NHS PLAN Local medical staff.
These strategies recognise that transformation cannot be delivered through isolated organisational decisions. Systems are now mapping their full estate portfolios, forecasting population need over 10 to 30 years, prioritising neighbourhood-based assets, strengthening community diagnostics, redesigning clinical adjacencies, integrating primary, community, mental health, and acute services and embedding digital requirements into all estate planning. This approach aligns capital investment with long-term care delivery and enables integrated models of care to take root. Together, the NHC Programme and ICS led strategies
From experience, resolving this misalignment is not
always about complex structures or new programmes. In some cases, progress has been unlocked simply by creating the space for estates and digital leaders to plan together. A single meeting, shared workshop or joint governance forum can enable early cross fertilisation of ideas, surfacing interdependencies between capital plans, digital requirements, and clinical pathways before decisions are locked in. Where this alignment happens early, systems are better able to avoid embedding legacy models of care and instead design infrastructure that genuinely supports digital-first, neighbourhood-based delivery. Across all three shifts, a clear message is emerging from NHS leaders: transformation is no longer constrained by ambition but by the practical challenge of aligning estates, digital capability, and clinical pathways at system scale.
Claire Colgan
Claire has 20 years’ experience in the real estate industry, having progressed to lead the UK Real Estate Advisory business at Turner & Townsend. Her UK-based team of 60 Real Estate consultants help a diverse portfolio of UK and international private and public sector clients to make informed decisions regarding their future real estate needs; optimising operational performance and making informed real estate decisions. The team deliver HMT Green Book Business Cases, develop real estate investment strategies, set up industry best practice target operating models for real estate functions, and provide stakeholder management services to enable workplace change and align FM strategy to business objectives to optimise operational performance.
How the NHS is responding – NHCs and system-level infrastructure planning The DHSC’s Neighbourhood Health Centre (NHC) Programme is one of the clearest national illustrations of the 10 Year Plan being translated into practice. It aims to transform access to local care by creating a national network of centres that bring urgent care, primary care, community services, diagnostics, mental health support, prevention, and wider wellbeing services together under one roof. The scale of the ambition is significant. The government
has committed to delivering 250 NHCs by 2035, with the first 120 open by 2030 and an initial wave of 27 centres to be completed by 2027. These first 27 form part of an initial tranche of 50 centres backed by £200m of government investment to upgrade or repurpose existing NHS estate.
Once opened, NHCs will offer an expanded range
of services including urgent treatment, GP appointments, pharmacy services, community diagnostics, and, over time, debt advice, employment and family support, and voluntary sector services. Many will operate extended hours and are being prioritised for areas with the highest levels of deprivation to maximise impact on inequalities. Crucially, the programme goes beyond physical infrastructure. It defines a consistent national model for neighbourhood-based care, standardising the core functions that centres will deliver, and embedding digital first requirements into the design from the outset. By grounding investment in population health need, deprivation data, future clinical pathways, and integrated service models, the NHC Programme replaces piecemeal capital projects with system-wide investment. This shift enables sustainable redesign rather than incremental change and positions neighbourhood infrastructure as the backbone of the NHS 10 Year Plan.
System and regional infrastructure strategies ICSs across England are developing system wide infrastructure strategies shaped by the 10 Year Plan.
28 Health Estate Journal September 2026
show that the Plan is actively shaping transformation, not passively influencing it.
What is still missing: digitally enabled clinical pathway transformation Despite progress, one critical enabler remains underdeveloped: clinical pathway transformation. This is the hardest ask of the NHS because it requires deep operational and cultural change across professional and organisational boundaries. Without redesigned pathways, the NHS risks delivering outdated models of care inside modern, community-based facilities.
Digitally enabled pathways are the missing connection
between new buildings, service models, digital capacity, workforce expectations, and patient behaviours. But progress has been slow. Many trusts are developing estate transformation proposals without the clinical pathway clarity needed to define service requirements, digital needs, or workforce design. Estate and digital leaders are not consistently involved in pathway design, slowing transformation and risking misalignment between clinical ambition and infrastructure. Delivering the 10 Year Plan requires reimagining clinical
pathways for a neighbourhood-centred, digital-first system. This includes: 1. Redesigned referral flows. 2. New diagnostics routing. 3. Updated follow up models. 4. Shared care across sectors. 5. Digital prevention and self-management. 6. Integrated multi agency responses.
Only when pathways change can the Three Shifts be realised in practice. As the NHS navigates rising demand, widening inequalities, and accelerating digital expectations, the 10 Year Plan remains the most coherent framework for sustainable transformation. It connects estates, clinical priorities, digital capability, and workforce change into a single long term direction. The Three Shifts at the Plans core are already shaping
practice, from neighbourhood-based models and regional infrastructure strategies to digital first pathways. National programmes, including the NHC Programme, show how these shifts can be turned into concrete progress. Yet new buildings alone will not deliver the future NHS.
The decisive step now is transforming the pathways that operate within them. Digitally redesigned pathways are the engine of change, enabling upstream care, integrated support, multidisciplinary working, and better outcomes. The next decade will require bold, coordinated decisions. The 10 Year Plan provides the direction needed to make them. If embraced not as a policy document but as the operating logic for transformation, it can lead the NHS toward a model of care that is more local, more preventative, more digital, more integrated, and more resilient for the generations to come.
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