4 Strategies to Tackle the NHS Real Estate Challenges that Improve Efficiency and Effectiveness

“We operate 21st century healthcare from 19th century buildings. It is increasingly unsustainable.” So said one NHS leader responding to NHS Providers’ survey of trusts included in the government’s flagship New Hospital Programme (NHP), underpinned by its manifesto commitment to build 40 new hospitals by 2030. BMJ 2022;378:o1862


Existing real estate throughout the NHS can be a challenge and a bottleneck to increasing efficiency. The New Hospital Programme is an exciting prospect of new hospitals which will bring a large amount of new, innovative, up to date facilities into action that suit new ways of delivering healthcare. However, the plans have somewhat been delayed due to funding and other issues, meaning this complex programme is an ongoing project that will take time, how long who knows.


With new hospital developments somewhat in the distant horizon, current NHS estates are under pressure to continue operating. The challenge is now how existing estate can be improved to increase efficiency and effectiveness. This will require changes in the way estate is managed from optimisation and space utilisation to new technologies and flexibility of working.


“This estate has important contributions to make in delivering savings and reducing running costs. These must be undertaken to meet the challenges of funding the NHS in the future and will form part of the government’s drive to increase the efficiency of the public sector estate. Accordingly, a significant step change in the way this estate is managed has to be achieved.” Department of Health; Health Building Note 00-08

Here's 4 ways to improve efficiency and effectiveness in NHS real estate.


Estate optimisation


Optimisation of current estate can be achieved through the introduction of more effective working practices. There is a need to provide a workplace that allows for increased productivity and more collaboration across multiple teams, acting as a catalyst for cultural change across the organisation.


This shift in working practices has changed the needs and requirements within all areas of healthcare but especially estates. With staff adopting a hybrid model of working from multiple locations, and a lot from home, it calls for this shift to be managed so that it creates a great employee culture whilst increasing productivity across departments. This requires the repurposing of estates to ensure staff have collaboration zones, private spaces, optimised clinical rooms, garden meditation areas and much more. The standard room by room layout of a typical hospital is becoming a thing of the past.


“Initial investment is likely to be required to provide workplace solutions that meet the needs of the organisation. A programme should be developed in order that more effective working becomes “business as usual” Department of Health; Health Building Note 00-08


Space utilisation


An essential tool to the improvement of space utilisation is a regularly updated asset management system that allows estates managers to identify unused or underused space on a room-by-room level.


Information and data gathered from this system is extremely valuable in guiding rationalisation strategies and reconfiguration of underutilised space. It supports more effective ways of working as estates spaces are monitored and allows spaces to be utilised more effectively, based on the usage insights gained. This could involve the repurposing of existing rooms for different uses, with the increase in modular architectural furniture now available, the purpose of rooms can easily be changes without costly construction works.


It is important to note that any rationalisation of estates should be service led to ensure services can continue to operate at optimum performance without any disruptions.


New technologies


“The role of estates professionals will need to adapt so that they become more creative in their understanding of the potential of technology in order to promote innovative property solutions that will make a real difference to patient care.” Department of Health; Health Building Note 00-08


Bringing new technology to an existing estate can transform its efficiency, and not just within estates but the whole healthcare service provided. The introduction of new ways of working has changed the needs within real estate. For example, the shift from private offices to open office spaces has now transformed to a hybrid model where both open offices and individual quiet private spaces, such as modular acoustic pods, are needed for clinicians to conduct video and phone consultations. As a result the number of full size clinical rooms required is reduced and optimised spaces for remote consultations are in demand.


“Changes in healthcare delivery, together with increasing use of technology, are likely to see the number of facilities providing NHS services reducing over time. Telemedicine, self-monitoring and medication, wireless access and mobile working will all contribute to a reduction in the use of and need for space. The potential impact of technologies should be recognised in business plans and estates strategies.” Department of Health; Health Building Note 00-08

Flexibility and future-proofing


“Buildings and space should be flexible to support different levels of acuity, function and/or technology. Healthcare planning should ensure efficient patient flows to minimise delays and waiting times.” Department of Health; Health Building Note 00-08


Innovation is really at the core of adapting current real estate in a way that makes a big difference. Innovation and ideas should be encouraged such as the use of step-up or step-down facilities, premises that accommodate integrated health and social care services, multifunctional rooms and easily adaptable rooms for future-proofing. A great example of this is the use of modular acoustic rooms that can be built into multiple configurations with the same parts, allowing for future flexibility with the space, such as the Verandas installed at North Middlesex University Hospital.


Creating a patient centered healthcare estate is just as needed as creating a staff centered estate. It’s important to focus on what matters to both and what they see making a difference in the future and adapting estates to suit. The classic hospital waiting room is one no-one likes so it’s about innovating to create an attractive and pleasant environment, but with the increase in virtual appointments the typical waiting room may change to create better patient flows.




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