NHS estate

It is our vision for all care to be delivered in modern, high quality, fit for purpose, accessible premises. Robust strategic planning of estates across London will ensure high quality NHS estate that meets agreed standards and disability access requirements, the system will incentivise efficient and effective use of assets and unused or under-utilised assets will be consolidated or disposed of to build an investment fund for local priorities.

Our challenges

The NHS is one of the largest owners of land and buildings in London. The physical footprint of London’s hospitals is around 1,000 acres – that’s three times the size of Hyde Park, and larger than the City of London. The book value of the estate is more than £11 billion, with around 70% belonging to acute hospital trusts. The remainder comprises mental health (nine trusts comprising 85 sites) and community health trusts. There are more than 1,400 GP practices, and their buildings are valued at around £1.5 billion.

Despite the scale of the NHS, the quality of NHS estate is highly variable. London has some of the finest hospital buildings in the world, such as the facility at University College London Hospital on Euston Road, and some of the poorest hospital facilities in Britain, such as Northwick Park, which has the highest backlog of maintenance in the country. Based on this, Better Health for London formed a number of recommendations around the premise: if the NHS were to better use its own property it would be a major opportunity for the city as a whole. Given that 80% of patient contacts with the NHS are in GP practices, and 70% of the assets are in hospitals, addressing these two elements should be prioritised:

1. Overhauling the GP estate in London – London’s GP practices are largely found in converted residential buildings – many are in poor condition. This means poorer patient experience and poor working conditions for London GPs. Some £1 billion is required in the GP estate in London to secure modern general practice that is accessible to all Londoners.

2. Overhauling the hospital estate in London – There are significant issues with current rules regulating capital: a lack of clear standards or enforcement process; too little incentive to dispose of surplus estate due to the combination of artificially low cost of capital and restrictions on retention of capital receipts; and no option to manage assets across the wider public sector.

About the programme

A collaborative estates programme will focus on four key areas:

1. Establishing strategic planning and capital boards

2. Developing a robust asset database

3. Ensuring estate meets robust quality standards

4. Understanding and developing levers and incentives to ensure estates strategies meets clinical strategy needs