UTILITY ENABLING WORKS
Invisible foundations: utility enabling works
Utility enabling works are the unseen foundations of major hospital redevelopment. Here, Leon Stefanski, senior project manager in the New QEH Design and Construction team at The Queen Elizabeth Hospital King’s Lynn, explores how early-stage infrastructure, multidisciplinary coordination, and cross-team collaboration shape the success of complex NHS transformation programmes.
On a cold, wet morning at the end of November, we stood in a leaf-strewn path of the estate watching the first excavations for a simple fibre diversion begin. It looked like a small trench in an unremarkable patch of ground, yet it marked the first visible step in a chain of works that would shape the entire redevelopment.
The work no one sees but everyone depends on Major hospital redevelopments are often understood through their visible stages. Stakeholders remember the design launches, the hoardings around the construction site, and the first spade in the ground. These moments are important. They demonstrate progress and reassure people that the future hospital is moving forward. Yet the real momentum of a redevelopment is shaped by work that rarely features in photographs. It is formed by what sits beneath the surface long before construction begins. Utility enabling works – the infrastructure that powers, connects and supports the estate – must be designed and delivered years in advance. Their purpose is simple: prepare the site to receive the new hospital. Their impact, however, is far from simple. When enabling works are delivered well, they quietly support progress without attracting attention. When they stall or misalign, they quickly become some of the most programme critical risks across the entire redevelopment. Across NHS estates, enabling works are often underestimated. The complexity is not always obvious, particularly when compared to the scale and ambition of the new hospital. A data diversion, the details behind a ducting route or a plant room upgrade can appear modest, yet these interventions determine whether the wider programme can move forward at all. They shape the order in which land can be released, structures can be built, decanting can occur, and resilience can be maintained. This article reflects on lessons learned from major
redevelopment programmes. It explores the range of enabling activities – from high impact power infrastructure to subtle digital diversions – and examines the multidisciplinary role required to deliver them. The technical challenges are only part of the story. The broader themes are strategic – clarity, alignment, and collaboration are
essential to create strong invisible foundations for future hospital transformation. Understanding why enabling works matter is only the starting point. To see their true impact, we need to look at the very different types of infrastructure that sit behind a major hospital redevelopment.
The spectrum of enabling works: from the obvious to the overlooked
When the biggest dependencies set the pace Every major redevelopment has at least one enabling activity that dictates the pace of the wider programme. For some schemes it is a new electrical connection. For others it may involve gas reinforcement, a major sewer diversion, or a complex telecoms route. In one of my
The Queen Elizabeth Hospital (QEH), King’s Lynn.
When enabling works are delivered well, they quietly support progress without attracting attention. When they stall or misalign, they quickly become some of the most programme critical risks across the entire redevelopment.
May 2026 Health Estate Journal 47
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