TRAINING AND DEVELOPMENT Knowledge sharing
The discussions were facilitated by the Regulations & Compliance Working Group.
between finding an alternative route to genuine compliance and striking out a requirement because it proved difficult. Contributors with experience in legal proceedings described investigators as relentless about why a derogation was made and who signed it off, whether the guidance was mandatory or advisory. The lesson: involve every relevant party from the start, and document the rationale, the sign-off, and the reasoning in full.
Where the tables pointed
‘Solutions’ at every table pointed upstream: engage earlier, survey earlier, decide earlier, appoint risk-owners earlier. Specific proposals included:
• A Stage 0 multidisciplinary review, modelled on a Quality Design Review,
before a preferred option is committed. • Costed decant strategies in business cases.
• A national position on when to retrofit and when to rebuild.
• Specifying equipment zones rather than fixed room sizes.
• Risk-proportionate processes by project scale.
• A baseline estate-information programme for legacy buildings.
so this proposal considers how the timing of key project activities could better reflect the reality of adapting existing buildings. A revised derogation schedule. Departing from guidance is often necessary in an existing building, and this proposal looks at how such decisions can be made more transparent, clearly owned, and defensible, using the schedule as a tool instead of just reporting.
Five things only policy
can fix The workshop also recorded issues for NHS England, DHSC and the Treasury:
• Short-term funding against a long-term estate. Annual capital cycles drive
move care into the community the strongest incentive to keep it.
• Slow business-case approval. Example: a large elective centre took nearly nine
rushed procurement and undermine whole-life thinking.
• Clinically led, place-based planning rather than estate-led planning.
• Eroded national technical capacity. Guidance revisions cannot be sped
• Succession planning for estates and capital teams.
Two proposals we can build
A healthcare retrofit overlay to the RIBA Plan of Work. Retrofit does not follow the new- build sequence the Plan of Work assumes,
years from bid to first patient, five of them clearing business cases.
• A two-tier estate. Higher delegated thresholds for stronger Trusts risk
Looking forward
A focused roundtable of public and private sector experts pressure tested
up without providing those with the capability and capacity to write them.
widening the gap with weaker ones.
• The acute revenue trap. Activity-based income gives the trusts expected to
the developing ideas of the NextGen Healthcare Network’s Regulations & Compliance Working Group in September 2026, allowing the team to continue building traction through cross-disciplinary, multi-generational experience. The team presented their work to date at Healthcare Estates 2026 and will begin a second round of consultation with the network members in late 2026 and into early 2027. The NextGen Healthcare Network is free to join, and events are free to attend. Professionals with five to 15 years’ experience, and a keen interest in building safe, resilient, and innovative NHS Estates for the future, are invited to join. If you are interested in reading the NextGen Healthcare Network’s detailed report of the workshop, please contact
team@nextgenhealthcarenetwork.co.uk.
Key NextGen
Contributors Thank you to all NextGen Healthcare Network members who attended the event and contributed to the discussions. We are especially grateful to the Regulations & Compliance Working Group who supported the smooth event and facilitated the discussions:
• Oliver Brooke, Part B
• Monty Jackson, University of Cambridge
• Jeremy Jones, Ramboll • Chloe Madge, Stride Treglown • Tom Nelson, Stantec • Joao Pinto, BDP • Kai Xin Tan, Fleet Architects
November 2026 Health Estate Journal 15
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