UTILITY ENABLING WORKS
When taken together, these experiences reveal consistent patterns that can guide future hospital schemes, helping new teams avoid familiar pitfalls.
What these experiences teach us Several lessons recur across enabling workstreams: n Early understanding of the estate prevents surprises. Surveys, investigations, and operational engagement provide a realistic platform for design.
n Multidisciplinary engagement strengthens decisions. When clinical, estates, digital, procurement, and finance colleagues are engaged early, assumptions are tested and refined.
n Differences between BAU and Projects can be used constructively. These perspectives provide valuable checks and balances.
n Governance must reflect statutory lead times and real world constraints. Business cases and approvals progress more smoothly when they acknowledge what can and cannot be influenced.
Render of conceptual new QEH design.
to that change in a controlled way becomes one of the programme’s most important disciplines.
Changing scope without losing control Design maturity develops gradually. Surveys reveal unexpected conditions. Chamber locations shift. Operational requirements evolve. None of this is unusual, but without structured change control, it can destabilise confidence. Controlled flexibility protects the programme. It ensures
Leon Stefanski
Leon Stefanski is a senior project manager in the New QEH Design and Construction team at The Queen Elizabeth Hospital King’s Lynn, a Wave 1 scheme within the national New Hospital Programme. He joined the NHS in 2025 following roles in Ministry of Defense Estates and the social housing sector. With a strong MEP background, Leon now leads utility enabling works & leads MEP in New QEH design and construction phases, with a focus on multidisciplinary coordination, improving the wider public estates sector and sharing lessons across the healthcare estates community.
that changes are understood, costed, and aligned with long-term intent. Change control is not a barrier. It is a safeguard. It prevents well intended adjustments becoming future constraints or unintended consequences. Clear communication is essential. Technical teams need guidance on how scope changes will be managed. Stakeholders need reassurance that decisions are justified. When the reasons behind changes are shared openly, flexibility becomes an advantage rather than a source of uncertainty. But even the best change control cannot succeed
without alignment between those who run today’s hospital and those building tomorrows. Bridging that organisational divide is often where progress is won or lost.
Two mindsets, one estate: bridging BAU and projects Business as Usual (BAU) and Major Projects teams approach risk differently. BAU focuses on resilience, safety, and continuity. Major Projects focus on transformation, sequencing and long-term development. Enabling works sit between these viewpoints, naturally creating tension. This tension is often productive. BAU colleagues highlight operational risks that may not be obvious from a design perspective. Project colleagues challenge short-term decisions that could create long-term constraints. When these viewpoints are engaged early, the project gains stability and momentum. Having worked across BAU Hard Facilities Management (FM), main contracting, subcontracting, and client-side delivery, I have seen how often misunderstandings arise when context is missing. A short briefing session can prevent weeks of delay. A shared site walk can clarify assumptions that technical drawings cannot fully convey. Small acts of collaboration therefore have a
disproportionate impact. They build trust, reduce misalignment, and support more confident decision making across the programme.
50 Health Estate Journal May 2026
n Collaboration is the strongest predictor of success. Shared understanding reduces rework, increases confidence, and improves programme resilience.
All these lessons reinforce a simple point: enabling works succeed when they are understood as a shared responsibility. These lessons do more than shape individual projects; they set the foundation for how the entire New Hospital Programme can move with more confidence and consistency.
Why strong foundations shape the future We are at the beginning of what has been formally described as the UK’s biggest hospital building programme in a generation, with the New Hospital Programme establishing a long-term, multi-wave pipeline of investment intended to renew and modernise acute care across England. Alongside this, government commitments of up to £15bn across consecutive five year waves signal the most sustained capital investment the NHS has seen for decades, providing stability, predictable funding, and the opportunity to reshape the healthcare estate at a scale not witnessed since the major hospital building programmes of the late twentieth century. As this generational programme gains momentum, the lessons learned in its earliest phases will pay dividends if they are captured, shared, and managed effectively. The healthcare system – from Trusts to regional teams to national bodies – stands to benefit significantly from applying these insights. Strong early foundations do more than support individual projects. They create long-term value that the wider healthcare industry will continue to benefit from throughout the life of the New Hospital Programme and far beyond. The visible transformation of a hospital depends on
work that happens quietly – months or years earlier. Utility enabling works shape the pace, feasibility, and resilience of the wider redevelopment. Their success is not measured by how visible they are, but by how smoothly the programme progresses because of them. As estates become more complex and digital systems more essential, these early activities will only grow in importance. National programmes require resilience, compliance, and long-term thinking. Investing in early strategies, collaboration, and clear narratives is essential for future hospital transformation. Well delivered enabling works rarely attract attention.
They do not feature in updates or photography. Their invisibility becomes the sign they were done well. They allow the new hospital to take centre stage. And that is exactly as it should be.
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