for the NHS and councils to assess the outline viability of repurposing existing retail/ office space’. Step 1 entails desktop research into local strategies and plans, and information about the property and local area. Above right: Smriti Singh and Jacqui Baxter say: “There are many interdependent factors in developing a healthcare facility; for example, the spatial and structural designs are dependent on the facility requirements.”


Smriti Singh


Smriti Singh, managing director of Symbi Consulting, has over 20 years’ experience of providing strategic advice and delivering change and transformation programmes in the health and care sector. She specialises in developing vision and strategy for new developments, coordinating and authoring business cases, leading senior stakeholder engagement, and supporting client- side co-ordination and monitoring, ‘to enable delivery of true transformation’. She has designed


and run numerous clinical engagement sessions, workshops, and training programmes for NHS teams, is a thought-leader, and has published on healthcare strategy – including the future of hospital buildings. Passionate about transformation of healthcare, and bringing about more integrated models, she has published on this topic, and worked with clients to develop integrated ways of working and bring that thinking to their estates.


of the Thames, which co-locates a waterpark, gym, café, and a range of healthcare and support workers, to help with mental, physical, and financial health. This is a £40 m joint local authority, Barking Riverside Ltd (BRL), and CCG development in the pipeline. BRL is providing land and funding to the project, and is a key partner. Barking Riverside is a residential development scheme being led by Barking Riverside Ltd as master developer. BRL is a joint venture between the housing association, L&Q, and the Mayor of London. There is a strong and well-established case for


more healthcare facilities in the community, but with all the pressures on budgets, and Net Zero regulations, new-build schemes may not always be the answer. Repurposing existing buildings within town centres not only brings healthcare into communities – which is progress from the NHS perspective, but it also has regenerative benefits to town centres; research by Legal & General shows that 48% of visitors to town centre healthcare centres go on to shop at local retailers.


NHS and local council collaboration While government bodies have for decades acted as operational property owners and managers, on the whole they have tended not to invest in commercial properties for financial return, or speculatively to aid regeneration. However, in the mid- to late-2010s local councils started to purchase a considerable amount of commercial property for these reasons. The trend spiked, with councils spending £6.6 bn on commercial property between April 2016 and April 2019, over 14 times the amount spent in the previous three years. While some councils purchased outside their own borough purely for investment reasons, many of the commercial buildings were purchased for regeneration and economic development strategy, but remain without a detailed development plan. A significant number of these commercial properties are now vacant, or likely to become so due to a combination of market and regulatory factors, so the need for development plans is now urgent. Changes in shopping habits, with the rise of online retail, have resulted in more vacant high street and shopping centre units. The move towards home/hybrid working has also changed what occupiers want from office space, resulting in limited demand for older-style office accommodation. Further


32 Health Estate Journal June 2025


changes in environmental standards (Energy Performance Certificate requirements and Net Zero targets) for office space will also render some buildings unoccupiable, or in need of considerable refurbishment, before they can be used. All these factors add to the current economic pressures on councils, while they still need to fulfil environmental, social value, and governance criteria, from their properties.


NAO research Research undertaken by the National Audit Office shows that the number of vacant council-owned properties had increased by 11.2 % between 2017 and 2023, and that figure is likely to have increased further since then. For the two years proceeding December 2023, there were 4,908 council-owned non-domestic properties which were vacant for part of that period, with many remaining that way at the end. The annual cost to councils of holding vacant properties is over £44 m, and the total area of these properties is 8.3 million m2


, which can be analysed


to equate to over 4,000 health centres. Some of these council-owned buildings or sites have


the potential to be the ideal location for health hubs, but bringing together all the parties – including the private sector – to bring finance and expertise, needs a clear, systematic approach. The different knowledge, objectives, and financing/budgets of the parties needs to be carefully navigated. While NHS and council leaders all want the best for their local residents, the structures, funding systems, and ways of working we have inherited, do not always support collaboration. Enabling all the relevant parties to bring priorities into alignment will be a key factor in the development of a scheme, and while in the long-term the English Devolution White Paper (published in December 2024) should help facilitate a more collaborative approach, shorter term there will be disruption for councils, which also needs navigating. Collaboration within the public sector is nothing new, and we have worked on various initiatives to collaborate across councils and their local NHS. However, many good ideas have struggled to move forward or fallen down due to misaligned objectives and ‘chicken and egg’ scenarios. We have seen scenarios where councils have offered space for a new primary care facility,


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