After welcoming delegates to the IHEEM Wales Regional Conference 2026, IHEEM CEO Pete Sellers introduced the event’s theme of Navigating uncertainty — contingency and resilience in healthcare estates. Faced with both the everyday pressures of running of NHS states and facilities and the global pressures that have seen a rise in uncertainty across the board — not least when it comes to the cost of everything from energy to construction materials — resilience in healthcare estates — and indeed healthcare personnel — is becoming ever more key when it comes to an NHS that is continually having to do “more with less” under sustained pressure.
Exploring these themes, the first keynote of the two-day event was A view from the bridge from Jacqueline Totterdell, director general for health and social services and NHS Wales chief executive. Speaking via video, Jacqueline began by recognising the key importance of healthcare engineers and estates managers.
“Thank you so much for inviting me to talk with you at your conference today,” she began. “Engineers and estates professionals are critical to the safe, reliable, and resilient operation of NHS Wales and directly underpin patient care and service continuity. You manage our infrastructure risks, statutory compliance, and all of our safety systems, like power, heating, ventilation, medical gases — I could go on — and all of those impact on health service operations and performance.
“NHS Wales faces significant service and financial pressures, compounded by energy [costs] and increasingly unsuitable healthcare estate,” Jacqueline continued. She highlighted the advancing age of many healthcare buildings in Wales, pointing out that some 10 per cent of the NHS Wales estate was built before 1948, with barely a quarter (23 per cent) having been built over the last 20 years. This, she said, posed significant challenges when it came to investigating opportunities and implementing solutions for energy efficiency and carbon emission reduction across the estate.
A shift towards prevention
Nonetheless, Jacqueline reflected that the healthcare strategy A healthier Wales: long term plan for health and social care continued to drive a shift towards prevention, integrated care, and delivering more services closer to home.
“To date,” she continued, “we’ve had 46 projects approved by the Integration and Rebalancing Capital Fund, with capital funding requirements of over £182m. Of those 46 projects, 35 relate to integrated care and social care hubs, seven relate to the rebalancing of the adult social care market, and four relate to the elimination of profit from the care of looked-after children.
“These schemes provide a platform for systems sustainability by bringing services together in our community settings, improving accessibility to the public, and strengthening integration and coordination across health and social care. Quality and safety are non-negotiable, with estates compliance central to protecting our patients, our staff, and our services.”
Targeted estates funding
Jacqueline drew attention to the Welsh Government’s Targeted Estates Funding programme (TEF), which is intended to focus investment on six key estate categories for NHS organisations in Wales.
These categories are:
- Infrastructure (including Emergency Department facilities improvements for patients, general building and engineering upgrades, and rationalisation).
- Fire safety.
- Mental health.
- Decarbonisation
- Infection Prevention Control.
- Decontamination.
“The Targeted Estates Fund (TEF) has allowed us to address key estates issues without the need for detailed business case,” said Jacqueline. “Over a two-year period, a total of £140m will be supporting this agenda: £80m of core NHS capital, and £34m from discretionary capital.”
Jacqueline pointed out that, at present, the maintenance backlog across NHS Wales stood at well over £1bn, with some £329m of that total categorised as ‘high risk’. While this backlog undoubtedly made the delivery of safe and reliable services “challenging”, Jacqueline revealed that, thanks to targeted estates investment, the maintenance backlog increase across 2024/25 had been less than in previous years (although an increase of £56m during that period is, of course, far from insignificant). She said that this recent increase reflected “significant inflation across the constructing sector”.
When it came to investment in NHS Wales estate, Jacqueline was clear on how and where funds needed to be targeted.
“We must focus on the highest priorities and avoid the short-term fixes that perpetuate unsafe or inefficient buildings,” she said. “The Welsh government is investing over £500m this year to modernise the safety of the NHS estate. We’re upgrading critical infrastructure, replacing essential equipment, enhancing digital systems to support new ways of working, and backing major regional diagnostic and surgical hubs. The increase in discretion capital to £112m this year will further assist organisations to tackle their highest risk [priorities]. Any funding should deliver long-term value by improving outcomes, reducing energy and operating costs, and supporting future models of care.”
Long-term value
Part of achieving that long-term value, according to Jacqueline, was the disposal and/or demolition of surplus buildings, which she said was “essential to reduce costs and reduce capital investment”. She highlighted a demolition project at the University Hospital of Wales which had freed “significant space” on that site, and reflected that the NHS Wales Building Resilience Survey, undertaken by NHS Wales Shared Services Partnership — Specialist Estates Services (NWSSP-SES) on behalf of Welsh Government, had “highlighted the need to strengthen structural, mechanical, and digital resilience across the estate”. She said that three top issues had been identified, namely:
- Electrical infrastructure capacity constraints — 35 per cent of sites reported less than 10 per cent spare grid capacity.
- Water resilience — supply disruption needed to be considered and tested.
- Heating and hot water resilience — contingency planning was inconsistent.
Jacqueline continued: “The delivery of future healthcare services will increasingly rely on original solutions, community-based facilities, digital pathways, and new technology. All of these are dependant on a safe, modern, and sustainable estate.”
Flagship healthcare projects
In terms of new projects, Jacqueline pointed to The Llantrisant Health Park — a major new healthcare development close to the Royal Glamorgan Hospital. Designed to improve access to diagnostic tests and planned surgery for people across South East Wales, construction on the first part of the project — a Community Diagnostic Hub — began in March. She also mentioned the new Velindre Cancer Centre in Cardiff, which is due to open its doors in early 2027.
With a significant amount of NHS Wales healthcare estate no longer fit for purpose, the scale of the challenge was clear. “We need to make sure that, should another pandemic or crisis hit our country, we can use our accommodation and ward space flexibly so that we can make ourselves future-proofed,” Jacqueline concluded. “We must do something differently. We must work differently. We must find new ways of getting business cases, buildings etc. done in a way that actually makes sense. Otherwise, we’ll be in a situation where our hospitals are no longer fit for patients and we can’t treat them there. Something needs to change. I hope you’ll be on that journey with me. Thank you so much.”