Willmott Dixon Interiors recently brought together senior NHS estates professionals and specialists in design, project, and cost management to reflect on topics including planning risk, delivery capacity, decarbonisation, and digital readiness. Reflecting on these discussions, Will Walkinton, healthcare sector lead at Willmott Dixon Interiors, explores the growing gap between policy ambition and on-the-ground delivery across healthcare estates.
Having been at the centre of government discussion, investment in community care hubs reflects a commitment to the expansion of neighbourhood health infrastructure in a bid to reduce pressure on acute facilities. However, there are concerns over the gap between strategic ambition and delivery reality.
New, purpose-built facilities seem to be the focus, yet experts are clear that this is unlikely to be deliverable at scale. Planning, logistics, and time constraints all mean that refurbishment and reuse of existing buildings need to be the dominant approach.
Even then, questions remain about staffing models. There is scepticism over whether clinical teams will choose to work across multiple smaller sites, particularly when services are already stretched. This could push Trusts towards greater reliance on outsourced provision, bringing cost and political pressures. Under all of this is uncertainty around the long-term funding and operating model for community hubs.
The NHS Oversight Framework 2025/26 categorises Trusts on a scale of 1 (Segment 1: ‘High performing’) to 5 (Segment 5: ‘Most challenged’) based on financial performance and delivery capability. This classification determines the level of oversight intensity and access to improvement support, and directly influences the pace at which projects can move forward.
While the Budget signalled intent, many NHS Trusts still lack clarity on public and private investment. Until that picture is clearer, there is a risk that community hubs become more of a policy aspiration than a deliverable solution.
Within the current framework, financial deficits can restrict how highly a provider can be rated. Trusts in NHS Oversight Framework 2025/26 Segments 3 (‘Mixed performance’) or 4 (‘Significant concerns’) may therefore find it harder to take bold estate decisions without clear capital backing. For some organisations, the risk of slipping further down the segmentation scale makes caution the default position.
Planning pipelines
While additional funding for planning teams is also welcomed, most feel that any improvement would take time to filter through, particularly given the scale of applications already in the system and the complexity of healthcare schemes.
Fundamentally, planning risk appears to be underestimated within programmes, with tight timescales and live clinical environments posing significant hurdles. Planning backlogs remain significant, healthcare schemes continue to be among the most complex in the system, and any uplift in capacity will take time to materialise.
From an oversight perspective, Trusts in Segment 2 (‘Performing well’) or 3 (‘Mixed performance’) are particularly sensitive to missed trajectories, as sustained underperformance may trigger enhanced monitoring or formal improvement support. Estates programmes are therefore increasingly being scrutinised not just for quality and compliance, but for their contribution to broader operational resilience.
Building Safety Act in practice
The Building Safety Act represents a structural shift in how NHS estates plan and deliver projects. Yet pressure is compounded by the scale and complexity of the existing estate. Most Trusts are working through backlogs and trying to stay ahead of new requirements. Simultaneously, capacity constraints and uncertainty over requirements have slowed approvals, creating delays across estates.
Early signs of improvement include reforms to structure and resourcing, which are expected to ease bottlenecks over time. Estates teams are increasingly having to adapt, placing greater emphasis on early design engagement and upfront coordination.
Pre-application meetings with the regulator are generally seen as helpful, and some people report quicker turnaround times at early stages. At the same time, it is clear the system is under strain, and a consultation is expected on which projects genuinely need to go through the full process.
While digital transformation is accelerating across the NHS, estates teams often feel left reacting rather than planning. Examples of IT systems overheating or simply reaching capacity highlight the gap between digital ambition and the physical infrastructure supporting it.
Developments including electronic patient records, data storage, and automation are positive. The challenge for estates teams is how to retrofit resilience, cooling, and power into assets never designed for this level of demand.
Digital reliability feeds directly into access standards, productivity metrics, and patient safety indicators that form part of the national oversight picture. Infrastructure constraints therefore risk having wider organisational consequences beyond estate compliance alone.
Sustainability constraints
The topic of decarbonisation prompts a more frustrated tone among NHS estates professionals. Its importance is recognised, but there is a shared sense that current funding structures make delivery harder than it needs to be. The Building Safety Fund came up in discussions repeatedly, particularly the restrictions around how money can be spent, the inability to move funding between projects, and the level of reporting required. The risk of having to return unspent funds at a higher value only adds to the pressure.
Several Trusts describe keeping schemes on the shelf so they can move quickly if funding becomes available. However, preparing projects to that level costs money in itself. Some are exploring solar sleeving or connections to external energy networks, although the long term financial case does not always stack up. Heritage buildings are widely acknowledged as one of the hardest challenges, where decarbonisation options are limited without major intervention.
For organisations already operating in deficit, the tension is acute. The current oversight framework makes clear that financial performance influences overall segmentation. Investment decisions must therefore balance long-term sustainability against short-term financial optics: a dynamic that could slow meaningful progress toward net zero.
Funding and procurement
When it comes to funding and procurement, there is a lot of interest in whether budgets can be rolled over. The inconsistency across Trusts makes longer term planning difficult.
Grouping projects, the future role of the ProCure23 (P23) framework, and where capital decision making should sit, are all key topics discussed but with no clear consensus. M&E is consistently described as an area where early involvement really matters. Many feel that bringing M&E partners in before Stage 2 can avoid problems later and improve overall delivery, particularly on complex refurbishments.
The fourth generation of the ProCure framework, P23 is designed to support the design and construction of capital projects across the NHS estate. It offers NHS customers a fast-track, mini-competition procurement route to access experienced and proficient partners who can support every stage of a project — from business case development to sustainability and decarbonisation, through to modern methods of construction, disruption mitigation, benefit realisation, and optimised occupation.
NHS Property Services
Another emerging issue for NHS Trusts is the potential restructure of NHS Property Services. Assets currently managed centrally by this partner would be transferred to individual Trusts, Integrated Care Systems (ICSs), or local bodies.
The benefits include greater control over capital allocation, with Trusts able to make faster, more targeted decisions on refurbishment, repurposing, or disposal of assets, in line with local priorities. The move could also improve accountability by clarifying responsibility for maintenance, compliance, and safety.
However, in the short term estate leaders are likely to be managing another layer of structural uncertainty at a time when delivery expectations across the NHS continue to rise.
Ownership and responsibility
For many Trusts, NHS Property Services has provided both a landlord and a delivery partner for primary and community facilities. Any move to abolish or significantly restructure the organisation raises immediate questions about ownership, responsibility, and investment across a large portion of the estate portfolio.
In practical terms, estates teams are concerned about what happens to existing leases, maintenance responsibilities, and capital programmes if assets are transferred to ICSs, local Trusts, or alternative public bodies. While increased local control could offer opportunities, there is also a risk of fragmentation if responsibilities are devolved without clear funding mechanisms or technical support.
There are potential implications for the delivery of neighbourhood health infrastructure, as many community facilities currently sit within the NHS Property Services portfolio. So, any transition period could delay delivery.
Uncertainty over asset management roles and responsibility can affect progress too. Clear governance over who can approve works, who manages risk, and how long assets will remain within organisational control is key. Without that clarity, projects may stall.
There is a strong consensus from NHS estates teams that they need greater visibility of their future pipeline to support better planning, investment and delivery. Without that clarity, Trusts and delivery partners can struggle to align resources and maintain momentum.