It was one of the questions raised at Healthcare Estates in Manchester, and it keeps coming up. The NHS knows what it needs: better outcomes, redesigned pathways, smarter use of digital and more care closer to home.
The hard part is turning that into something that can be funded and delivered while services cope with daily pressure.
We caught up with Eleanor Jackson at the event – a healthcare planner whose 15 years of NHS operational and clinical experience informs her client work within the healthcare planning team at Ridge.
Start with the service, not the estate
It comes back to putting the brief before design. Teams often discuss the estate before the service model is settled, and design starts before anyone has tested what the investment is meant to achieve. The starting point should be what the service needs, who it is for and how it should work. Design follows from that, because facilities exist to support people.
An evidence-led brief sets out the outcomes wanted, backed by a clear view of demand, workforce, digital opportunities and future flexibility. Without it, a project can head very efficiently towards the wrong answer.
Bring thinking together early
Clinical teams focus on safe, effective care and finance teams on affordability and value. Both are right. Problems start when the two views meet too late, and the result is either an unaffordable service model or a cost-led design that limits how people can work. Treating affordability as a design parameter and making compromises openly keeps each phased decision aligned with the longer-term roadmap.
“A strong business case brings clinical need, service ambition and affordability together from the outset. It allows teams to test the options and understand the trade-offs early, so investment decisions are based on what delivers the right outcomes as well as what can realistically be afforded.”
– Leonard Poon, Partner, Cost Management
Look at what’s already there
The NHS has a vast estate and we still don’t fully understand how it is used. New space is often proposed before anyone has looked at occupancy, underused capacity, or what service redesign, better scheduling or shared use could release. Some estate is no longer fit for purpose – RAAC is the obvious example – and not everything can or should be saved. But much of what is needed may already be there.
Lived experience reveals barriers and practical needs that activity data never will. Buildings and equipment don’t deliver care; people do. ”
Eleanor Jackson
Project and Programme Delivery, Associate Healthcare Planner
Give people a say
Sustained engagement, education and shared understanding is what moves projects forward. The people who deliver care need a real say in where a project is heading, as do patients, carers and service users, whose lived experience reveals barriers and practical needs that activity data never will. Buildings and equipment don’t deliver care; people do.
Substance over appearance
We know all of this, yet the pressure to deliver visible results still drives decisions. A high-profile new facility attracts more recognition than redesigning services to improve the care patients experience, yet a system that rewards appearance over substance is one the NHS can’t afford. Facilities can’t operate themselves, so they need to support the people and the care they deliver.
“A new building is only one part of the change. That’s where operational readiness comes in, making sure that people and processes are prepared for how care will work in practice.”
– John Clucas, Healthcare Partner and Operational Readiness Management Lead
That starts with understanding the service and the patients, then deciding what needs to be where and how it will be delivered. It won’t always mean a new clinical setting, and often it means making better use of what is already in place.
Let's talk
Our healthcare planning team works on everything from live clinical refurbishments to major estate optimisation programmes. Across all of it, projects deliver better outcomes when estates, services and operations are planned together and the right people are involved early.
Eleanor Jackson is a healthcare planner with more than 15 years’ NHS operational and clinical experience. Contact her at eleanorjackson@ridge.co.uk
Wayne Ashton is a partner at Ridge and leads our healthcare planning team. Contact him at wayneashton@ridge.co.uk.
Explore our wider healthcare expertise. For more on operational readiness management, contact John Clucas, or speak to Leonard Poon about business case development.
