INFRASTRUCTURE
redundancy in place. This puts even more pressure on the need for proactive planning. To manage this, a national programme of infrastructure risk assessments should be prioritised. Supported by experienced delivery partners and driven by data, this approach would enable a consistent and reliable understanding of estate condition across all Trusts. Crucially, it would help to shift the system from reactive firefighting to planned resilience – allowing NHS organisations to prioritise high-risk areas with confidence and transparency. However, this can’t be done in isolation. It requires
shared learning, collective ownership of risk and a unified approach to estate safety.
Beyond quick fixes There needs to be a fundamental shift in how we view NHS estates. Backlog funding has often been used as a plaster – quick wins for urgent problems – but these rarely deliver sustainable value. True resilience demands longer- term thinking.
Planning must move away from reactivity. Estates should be clinically driven, future-focused and above all, patient- centred. Each repair, upgrade or investment must be seen through the lens of care outcomes. Recurring repairs don’t just pose risks to patients – they undermine productivity and staff morale. It’s time to ask: what is the long-term cost of short-term thinking? The solution lies in integrated, service-led estate
strategies. These should be developed in parallel with clinical strategies, shaped by local need and supported by real-time asset tracking. Digital tools can help monitor condition, schedule maintenance and highlight performance issues – all contributing to greater reliability and efficiency. Early contractor involvement will also be essential. By bringing contractors into the fold early, Trusts can draw
on practical insight into buildability, logistics and cost, ultimately leading to better-informed decisions and fewer delays. Strategic master planning – grounded in real operational input – ensures that everyone from clinicians to designers is aligned from the start, helping projects begin with clarity and confidence. Embedding these principles is central to planning for resilience, ensuring that the NHS estate can adapt to future pressures while continuing to deliver safe, high- quality care.
Delivering in live environments Unlike commercial buildings, NHS hospitals can’t close their doors at 5pm. Critical works must take place around active clinical services, and often severely unwell patients, making the stakes far higher, and the margin for error far smaller. This makes careful, anticipatory planning a non-negotiable part of resilience, balancing infrastructure needs with uninterrupted patient care. This unique challenge demands precision planning. Risk assessments must be carried out at the earliest possible stage, with clear protocols in place for infection control, air quality and fire safety. Involving stakeholders such as fire officers, clinical leads, maintenance and infection prevention teams from day one helps build practical, manageable delivery plans that protect patients while work takes place. Where possible, works should be phased to minimise
disruption – with noisier or more intrusive elements scheduled during off-peak hours. Communication is equally critical. Staff, patients and contractors must all be kept informed, ensuring expectations are aligned and any potential issues can be addressed early. One of the most effective ways to navigate these
complexities is by partnering with a project management consultancy that specialises in healthcare environments. These specialists understand the challenges of delivering in live clinical settings – from safety standards and infection control to procurement and compliance. Their involvement often leads to better planning, faster delivery and more efficient use of resources.
Wood Wharf health centre combines natural light, calming colours and nature-inspired elements to help create a comfortable waiting area.
Recurring repairs don’t just pose risks to patients – they undermine productivity and staff morale. It’s time to ask: what is the long-term cost of short-term thinking?
October 2025 Health Estate Journal 161
The design of a new modular theatre unit in Newark is the result of a collaborative approach between clinicians, contractors, and construction teams.
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