With the UK government pledging millions to upgrade the NHS estate, the spotlight is on the infrastructure that supports the healthcare the health service delivers. The headlines often focus on staffing shortages or waiting times, but the physical environment in which care is delivered plays a crucial, yet often overlooked, role across many aspects of the health service including patient outcomes, staff wellbeing, operational efficiency and more
Back in June, the government published a 10-Year Infrastructure Strategy, designed to address the maintenance backlog in schools, colleges, hospitals and courts. The plans are backed by at least £725 billion of government funding over the coming decade, from which at least £9 billion will be allocated in 2025-26 to address the critical maintenance needs of health, education and justice estates. This will rise by over £10 billion per year by 2034-35.
In turn, it is hoped that this will increase access to quality, modern public services, following years of underinvestment, and deliver significant real-world benefits for patients, students, staff, and communities.
There will be over £6 billion a year for the NHS estate to create safer hospital environments across England with reduced waiting times, improved patient outcomes, and better working conditions for NHS staff. With plans to eliminate RAAC concrete and address critical infrastructure risks, patients will receive care in modern facilities that support their treatment and recovery.
The strategy directly supports the government’s mission to build an NHS fit for the future, with healthcare facilities that enable earlier diagnosis and better treatment outcomes.
Chancellor of the Exchequer, Rachel Reeves said: “Infrastructure is crucial to unlocking growth across the country, but for too long investment has been squeezed. Crumbling public buildings are a sign of the decay that has seeped into our everyday lives because of a total failure to plan and invest.
“We’re not just fixing buildings – we’re enhancing public services, improving lives and creating the conditions for sustainable economic growth in communities throughout the UK.
“This will deliver the decade of national renewal we promised Britain, and fulfil our Plan for Change goals to kickstart economic growth, and build an NHS fit for the future.”
Earlier this year, the government established the National Infrastructure and Service Transformation Authority (NISTA) which will work with partners across government and industry to effectively implement the strategy across the whole of the UK.
NISTA will periodically review the progress made and work with devolved governments to ensure that infrastructure strategy across the UK is joined up.
Becky Wood, chief executive officer of NISTA, said: “This investment is a welcome part of the 10 Year Infrastructure Strategy and will help us to address some of the challenges that our key public services have faced over recent years.
“Strategic preventative maintenance based on longer-term plans is a more effective approach than making decisions in the absence of certainty about the future – and will ensure our vital public services remain resilient and fit for purpose.
“By approaching replacement and maintenance of our infrastructure in an informed and systematic way, we can target interventions effectively and plan properly for the future.”
In September, it was announced that seven more hospitals have had their reinforced autoclaved aerated concrete (RAAC) removed. A further 12 are set to be clear by March 2026. The government has pledged to eliminate RAAC from the NHS estate by 2035.
The removal is supported by £440 million this year. The seven hospitals are Kidderminster Hospital, Kidderminster; Broomfield Hospital, Chelmsford; Homerton University Hospital, London; Scunthorpe General, Scunthorpe; Churchill Hospital, Oxford; Queen Victoria Hospital, East Grinstead; and New Cross Hospital, Wolverhampton.
The state of the estate
In 2022, it was found that 22 per cent of 8,911 premises were built before the NHS was established in 1948. These buildings are cramped, crumbling, and outdated, with GPs reporting that 22.4 per cent of general practices are not fit for purpose. Ageing infrastructure brings with it a host of challenges: outdated layouts, poor energy efficiency, limited accessibility, and inadequate facilities for modern medical technologies.
This is not just a logistical issue, it’s also a clinical one. Cramped wards, poor ventilation, and lack of privacy can negatively impact recovery times, increase infection risks, and reduce patient satisfaction. For staff, working in dilapidated environments contributes to burnout and low morale. In short, the condition of NHS buildings directly affects the quality of care.
How modernisation enhances patient care
Modernising NHS infrastructure enables us to think about how healthcare environments can actively support healing, efficiency, and inclusivity. The design of a building can positively influence the experience of patients and the effectiveness of clinical care.
From accessibility and infection control to digital integration and environmental sustainability, healthcare infrastructure offers the means to improve patient outcomes and staff wellbeing.
Modern facilities can be built to accommodate patients with mobility issues, sensory impairments, or cognitive conditions. Wider corridors, step-free access, and intuitive signage make a huge difference in patient experience.
New buildings can be designed with infection prevention in mind, incorporating features like better airflow systems, antimicrobial surfaces, and single-occupancy rooms. This is especially critical in the post-COVID era, where airborne pathogens remain a concern.
Upgraded infrastructure allows for the integration of digital health tools. This could include anything from electronic patient records to telemedicine suites and AI-assisted diagnostics. In turn, these technologies streamline care and reduce administrative burdens.
Modular design and adaptable layouts can help facilities to respond quickly to changing demands, such as surges in patient numbers or the need for specialised treatment areas.
Energy-efficient buildings reduce operational costs and environmental impact. Natural lighting, green spaces, and eco-friendly materials also contribute to a healing environment.
Supporting staff and services
Modernising NHS buildings would also have a positive effect on staff. Staff retention and recruitment are continuing to pose challenges for the NHS, and working conditions play a significant role. Bright, well-ventilated spaces with adequate rest areas, ergonomic workstations, and access to nature can improve staff wellbeing and productivity.
Moreover, upgraded facilities can support multidisciplinary teams and integrated care models. Co-locating services within a single site fosters collaboration and continuity of care.
Strategic investment and long-term gains
The scale and ambition of the government’s infrastructure strategy mark a significant moment for the NHS estate. With billions earmarked for critical upgrades, there is now a clear pathway to address longstanding challenges in healthcare infrastructure. While the success of these plans will depend on sustained investment, strategic planning, and effective implementation, the potential benefits are substantial.
Modern, well-designed facilities can enhance patient care, improve staff wellbeing, and support more efficient service delivery. As reinforced autoclaved aerated concrete is removed, digital tools are embedded, and accessibility is prioritised, the NHS estate can evolve to meet the demands of the population it is there to serve. If delivered as intended, this programme could help ensure that patients across the UK receive care in environments that are safe, supportive, and fit for the future.
Though challenges remain, the direction of travel is promising, and with continued focus and collaboration, the NHS estate may soon reflect the high standards of care it strives to deliver every day.
