The NHS estate is under increasing strain due to underinvestment, rising demand, and a £13.8 bn maintenance backlog. While high-quality estate is available, much of it remains underutilised, and optimising these assets is essential as the NHS shifts towards out-of-hospital care. Here, Baxendale Senior consultant, Kelsey Price, and head of Healthcare Estate Planning, Jim Brooks, and Abintra director, Tony Booty, argue that by combining sensor data with local knowledge, organisations can ‘uncover hidden capacity, optimise space, and reduce reliance on outdated buildings’. They explain how the two businesses are ‘helping healthcare organisations make smarter estate decisions’.
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.
The consequences are increasingly visible: leaking roofs, outdated IT systems, and inadequate clinical spaces that fail to meet modern service demands.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.
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