Nurse consultation with female patient

Our latest thought leader article on how flexible use of space is driving better utilisation, value and outcomes

All estates are different and create a variety of challenges. I spent the first 20 years of my career managing different parts of our country’s railway estate. For the last 5 years, I have been involved in managing part of the NHS estate with Community Health Partnerships (CHP), specifically around community and primary care. Despite them being so different, there are similarities.

The railway estate is old, most areas going back to the Victorian era, but I am always amazed by just how much of both the primary care and acute estate predates the formation of the NHS in 1948. Science, immunisation, the diagnosis of conditions and how we treat those conditions has changed immeasurably since then and it is difficult for a bricks and mortar estate to keep up with the speed of progress. So, a real challenge for the NHS estate is both being relevant by providing what is needed and importantly when, and where, it is needed.

There are over 300 LIFT buildings in the CHP portfolio, and they are modern, state-of-the-art healthcare buildings. They were all built in the 21st century and given the recent and widely publicised issues with RAAC, CHP can move forward rather than worry about the changes, and cost, this problem might bring to their buildings in delivering place-based care.

Updating the CHP estate

It is important that we continually upgrade our buildings to make sure they are utilised to their full potential, whether it be helping to install MRI scanners to deliver Community Diagnostic Centres, like CHP have at Finchley Memorial Hospital, London and Washwood Heath, Birmingham, or carrying out conversions to make the space more suitable for delivering clinical care in 2023.

A fantastic example of creating modern, fit for purpose, spaces can be seen at Bath Street Health and Wellbeing Centre, Warrington. Previously in a Victorian hospital, the service is now based out of an ultra-modern, clean, safe, and accessible space within the heart of Warrington.

The success of these projects will also help more patients receive elective care in the  community and aid the NHS primary care recovery. Although finding space, and capital to fund, extra services can pose a challenge, it is imperative to make the most of our buildings for those who use them. Each building must offer value for money for tenants.

CHP proactively work with our partners to identify opportunities to provide more services while making the best use of space and getting greater value for money from these core NHS assets. There is also no backlog maintenance that needs to be funded.

The Importance of Creativity

Compared to 2001 when the LIFT programme began, many of CHP’s buildings are now unrecognisable due to the success of our partnership working and adapting our buildings to support areas of high health need in a way that works for patients. It is our aim to help them receive treatment closer to home and create buildings that help the community they are in.

It is not necessarily all about major capital-intensive works, which take time and money. Sometimes, it is important to look at the little things that can make a big difference. That can be how to intensify use. After all, the bricks and mortar are paid for whether the building is used one day a week, or seven. Triangulating clinical need, staff resources and underutilised space brings a simple cost-effective solution that does not need large capital investment. It can also be delivered quickly at the point of need, delivering positive results in local areas.

An example of this speed of delivery can be seen at Widnes Healthcare Resource Centre in the North West where there was no meeting room for tenants and local community groups. A rarely used second floor waiting area was converted into a new bookable space for them within a week. This minor variation shows what can be done with creativity, clarity of thought and without every project requiring large scale funding.

Buildings are, by their nature, inflexible. They were built, in most cases, to last and those that weren’t, if not needing to be rebuilt, will need to be vacated at some point. Changing space often takes time, though, and cannot always deliver value for money. Conversely, how buildings are used, and services delivered, can make a big difference and this is where flexibility is a distinct advantage.

Nationally, the COVID 19 vaccination programme showed what can be done in non-health environments such as shopping centres with capacity brought in at pace. Healthcare can learn a lot from this level of flexibility in its buildings and can apply it to the challenges it faces. Building standards are very important, but so is flexibility around them rather that rigidity.

To finish, I’ll use a famous (mis)quote from Animal Farm, “all standards are equal, but some are more equal than others”. Learning the art of flexibility creates a much more productive environment for the delivery of services and negating the challenges faced throughout the NHS estate.

To find out how the LIFT estate is demonstrating value and adapting to the changing needs of the NHS and local communities visit

Malcolm Twite is the Executive Director of Property and Operations for Community Health Partnerships.

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