ESTATE PLANNING However, there will always be situations where


Figure 2: An example building ‘heatmap’.


make estate planning and development within the NHS particularly complex: n Insufficient funding – Capital budgets are under constant pressure, with NHS organisations competing for limited investment.


n A complex funding landscape – Many NHS leaders struggle to navigate funding streams, with an NHS Property Services (NHSPS) report (2022) identifying a need for greater expertise in securing capital.


n Coordinating efforts across multiple providers – Estates planning often requires collaboration between multiple NHS Trusts, ICBs, and private sector partners. Misaligned priorities, governance complexities, and varying operational needs, create additional challenges in delivering integrated estate solutions.


n Cumbersome approval processes – Major estates projects must pass through at least 19 approval stages, moving between local Trusts, ICBs, NHS England, the Department of Health and Social Care, and the Treasury (NHS Confederation, 2025). This bureaucratic bottleneck leads to delays, inefficiencies, and increased costs.


Kelsey Price


Kelsey Price, Senior consultant at Baxendale, specialises in data- driven estate solutions that enhance patient care, operational efficiency, and long-term sustainability. With a Master’s in Public Health, she combines scientific insight with strategic estates planning to help healthcare organisations optimise infrastructure and service delivery. Her expertise includes health needs assessments, models of care transformation, demand and capacity modelling, space utilisation strategies, and business case development. She says she is ‘committed to ensuring cost-effective, flexible, and socially impactful, estate solutions that address the evolving challenges of the healthcare sector’.


n Workforce and operational constraints – Estates teams struggle to maintain and optimise NHS buildings while contending with financial constraints, workforce shortages, and ambitious Net Zero carbon targets.


These challenges not only stall progress, but prevent NHS organisations from making the most of their existing spaces – spaces that could be better utilised to meet demand. With new capital investment increasingly difficult to secure, relying on large-scale funding allocations for new buildings is no longer a sensible strategy. Instead, NHS Estates teams must shift focus towards maximising the use of existing assets. The reality is that actual space utilisation is often lower than perceived. The challenge isn’t always a lack of space, but rather how effectively it is used. Unlocking capacity is not just about building more, it is about better using what we already have. A data-driven, strategic approach to estates management can: n Optimise existing space to increase capacity without costly new-builds.


n Enhance flexibility to meet evolving service demands. n Improve staff wellbeing by creating more efficient and functional workspaces.


n Reduce inefficiencies and drive cost savings.


A lack of insight Many NHS organisations lack access to the insights needed to make informed decisions about space utilisation. This means valuable capacity is often underused or misallocated. The future of NHS estates isn’t just about new buildings; it is about ensuring that every square metre is used effectively, whether through optimising existing space, or designing smarter, more cost-effective, new facilities.


48 Health Estate Journal June 2025


The future of healthcare estates – what we have learned Through our work in healthcare estates planning, we have seen that embedding data-driven space planning into estates strategies is invaluable. Our key learnings include: 1. Technology is essential in bridging the gap between perception and reality in space utilisation. Sensor technology and real-time analytics provide objective insights, but real value comes from applying this data to drive efficiency.


new-builds are the right solution. When this is the case, having accurate data on space usage can significantly shape the size, layout, and cost of new facilities. By using sensor technology to inform decision-making, organisations can ensure that new buildings are designed to match actual needs, often leading to smaller, more efficient, and more affordable, developments than originally planned. Sensor technology offers an opportunity to shift from assumptions to evidence-based decision-making. By deploying sensors in specific buildings for a short period to answer a specific strategic question, organisations can make targeted, data-driven decisions without committing to long-term costs. Sensors enable organisations to capture real-time data on occupancy and movement, identifying underutilised spaces and inefficiencies. This data, when analysed and visualised effectively, provides a foundation for smarter space management. It helps Estates teams to: n Understand patterns of use. n Anticipate demand fluctuations across the day or the week.


n Explore opportunities for repurposing or redesigning space.


While there is an upfront cost associated with deploying sensors, it is a one-off investment. From our experience, the return on investment – whether through cash-releasing savings or avoided costs – far outweighs this initial expenditure.


A clearer picture of space requirements For example, in a new-build project, installing sensors in existing buildings where teams are currently based can provide a clearer picture of actual space requirements. This evidence could support a significant reduction in the size of a proposed new building, leading to substantial cost savings. However, data alone isn’t enough. The challenge isn’t just in collecting information, but in how organisations respond to it. If rooms remain empty during peak hours, is this due to inefficiencies in scheduling, or does the space no longer meet clinical needs? Should underused areas be repurposed for more flexible use, or could they be converted entirely? Technology provides insight, but real transformation


happens through people. Estates teams, operational leaders, and frontline staff, must work together to translate data into action. For example, in one community provider (see case study below), occupancy sensors revealed that clinic rooms were often booked but not actually used. On paper, the space was in high demand, but the reality was inefficiencies in scheduling, miscommunication between departments, and outdated booking processes. We worked with the teams to ensure a human-centred approach, ensuring that data-driven insights are not just theoretical, but that instead they lead to practical, impactful changes.


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