The first morning’s opening conference session, at an event themed ‘Pioneering estates for tomorrow’, was prefaced with an introduction from IHEEM’s CEO, Pete Sellars, who highlighted the ‘great line-up of speakers’, and told delegates that what made such events special was their engagement with those presenting. He explained that the first session’s keynote speaker would be Judith Paget, followed by colleague, Stuart Douglas, Director of NHS Wales Shared Services Partnership — Specialist Estates Services (see HEJ — June 2025). With Judith Paget not able to attend in person, Pete Sellars told delegates her presentation would be one recorded in advance. Following her conference address and the next, from Stuart Douglas, the pair were joined on stage for a lively Q&A session by Simon Russell, Deputy Director of NHS Wales SSP SES, and Mark Gapper, the organisation’s Head of Engineering.
A valued profession praised
Judith Paget began her address by thanking IHEEM and its Wales Branch for inviting her to speak. While sorry not to be able to attend, she said she was ‘really grateful to have the opportunity to record this message to show how much value we place on the healthcare engineering and estate management role across our NHS in Wales’. She said: “I recognise that there are significant challenges across the NHS, which often reflect the age and condition of many parts of our estate. The engineering and estate management functions are key to ensuring healthcare services across hospitals and other healthcare facilities can operate efficiently and effectively and maintain business continuity.” She added that she very much appreciates ‘the commitment of all colleagues who are working tirelessly to deliver clinical services compliantly and safely’.
“Today,” she explained, “I’d like to briefly outline some of the challenges for the NHS in Wales, and highlight some of the ways in which the estate can help respond to these. The pressures on our services remain, and we are dealing with these alongside a very difficult and pressing financial position.” Against this backdrop, she said it was the healthcare EFM and healthcare engineering community’s ‘collective responsibility’ to make sure it continued to rise to these challenges, and ensure that NHS Wales services ‘remain safe and accessible to those that need them the most’.
It was also key, she added, to ensure that all of the staff across the NHS in Wales feel supported and valued with the work that they do. She told the conference: “A Healthier Wales set up a vision for an integrated system with seamless services that focus on prevention and community-based care, and going into hospital only when absolutely needed.” This remained the aim where possible. Judith Paget said: “I want to continue to move healthcare services that do not need to be provided at all main hospital sites into the community, but recognise that this will take time and ongoing resources.” She continued: “Quality and safety are an integral part of everything we do. Serious, avoidable safety incidents are still occurring across the NHS, so it’s important that compliance risks are managed and mitigated against.”
Identifying the key risks
Given the increase in the backlog maintenance figure across NHS organisations, it was — she said — essential that the key risks to patient safety and business continuity were identified, and she was encouraged that work to better understand NHS Wales’s key risks was beginning to progress. She said: “Against this backdrop, I’d like to highlight a few of the key areas which relate to engineering and estate management. Over the next two financial years, NHS Wales will benefit from £80 m in funds, with investment in a range of areas — including infrastructure, fire safety, mental health, decontamination, and infection prevention and control.”
She had been pleased to receive reports of a wide take-up of this offer, and thereby a commitment from healthcare organisations to join NHS Wales’s management in directing funds in this way. Out of 337 bids received against all the categories, the Cabinet Secretary had been able to approve 278 of the bids. Over time, she was hopeful that this programme, building on the previous targeted estates backlog funding provided in 2024-2025, would make a meaningful reduction in the £135 bn worth of backlog maintenance figure, and improve the quality of the NHS estate in Wales. Here she reiterated the need to focus on the key estate risks and direct NHS Wales’s limited funds towards issues that affected patient or staff safety and business continuity.
Future business cases for capital funding would, Judith Paget explained, need to clearly demonstrate how schemes will reduce the backlog maintenance figures for the individual Health Board or Trust. She said: “Having had to divert significant funds at short notice in 2024/2025 to deal with the emergency roof failure at the Princess of Wales Hospital in Bridgend was very disappointing. I’m sure you’ll all agree it would be far better for patients, and much better value for money, for such activities to be planned as part of a normal lifecycle replacement, than to have to be reactive with significant disruption in cost.”
Understanding the estate’s condition was, she said, essential to avoid these situations arising, while recognising that ‘you can’t always plan for everything’, with the issues with Reinforced Autoclaved Aerated Concrete ‘a great example’ of that.
Space utilisation and rationalisation
She said: “Looking ahead, I would encourage you to ensure that not only are you on top of your estate surveys, but also that you are very clear on the risk status, to help focus your Board’s attention, and ensure that investment priorities can be targeted at the most important engineering and infrastructure items.” One clear area which she said her Welsh Government Finance Team had been promoting was space utilisation and rationalisation. Judith Paget said: “I would encourage you to ensure that cases for investment are built on solid foundations of demand and capacity assessments, to support projected spatial requirements. In all cases, existing estate rationalisation opportunities should be explored at the same time, to enable our limited funds to be focused on good and affordable stock. Ultimately, we want to optimise the NHS Wales footprint to ensure we are able to provide high quality care when needed for our patients.” This, she stressed, involved providing services ‘at the right place, at the right size facility, at the right time, and to modern and safe staff and patient standards’.
Judith Paget said she was keen to ensure that NHS Wales looks to reduce its emissions ‘as far as possible’ to contribute to the Welsh Ministers’ ambitions for the country’s public sector to be Net Zero by 2030. She said: “The challenges of having an ageing estate are clearly understood. We aren’t likely to be able to move to Net Zero in the short term, but we can work on what is deliverable, and ensure that new developments and major refurbishments take account of the newly released guidance on the Net Zero building standards.”
Building emissions falling
The NHS Wales Chief Executive said she was pleased to be able to report that building emissions had fallen by 5% since 2022, and 9% since 2018, despite potentially lower activity before the pandemic and — for NHS Wales — the Grange University Hospital being opened during a period with no buildings being closed directly related to it opening. Judith Paget said: “It is good work that the Welsh Government energy service is progressing with all Health Boards. The solar farm at Morriston Hospital has been a major success, and we are keen to promote other renewable energy schemes. The targeted estate funding has meant that we are starting to show the significant benefits of this investment to address decarbonisation.” She continued: “These actions not only reduce the amount of energy required, but improving the building fabric, while contributing to improve energy efficiency, also helps to improve the patient and staff experience.”
Looking forward, the speaker said she was ‘conscious that the future capital programme has been under pressure as funds are constrained’. “Nevertheless,” she told delegates, “we do have some exciting schemes planned. While I recognise that it was an onerous task for NHS organisations, and indeed Welsh Government of officials, the capital schemes identified by NHS organisations through the prioritisation exercise have helped us focus minds.” As a result, Health Boards and NHS Trusts had been given a clear message as to which capital schemes they should focus on in the short to medium term. “There are already some examples of good partnership working,” Judith Paget explained, “while I’m keen to encourage more; for Health Boards this will mean regional facilities for certain clinical services, with the necessary commitment from all partners. We cannot continue to have specialist clinical services provided at separate sites in relatively close proximity.” As well as being a workforce risk, this was also ‘an inefficient use of limited resources’.
New cancer treatment centre discussed
Judith Paget said she was delighted to see that delegates at the event would be receiving an update on the new cancer center being developed in south-east Wales — the new Velindre Cancer Centre in Cardiff (the subject of a separate presentation the same morning), describing the new facility as ‘a major investment which will ensure that cancer patients in south-east Wales have access to first-class facilities for their treatment.’ She added: “We’re also looking regionally at opportunities to centralise some diagnostic and treatment activity, to help tackle the waiting list backlog, and position us well to respond to higher activity volumes for the future. The aim is to locate these dedicated centres on green sites, which means they would not be affected by emergency or urgent care pressures. A good example of this is the regional orthopaedic hub at Llandudno Hospital in North Wales (which is currently under construction). She added: “As we move forward, we’ll see more people being treated at home or in the community, and an increased use of digital solutions and AI in our healthcare system in Wales. To conclude, engineering and estate management are key enablers to allow NHS Wales to provide safe and efficient healthcare services from compliant facilities to the Welsh population. Thank you for listening. I hope you have a successful conference yet again. Thank you for everything you do.”
This concluded her conference presentation, and having thanked her for speaking, session Chair, Pete Sellars, then introduced Stuart Douglas to the stage for his presentation, explaining that he would be ‘sharing his thoughts around the challenges his Chief Executive has just highlighted’.