ESTATE MANAGEMENT AND OPTIMISATION The authors stress that while ‘there are lots of
opportunities to create new healthcare facilities in existing buildings’, ensuring that the right first
steps are taken to ensure unnecessary costs are not incurred is key in any such ‘repurposing’ project.
but the local NHS commissioning organisation did not see the particular locality as its top priority for capital investment. In other scenarios, while the parties were keen to work
together, and a site was identified, development of a plan was hindered, as the Integrated Care Board was unable to give an indication of the amount of accommodation required, or the approximate rent it was able to pay. Until an overview was provided, it was not possible for the councils to commit to further investment to exploring the project, or to put in place any governance arrangements to oversee preliminary work, e.g. drawing up plans etc.
Repurposing over new-build Whilst there are challenges to NHS and local authority collaborations, there are substantial benefits to repurposing existing buildings. This could be a simple fit-out, or a comprehensive refurbishment, stripping the building back to its concrete frame with additions and cut-outs to provide a complete redesign. Not only does a comprehensive refurbishment present the potential for a reduced project/ construction timeframe and costs, but it also has considerable environmental benefits; even timber-framed new buildings cannot come close to the CO2
credentials
comparative to a refurbishment. The CO2 benefits of repurposing existing buildings have resulted in the growth of ‘retrofit first’ policies coming into effect, meaning that refurbishment must be considered before permission will be granted for the demolition and new build in some areas. Starting any building project requires a significant amount of senior management time. The early stages in particular can be very time-consuming and expensive (for example with the associated costs of consultant advice), when there is considerable uncertainty. To decrease that uncertainty and prioritise projects there are significant benefits to having initial overviews, with high-level consideration of all the potential factors. There is established experience drawing
on The Green Book and NHS guidance on building projects for new-build NHS capital projects, but the procedure for repurposing, which may well fall below the threshold for needing an HMT-compliant business case, is less clear-cut. We have seen instances where,
even where there is a strong desire to create more healthcare facilities near places where people live and work, it can be difficult for the parties to know where to begin. Some projects begin by commissioning designs, others by commissioning investigations, and some even begin the process of a Green Book business case.
June 2025 Health Estate Journal 33
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