How can the NHS transform its estate to support the future of healthcare delivery when ageing infrastructure, a growing maintenance backlog, financial pressures and ambitious sustainability targets demand action? 

The NHS estate is entering a critical period of transformation. The Government’s 10 Year Health Plan for England: Fit for the Future, published in July 2025, sets out a fundamental shift towards delivering more care in the community, moving from analogue to digital services and prioritising prevention over treatment. These ambitions will require a significant rethink of how NHS buildings, facilities and infrastructure are designed, maintained, utilised and managed to support changing models of healthcare delivery. 

The scale of the challenge is considerable. According to NHS England, the NHS estate comprises approximately 25 million square metres of occupied floor space and more than 1,500 directly managed hospitals, many operating around the clock. Meanwhile, the national backlog maintenance bill reached £15.9 billion in 2024/25, highlighting the growing risks associated with ageing infrastructure, critical building systems and the need for sustained investment. The Government's 2025 Spending Review and subsequent NHS Capital Guidance for 2026/27 to 2029/30 have committed more than £44 billion in NHS capital funding over four years, including £750 million annually for estates safety, alongside dedicated investment in the New Hospital Programme and RAAC remediation. 

However, significant challenges remain for NHS estates and facilities leaders. Balancing urgent maintenance requirements with long-term infrastructure investment, delivering net zero commitments while managing operational costs, and ensuring buildings remain safe, compliant and resilient all require difficult decisions about funding and priorities. At the same time, the shift towards digitally enabled and community-based healthcare creates new demands for smarter buildings, integrated estate data, improved asset management and more efficient use of existing facilities. Workforce shortages, procurement pressures and the need to demonstrate value for money further complicate the delivery of ambitious estates strategies. 

The Institute for Government & Public Policy’s National NHS Estates Conference and Exhibition 2027 will bring together senior NHS estates, facilities management, finance, infrastructure and sustainability professionals to examine these challenges and explore practical approaches to overcoming them. This conference will discuss how organisations can tackle backlog maintenance, strengthen infrastructure resilience, maximise capital investment, accelerate decarbonisation and harness digital innovation to improve estate performance. It will also explore how effective estate planning and facilities management can support patient safety, staff wellbeing and the delivery of high-quality healthcare. 

Join the Institute of Government and Public Policy at the National NHS Estates Conference and Exhibition 2027 to share best practice, learn from sector leaders and develop the knowledge, partnerships and strategies needed to create a safer, more sustainable, financially resilient and future-ready NHS estate.