5 Key Elements of Effective Healthcare Estate Strategies in 2025 

Effective healthcare estate planning demands a holistic approach that integrates critical aspects of facility management: from ensuring compliance and maintaining H&S standards to addressing building conditions, creating adaptable spaces, embracing sustainability, incorporating technological innovations, maintaining business continuity, generating supplementary income, and establishing financial viability.

With the NHS estate spanning over 24,000 buildings across more than 1,200 sites and requiring approximately £13.8 billion in backlog maintenance costs, strategic estate planning has never been more critical. To create resilient and  patient-centred estate facilities while optimising resources, here is what you should focus on:

1. 1. Estate Optimisation

Understand the NHS’s present needs and conduct future capacity and demand assessments to ensure future services and estates are optimised and fit–for–purpose. Alongside designing estates that can flex with fluctuating demand and evolving clinical models — through adaptable room configurations, movable infrastructure, and scalable departments — there is also a need to rationalise the estate portfolio. 

This includes relocating office-based functions currently situated within clinical spaces to release capacity for additional beds and frontline services. More radical approaches could involve acquiring community-based building stock to deploy services closer to patients, and refurbishing vacated hospital areas to deliver increased patient-centred clinical care for the nation’s most vulnerable people. 

Case Study:

The NHS MFT Estates and Facilities Strategy 2023-2028, in Section 3.4, Page 40, highlights that future facilities will be designed to be adaptable and flexible. This will be achieved by incorporating resilience and capacity planning into future developments. The strategy also recommends that designs allow for easy modifications to room layouts, services, fixtures, and fittings, ensuring that future changes in usage are not restricted.

2. Compliance Led Design

The Building Safety Act 2022 has reshaped the regulatory landscape for healthcare estates, broadening its focus beyond traditional safety measures to establish a more comprehensive approach to building safety. This legislation has introduced heightened accountability through the newly defined roles, safety case requirements and digital information record.

For healthcare facilities, this means greater emphasis on transparent safety management, regular building assessments, and robust compliance processes. In line with this shift, the NHS has also introduced updates to HTM and HBN to reflect evolving safety standards and best practices. The scope of compliance now includes broader considerations such as structural integrity, evacuation strategies, and long-term risk mitigation. These changes are designed to enhance safety, minimise costly modifications, and build resilience across NHS properties.

3. Sustainability & Net-Zero Target

To align with the NHS’s 2040 Net Zero Carbon mission, all estate strategies should already incorporate plans to achieve this goal. However, to be more effective, estate strategies should now include a detailed implementation roadmap with clear milestones, making it easier to track and escalate where needed.

In addition to initiatives such as renewable energy integration, sustainable material selection, and waste reduction, strategies should also incorporate sustainability-focused building enhancements. This includes the use of energy performance modelling to support a science-based optioneering process, helping to select the optimal balance of infrastructure improvements and thermal performance upgrades to reduce both embodied and operational carbon emissions.

Case Study:

In 2022, the NHS MFT energy transformation programme set specific targets for each building, combining on-site renewable energy generation with phased replacement of fossil fuel systems, targeting an 80% carbon reduction from a 1990 baseline, zero-waste by 2030, and net-zero carbon emissions by 2038.

Code Green: Delivering Net Zero Carbon at MFT 2022-2025

4. Digital Ready Healthcare Estates

In this digital era, smart healthcare is moving towards leveraging AI, IoT, digital pathways to enhance efficiency and patient care. As a result, healthcare organisations should consider designing right-sized, future-proof estates that enable digital healthcare delivery, such as dedicated spaces for servers / equipment and clinical areas that can accommodate emerging technologies such as AI diagnostics, with a minimum reconstruction.

 Case Study:

Northern Care Alliance NHS Foundation Trust’s Digital Strategy 2024-2030 explicitly connects estate development with digital capabilities, such as datacentre plans, ensuring buildings support evolving technologies and care models.

5. Cost-Effective Lifecycle Planning

Rather than focusing solely on initial capital costs, whole-life costing is now essential. It balances upfront investment with long-term savings through energy efficiency, reduced maintenance and space optimisation.

NHS England has emphasised that while carbon reduction initiatives  can generate substantial long-term financial savings by reducing energy consumption,  they often have a greater front-end capital outlay. To maximise the effectiveness of capital spend, carbon reduction initiatives should be selectively applied to appropriate new build and major refurbishment projects, where they can deliver the greatest impact. NHS England has also highlighted the importance of calculating whole-life costs and assessing financial paybacks against the additional capital costs associated with carbon reduction measures.

It is recognised that there will be a tipping point across the NHS estate, as more buildings become sustainable and self-sufficient, ultimately moving away from reliance on legacy infrastructure such as district heating systems. However, in the short term, this transition may result in increased operational costs until broader infrastructure projects are delivered and realised.

Case Study:

Mid and South Essex NHS Foundation Trust installed an air-source electric heat pump at its Broomfield Hospital site as part of its Green Plan to decarbonise the estate. The project is projected to save the Trust over £50,000 annually and reduce carbon emissions by 146 tonnes of CO₂, with a payback period of 16 years.