Better healthcare using data-driven insights

The NHS is one of the UK’s largest property owners, managing over 29 million square metres of estate at a cost exceeding £10 bn per year. These buildings are more than just infrastructure — they are the backbone of patient care, enabling safe, high-quality services and driving healthcare transformation. A well-designed, fit-for-purpose estate supports digitally enabled care pathways, enhances patient and staff experience, and unlocks efficiencies in service delivery.

Yet, despite its critical role, the NHS estate is in crisis. Decades of underinvestment, growing demand, and competing financial pressures, have left many hospitals, GP surgeries, and community facilities, struggling with ageing infrastructure and mounting maintenance backlogs. The Darzi Report (2024) warns of ‘capital starvation’ across the NHS, highlighting how investment in buildings and equipment has stagnated, while demand for services has surged. The NHS Estates Return Information Collection (2024) reinforces this concern, showing that while staff numbers have grown post-pandemic, investment in estate renewal has not kept pace.

‘Increasingly visible’ consequences

The consequences are increasingly visible: leaking roofs, outdated IT systems, and inadequate clinical spaces that fail to meet modern service demands. Since 2021/22, the NHS maintenance backlog has risen by £2.1 bn, while the funding available to address these issues has fallen by £707 m in real terms (The Health Foundation, 2024). The impact is far-reaching, as patient safety is compromised, staff productivity is hindered, and operational efficiency is at risk.

Simultaneously, demand for healthcare services continues to rise, and the way care is delivered is evolving. The NHS is shifting towards out-of-hospital care, recognising that many patients can be better treated in community and primary care settings rather than hospitals.

However, while the overall picture is concerning, there is also opportunity. Despite the estate’s challenges, many high-quality community and primary care buildings exist, but they are not being used to their full potential. These assets represent a critical resource that, if optimised, could relieve pressure on hospitals and improve access to care closer to home.

Integrated Care Boards (ICBs) have a pivotal role in ensuring that these assets are utilised effectively. By making better use of modern, high-quality buildings, the NHS can reduce reliance on poor-quality facilities, exit unsuitable sites, and reinvest the proceeds into modern, patient-centred infrastructure.

Delivering the right care in the right place

This is not just about estate management, it is about reshaping healthcare for the future, ensuring that the right care is delivered in the right place, at the right time. But why are estates projects so challenging? Several barriers make estate planning and development within the NHS particularly complex:

• Insufficient funding — Capital budgets are under constant pressure, with NHS organisations competing for limited investment.
• A complex funding landscape — Many NHS leaders struggle to navigate funding streams, with an NHS Property Services (NHSPS) report (2022) identifying a need for greater expertise in securing capital.
• Coordinating efforts across multiple providers — Estates planning often requires collaboration between multiple NHS Trusts, ICBs, and private sector partners. Misaligned priorities, governance complexities, and varying operational needs, create additional challenges in delivering integrated estate solutions.
• Cumbersome approval processes — Major estates projects must pass through at least 19 approval stages, moving between local Trusts, ICBs, NHS England, the Department of Health and Social Care, and the Treasury (NHS Confederation, 2025). This bureaucratic bottleneck leads to delays, inefficiencies, and increased costs.
• Workforce and operational constraints — Estates teams struggle to maintain and optimise NHS buildings while contending with financial constraints, workforce shortages, and ambitious Net Zero carbon targets.

These challenges not only stall progress, but prevent NHS organisations from making the most of their existing spaces — spaces that could be better utilised to meet demand.

With new capital investment increasingly difficult to secure, relying on large-scale funding allocations for new buildings is no longer a sensible strategy. Instead, NHS Estates teams must shift focus towards maximising the use of existing assets. The reality is that actual space utilisation is often lower than perceived. The challenge isn’t always a lack of space, but rather how effectively it is used. Unlocking capacity is not just about building more, it is about better using what we already have.

A data-driven, strategic approach to estates management can:

• Optimise existing space to increase capacity without costly new-builds.
• Enhance flexibility to meet evolving service demands.
• Improve staff wellbeing by creating more efficient and functional workspaces.
• Reduce inefficiencies and drive cost savings.

A lack of insight

Many NHS organisations lack access to the insights needed to make informed decisions about space utilisation. This means valuable capacity is often underused or misallocated. The future of NHS estates isn’t just about new buildings; it is about ensuring that every square metre is used effectively, whether through optimising existing space, or designing smarter, more cost-effective, new facilities.

However, there will always be situations where 
new-builds are the right solution. When this is the case, having accurate data on space usage can significantly shape the size, layout, and cost of new facilities. By using sensor technology to inform decision-making, organisations can ensure that new buildings are designed to match actual needs, often leading to smaller, more efficient, and more affordable, developments than originally planned.

Sensor technology offers an opportunity to shift from assumptions to evidence-based decision-making. By deploying sensors in specific buildings for a short period to answer a specific strategic question, organisations can make targeted, data-driven decisions without committing to long-term costs. Sensors enable organisations to capture real-time data on occupancy and movement, identifying underutilised spaces and inefficiencies. This data, when analysed and visualised effectively, provides a foundation for smarter space management. It helps Estates teams to:

• Understand patterns of use.
• Anticipate demand fluctuations across the day or the week.
• Explore opportunities for repurposing or redesigning space.

While there is an upfront cost associated with deploying sensors, it is a one-off investment. From our experience, the return on investment — whether through cash-releasing savings or avoided costs — far outweighs this initial expenditure.

A clearer picture of space requirements

For example, in a new-build project, installing sensors in existing buildings where teams are currently based can provide a clearer picture of actual space requirements. This evidence could support a significant reduction in the size of a proposed new building, leading to substantial cost savings. However, data alone isn’t enough. The challenge isn’t just in collecting information, but in how organisations respond to it. If rooms remain empty during peak hours, is this due to inefficiencies in scheduling, or does the space no longer meet clinical needs? Should underused areas be repurposed for more flexible use, or could they be converted entirely?

Technology provides insight, but real transformation happens through people. Estates teams, operational leaders, and frontline staff, must work together to translate data into action.

For example, in one community provider (see case study below), occupancy sensors revealed that clinic rooms were often booked but not actually used. On paper, the space was in high demand, but the reality was inefficiencies in scheduling, miscommunication between departments, and outdated booking processes. We worked with the teams to ensure a human-centred approach, ensuring that data-driven insights are not just theoretical, but that instead they lead to practical, impactful changes.

The future of healthcare estates — what we have learned

Through our work in healthcare estates planning, we have seen that embedding data-driven space planning into estates strategies is invaluable. Our key learnings include:

1. Technology is essential in bridging the gap between perception and reality in space utilisation. Sensor technology and real-time analytics provide objective insights, but real value comes from applying this data to drive efficiency.

2. However, data alone doesn’t create change, people do. Engaging frontline staff ensures that insights translate into practical solutions. By combining real-world knowledge with data, organisations can develop meaningful space optimisation strategies that are both actionable and meaningful.

3. Embedding data-led space planning delivers long-term impact. Integrating insights into strategic decisions creates agile, sustainable environments that enhance staff efficiency, patient experience, and system-wide effectiveness.

By embedding data-driven approaches into estates strategies, healthcare organisations can create more agile, efficient environments. This is not just about cost saving, but about ensuring that healthcare estates remain fit-for-purpose, adaptable, and sustainable. The future lies not only in new-builds, but in optimising the space that already exists.

Case study: Community provider in Devon

1. Background

The community provider faced challenges which acted as a barrier to delivering its estate strategy. At the heart of the issue was the Children, Young People, and Family Hub, which was a plan for a strategic facility that had reached Outline Business Case (OBC) stage, but was deemed too unaffordable to progress to Full Business Case (FBC). With no viable funding route, the project was effectively stalled, leaving teams dispersed in outdated and inadequate premises with no clear path forward. The consequences were significant:

• Unsuitable environments — The existing buildings were not fit for purpose, negatively impacting both staff and service-users.
• Teams without a base — Some teams had no permanent workspace at all, hindering collaboration, communication, and service delivery.
• Underutilised good-quality buildings — While some good-quality, well-maintained buildings existed, there was no clear strategy or data to support their optimal use.

The provider needed a data-driven approach to unlock estate capacity, improve space utilisation, and enable more effective service delivery without relying on unaffordable new builds.

2. What we did

In a joint venture between Baxendale and Abintra, we conducted a sensor study where occupancy sensors were deployed across multiple buildings for a defined period, to understand space utilisation trends.

The study focused on two key types of spaces:

• Workplaces — Offices, workstations, and clinical spaces, used for day-to-day operations.
• Collaborative spaces — Clinic rooms, group rooms, training spaces, and meeting rooms.

The sensor installation using Abintra’s Wisenet hardware and software ran for three months, continuously recording occupancy patterns to build a comprehensive dataset and run detailed reports. We integrated real-time sensor data with existing space booking system information and target occupancy rates, allowing for a detailed, objective analysis of actual space usage.

3. Key factors considered for analysis

To optimise space sustainably and effectively, our analysis focused on:

• The purpose of the space — Clinical areas, meeting rooms, and flexible workspaces serve different functions, requiring tailored approaches.
• The actual vs. expected usage — Real-time data was benchmarked against target utilisation rates to highlight inefficiencies.
• Capacity alignment — Space allocation was assessed to ensure that it met actual demand, preventing both underuse and overbooking.

4. Target utilisation rates

To ensure meaningful comparisons, we set target utilisation rates based on space type and function:

Workplaces:

• Clinical spaces: Minimum 65%, target 70% utilisation.
• Hot desks & meeting rooms: 60% target utilisation.
• Fixed workspaces (offices for permanent teams): 80% target utilisation.

Collaborative spaces:

• Meeting rooms: 60% target utilisation.
• Training rooms: 50% target utilisation.

5. Findings

The average findings across all the buildings are shown in Table 1. The graph in Figure 1 shows real example data. It compares the room booking data, sensor usage, and target usage, by space type.

The data was visualised as an interactive floor plan heatmap (see Figure 2), offering a real-time, intuitive view of space utilisation across the estate. By overlaying sensor data onto building layouts, we could pinpoint which areas were underused, over-occupied, or misaligned with actual demand. This visual clarity facilitated meaningful conversations with teams, helping to uncover the underlying reasons behind usage patterns, and therefore informed data-driven and people-driven optimisation recommendations.

The graph in Figure 3 shows average occupancy levels across the working week in one of the buildings. It highlights significant variation in space usage. Occupancy peaks on Tuesday at 40%, remains relatively stable on Wednesday and Thursday at 37%, but drops significantly on Monday (20%), and even further on Friday (15%). This trend suggests opportunities to redistribute workloads, encourage flexible scheduling, and optimise space usage on lower-occupancy days.

6. Key insights

• Underutilised, high-quality buildings — average building usage ranged from 31% to 48%, well below the 60% target. Several well-equipped spaces remained empty, while other teams operated in sub-optimal conditions, or lacked a dedicated base.
• Mismatch between bookings and use — teams frequently booked spaces but did not use them, leading to inefficiencies and wasted capacity.
• Significant variation across the week — space occupancy generally peaks mid-week, with particularly low utilisation on Mondays and Fridays, suggesting opportunities for better scheduling.

These findings highlighted a significant opportunity to improve space utilisation and optimise the estate.

7. Recommendations

Clinical spaces:

• Improve approach to clinic room scheduling so that excess capacity can be released. This will likely require integration of room booking and appointment scheduling systems.
• Transfer clinic appointments that are currently being provided from poorer quality buildings, which will result in improved services and recurring savings.

Non-clinical spaces:

• Relocate teams from other buildings into underutilised office space across surveyed buildings.
• Use the space freed up to establish a Hub for Children and Young People’s Family Services.

Benefits

• Improved clinical space utilisation — increased appointment availability, reduced backlogs, and better patient access.
• Enhanced flexibility — real-time adjustments, better clinician workflows, and optimised scheduling.
• Cost avoidance — maximised use of existing estate, and therefore a reduced need for new infrastructure.
• Cash-releasing savings — optimised space use, which enables buildings to be released, generating revenue savings.
• Stronger team collaboration — co-located teams in logical, well-planned spaces, improving communication and efficiency.

If you need support in optimising your estate, leveraging data-driven insights, or making informed investment decisions, we are here to help. Get in touch to explore how we can work together to maximise your existing assets, improve space utilisation, and ensure that your facilities are fit for the future.