Unlocking NHS capital development

With platform-led design

Martin Staehr

_{Group Managing Director}
_{Kier Construction}

Also on this panel:

Sir Jonathan Van-Tam

_{Senior Advisor 5654 & Company Former Deputy Chief Medical Officer for England}

Emily King

_{Industrial Director,}
_NHP

Fiona Daly

_{Director of Estate Sustainability and Workforce & National Deputy Director of Estates,}
_{NHS England}

Quick read

Standardisation should focus on what matters most: clinical function, safety and maintainability: not a one-size-fits-all building aesthetic.
Population ageing and chronic illness were framed as a “ticking time bomb”, meaning today’s clinical buildings must stay adaptable for decades, including future pandemics.
The New Hospital Programme starts with clinical demand modelling, then uses repeatable “building blocks” especially the inpatient room to create delivery certainty and support supply chain investment.
NHS England set out a practical way to manage an ageing estate: splitting assets into “core, flex and tail” to decide what must be retained, adapted or disposed of to reinvest.
Phased delivery is essential: rebuilding in manageable chunks, backed by clearer pipelines and fewer funding barriers.
Sustainability is now non-negotiable, with flooding, overheating and energy security treated as core to safe care.

This session brought together perspectives from clinical leadership the NHS England estate and workforce agenda and the New Hospital Programme to explore how the NHS can deliver more clinical capacity and better environments through platform-led design. The discussion landed in a practical place: the NHS has significant pressures on demand an ageing and inconsistent estate and a need to deliver safely at pace , so the way capital programmes are designed specified and funded matters as much as the headline investment.

A consistent theme was the scale of change facing healthcare over the lifespan of any new facility. Sir Jonathan Van-Tam framed this in demographic terms: an ageing population living longer with chronic illness will increase demand and complexity and the system must plan for that reality over several decades. Mental health was also highlighted as a growing driver of demand and as something influenced by the built environment , for customers patients and staff alike. Alongside this the ongoing policy shift towards community-based care will change what “clinical space” looks like with neighbourhood facilities playing a larger role in prevention and early intervention.

Sir Jonathan Van-Tam
^{Explained how the system must plan for an aging population over the coming decades.}

The population is ageing and really quite rapidly… they are the ticking time bomb.

Sir Jonathan Van-Tam, 5654

From an estate perspective Fiona Daly described the tension between ageing assets and new delivery. The panel noted the scale of backlog maintenance and the need to make decisions that go beyond replacing individual buildings. A practical response discussed was classifying the estate into “core flex and tail”: core assets that will be needed regardless of service model changes flex assets that must be able to change function over time and tail assets that can be disposed of to release value for reinvestment. This approach supports better long-term planning and avoids assumptions that tomorrow’s service model will mirror today’s even on the same site footprint.

We’ve split the estate into core, flex and tail. Core is the estate you’ll need whatever happens, flex is estate that may need to change function over time, and tail is the estate you can dispose of and reinvest.

Fiona Daly, NHS England

One of the really important things about both the neighbourhood centres approach and the New Hospital Programme is that it is a system, not a design. We don’t think of two drawings and every hospital being the same two drawings.

Emily King, NHP

_{^{Illustrated highlight from the panel discussion - by}}_{^{David Lewis}}

Platform-led design and industrialisation were presented as a way to make that adaptability achievable without sacrificing reliability in delivery. Emily King emphasised that the intent is “a system not a design” , standardising where it reduces risk and improves quality while still allowing buildings to respond to place. The New Hospital Programme approach begins with demand modelling and clinical briefs then uses repeatable “clusters” with a standardised inpatient room as the central building block. That room is tested extensively through clinician engagement prototyping and supply chain input with the aim of ensuring predictable quality and faster installation. The panel described how this enables earlier supply chain planning by translating clinical need into quantifiable components (such as numbers of rooms en-suites and façade area) supporting more confident investment decisions across the delivery ecosystem.

The discussion also tackled a familiar reality in healthcare projects: multiple stakeholders with strong preferences. The panel’s position was clear , standardisation should be “contractually mandated” for critical interfaces and high-risk components (for example the inpatient room and key MEP interfaces) while leaving room for local expression where it does not create avoidable complexity (such as façade appearance). This is a deliberate “pick your battles” approach: lock down the elements that drive safety install-ability and maintainability; don’t waste effort debating what does not materially improve outcomes. Sir Jonathan added a challenge to traditional ways of capturing clinical requirements arguing for evidence-led specifications and stronger input from junior clinical staff who will work in these environments for decades , rather than defaulting to the loudest or most senior voices.

Community integration featured strongly through the neighbourhood health centres discussion. The panel described a similar model: standardise what makes clinical sense but allow a “civic wrapper” so facilities feel locally owned and support broader regeneration aims. The intention goes beyond clinical throughput , using health investment to strengthen high streets connect to housing growth improve access in areas of deprivation and create jobs that contribute to better long-term health outcomes. Importantly the panel acknowledged the need to remain flexible as local needs evolve using data and regional insight to adjust how and where facilities are delivered.

On delivery and funding the conversation moved to phased development. Fiona set out why the next decade is likely to rely more on smaller staged schemes rather than many £300m–£500m projects funded as single events. The panel advocated a return to long-term site planning , development control plans and “masterplan” thinking , then delivering in manageable chunks. A specific example referenced work exploring rebuilding in ~£25m increments to keep programmes moving and reduce reliance on “all-or-nothing” business cases. The increase in the business case threshold (moving from £25m to £300m for central review) was described as reducing barriers and enabling more autonomy provided schemes properly account for revenue impacts and whole-life cost.

We have to build things in chunks, because we have to think completely differently about how we redevelop things.

Fiona Daly

Sustainability was positioned as integral to clinical safety and operational resilience not a separate agenda. Fiona referenced the NHS net zero ambition (net zero by 2040 for the NHS) alongside the practical challenge of retrofitting existing buildings. The panel highlighted a more standardised approach to decarbonisation by building archetype and the growing focus on resilience: flooding overheating biodiversity and energy security. Emily described how embedding standards early allows design choices to be tested before plans become fixed , including understanding carbon impacts of key components like façades and making difficult trade-offs earlier in the process. Sir Jonathan also reinforced the need to design for future pandemics arguing that infection control and surge capacity should be assumed over the life of any new facility.

Questions from the floor reinforced two practical points. First patient input is being gathered through structured engagement and a feedback process tied to prototypes (including QR‑code enabled feedback) with an emphasis on fundamentals such as visibility of staff space for families and a supportive recovery environment. Second the workforce challenge is immediate: a large proportion of the workforce is approaching retirement and the industry needs to create clearer routes for young people through entry roles apprenticeships and long-term careers , supported by better working conditions and more stable pipelines.

Overall the session left a clear message for the supply chain and delivery partners: protect what has been agreed and tested invest in people and focus innovation on improving outcomes rather than re-opening settled decisions. The “build it like you own it” mindset summed up the panel’s expectation , quality maintainability and resilience are not optional extras when the estate must serve communities for generations.

Key take-aways

Standardise the high-risk high-impact elements (clinical function interfaces maintainability) and stop re-litigating decisions that undermine certainty and quality.
Plan for phased delivery with long-term site control plans enabling upgrades and rebuilds in manageable increments rather than waiting for infrequent “big bang” funding.
Treat resilience and sustainability as core requirements from the outset , alongside designing for future surges and infection control , because the estate will face climate and pandemic pressures within its lifetime.
Use standardisation to improve day-to-day experience, not just delivery efficiency, so staff can work more confidently, maintenance is simpler and patient environments remain consistent and reliable.

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