PROCUREMENT AND GOVERNANCE
Frameworks, funding and the future of NHS estates
Simon Hunt, strategic account director at Sypro, explores what the new NHS funding means for healthcare construction management at a time where improvements to both existing and new infrastructure have never been greater.
The NHS is operating under immense strain. Crumbling infrastructure, record-high waiting lists, and mounting pressure on staff have all become defining challenges. With some facilities dating back to the mid-20th century, many are no longer fit-for-purpose, while soaring energy costs, safety concerns, and growing maintenance backlogs compound the problem. Meanwhile, demand for services continues to rise. An ageing population, increasingly complex care needs, and regional health inequalities have intensified the need for modern, flexible healthcare environments. The latest NHS spending review could be a turning point. With a 3 per cent annual funding uplift and up to £10 bn earmarked for digital transformation by 2028/29, there’s now a rare opportunity to upgrade the healthcare estate at scale. With more money comes more projects – and with more projects comes significantly more risk. This raises a pressing question: with more money flowing into the system, does the NHS have the capability and governance to deliver new-builds and refurbishments that are timely, efficient and future-ready? From routine upgrades to full hospital redevelopments,
healthcare construction is uniquely complex – with high risks and high stakes. Therefore, effective contract management isn’t a nice-to-have; it’s mission critical. To deliver value from this investment, the NHS must
The NHS needs tools and systems in place that offer real-time visibility of project performance.
urgently address long-standing issues in procurement and governance. That means adopting robust frameworks, strengthening contract management and embracing digital tools that support transparency and timely decision- making.
Healthcare construction is not like other sectors Delivering construction projects in a healthcare setting comes with unique challenges. These are not just brick- and-mortar builds. They are live, operational environments where staff continue delivering frontline care while sites are refurbished, extended or entirely redeveloped around them. The pressure is immense. There’s the complexity of design and equipment, a diverse mix of stakeholders and strict regulatory frameworks – all underpinned by the fact that these projects are funded with public money. Every decision is scrutinised. Every delay has clinical implications, and every penny spent must be justified. This complexity is only heightened by the growing demand for faster delivery. With an ageing population and rising pressure on the NHS estate, Trusts are under intense pressure to upgrade old infrastructure while maintaining service capacity. In this context, poor contract management doesn’t just waste money, it undermines the future resilience of the healthcare system.
The root of most delays lies in scope and change One of the most common reasons NHS construction projects stall or go over budget is scope. A well-meaning request from a clinical team late in the process, an estates team overstretched and unable to provide timely input, or unclear governance around who signs off on change – all of these factors can derail even the best-intentioned build.
Once a change is made, the downstream implications are rarely minor. Delays in materials, workforce reallocation, and programme disruption all begin to snowball, especially when managed via spreadsheets or disconnected systems that fail to flag issues in time. That’s where proactive, structured
contract management delivers. Projects need clear scopes and well-defined decision pathways to track and manage change in real time. Without these, early warning signs are missed, and by the time problems surface, they’re often too late to fix without major disruption. The Procurement Act, combined with
the wider digital transformation agenda, signals a clear shift in government
180 Health Estate Journal October 2025
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