ESTATES MANAGEMENT


Research & Innovation Centre at Leeds Teaching Hospitals NHS Trust.


Simon Yeo


Simon Yeo is healthcare sector lead (South West) at Gleeds, specialising in healthcare estates strategy, infrastructure planning, and capital programmes. Before joining Gleeds, he spent over 23 years working within NHS estates, including leadership roles in both provider organisations and system- level estate planning. A Fellow of IHEEM, his work focuses on helping NHS organisations plan and evolve their estates to support changing models of care.


in isolation, even though their cumulative impact may shape how the estate evolves over time. System collaboration also becomes increasingly important as models of care evolve. The estate that supports them rarely sits neatly within a single organisation. Acute hospitals, community services, primary care, mental health services, and diagnostic infrastructure all form part of the same wider landscape. Where organisations begin to plan the estate at that broader system level, it becomes easier to consider how services might be delivered differently across settings rather than simply expanding existing facilities. None of this removes the operational pressures estates teams face every day. Backlog risks, service requests, and investment decisions will always remain part of the role. However, when organisations create even small opportunities for strategic reflection, the conversation begins to widen. Estate decisions start to be considered not only in terms of maintaining existing buildings, but also in terms of how the wider estate can support the long-term direction of health and care systems.


Andy McNulty


Andy McNulty is Gleeds’ head of healthcare. After initially joining Gleeds in 1993, and then returning in 2014 as a director, Andy has managed the health team for over ten years. Andy’s role involves supporting Gleeds teams and clients in the planning and delivery of complex healthcare projects, ensuring both financial and environmental sustainability. In addition to framework and client management he also focuses on identifying training, development and upskilling requirements across Gleeds’ core services to reflect the changing requirements of the NHS.


How the estate is really shaped By the middle of the afternoon, the pace of the day has not eased. The estates leader who has been dealing with backlog risk, operational pressures, and capital programme deadlines throughout the day is still navigating the same flow of decisions. A new request for space may have appeared. A project programme may suddenly face delay or require acceleration. An unexpected infrastructure issue demands attention. In the background, the organisation may already be operating at OPAL 3, with pressure building towards OPAL 4. Meetings that might normally unlock decisions are postponed, and progress slows as the system focuses on managing immediate pressure. All while emails continue to arrive and meetings continue to fill the calendar. None of this feels particularly strategic in the moment. Most of it simply feels like the practical work of keeping a large and complex healthcare estate functioning safely. Yet it is within these ordinary moments that the future


shape of the estate is often quietly determined. Every decision about how space is configured, which


projects are prioritised, where investment is directed or how services are accommodated contributes incrementally to how the estate evolves. Over time, these individual choices accumulate, influencing how buildings are used, how services are organised, and how effectively the estate can support changing models of care.


Lasting consequences For most estates leaders, none of this will feel like a revelation. It is simply the lived reality of the role. Those working across NHS estates know instinctively that operational decisions made today can have consequences that last for decades. Strategy documents and infrastructure plans help organisations articulate direction and align ambition. But


56 Health Estate Journal June 2026


the estate itself rarely changes through strategy alone. There are, of course, moments when change happens at a much larger scale. Major national programmes such as the New Hospital Programme, including the development of Hospital 2.0, will reshape parts of the NHS estate through significant capital investment and the construction of entirely new facilities. But those moments remain the exception rather than the


rule. For the vast majority of the NHS estate, change


happens more gradually, through the steady flow of decisions made every day in response to real operational needs. This is why the role of estates leadership within


healthcare systems is so significant. The individuals making these decisions are not only maintaining buildings or delivering capital projects; they are shaping the environments in which care will be delivered for many years to come. That influence may not always feel visible in the moment. A day filled with operational pressures can easily feel disconnected from the longer-term direction of the organisation or the wider system. But viewed over time, the impact becomes clearer. The configuration of clinical space, the location of diagnostic services, the development of community facilities, the resilience of infrastructure and many other choices all reflect decisions made over years of operational leadership. Each one may have been taken to solve an immediate


challenge. Together they determine how effectively the estate supports patients, staff and the wider health and care system.


Major capital programmes will always play an important role in reshaping parts of the estate. But for most organisations, the estate evolves in a quieter way. It evolves through the steady accumulation of


operational decisions taken every day across the system. Through our work across multiple organisations and


systems, we see this pattern repeatedly. The future NHS estate is not shaped only through strategy documents or national programmes. It is shaped through thousands of decisions made in real time by estates leaders responding to the operational realities of healthcare. So while the pace of another busy working day may leave little room for reflection, the decisions taken throughout the day matter more than they might initially appear.


Because over time those decisions quietly shape the


environment in which care will be delivered. And tomorrow morning, the process begins again.


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