Shared Infrastructure: Unlocking the True Potential of Healthcare Estates

When Estate Decisions Become Reputational

Public sector estates are no longer judged solely on operational efficiency. They are visible symbols of stewardship, value for money and public trust.

Recent criticism of a £150 million government headquarters in Glasgow highlighted this shift. While the building itself attracted attention for its scale and specification, it was the reported lack of occupancy that drew the sharpest response. The perception of “emptiness” cut through more strongly than the architecture itself. For healthcare organisations, the lesson is clear: underused space is no longer a quiet inefficiency. It is a reputational risk, particularly at a time when services are stretched and resources constrained.

A Fragmented Landscape

NHS organisations, local authorities and third‑sector partners often serve the same communities and, increasingly, share premises. Yet operationally, they still tend to function in silos rather than together. This fragmentation leads to duplication: multiple reception areas, meeting rooms, offices and support spaces operating side by side, each funded and managed separately. As Matt notes,

Despite often sharing premises, organisations still work in silos, missing opportunities to integrate services in ways that would directly benefit patients and communities.

The result is higher costs, less flexibility and a built environment that does not always reflect how care is delivered on the ground.

The Challenge: Why Healthcare Estates are Hard to Share

The strategic case for shared estates is clear, but the operational reality is far more complex. Hybrid working has introduced unpredictable occupancy patterns, where buildings may be half empty on some days and under pressure on others. For Trusts, ICS bodies and community providers, this volatility breaks traditional planning assumptions and forces organisations to heat, light and maintain more space than they actively use – carrying both financial and environmental consequences.

On top of this, there are structural barriers. Different governance arrangements, funding models and compliance requirements can make shared use challenging. Concerns around accountability, data protection, clinical safety and infection control must all be addressed. At the same time, capital investment to reconfigure space or introduce supporting technology is harder to secure in a constrained funding environment.

Reframing the Estate as a Shared Asset

Despite these challenges, there is a significant opportunity to rethink the healthcare estate. As Matt notes, viewing it as a connected, shared asset rather than a set of organisational silos creates the foundations for more integrated, effective services. The examples he shared, such as One Public Estate and the growth of integrated health and community hubs, demonstrate what is possible when organisations approach their estate collectively rather than in isolation.

In practical terms, this can mean co-locating GPs, community nurses, mental health teams and social care professionals in a single setting, supporting faster referrals and more coordinated care. It can also involve opening up underused NHS buildings for outreach clinics, diagnostics or community services, while repurposing surplus non-clinical space to meet local health needs. Crucially, this approach focuses on making better use of what already exists, rather than defaulting to new build solutions. Important to highlight, as Matt puts it, shared estates are not simply about reducing costs. They are about “eliminating duplication, supporting collaboration and improving how services are experienced by patients.”

This raises the key question: how do we make shared healthcare estates work in practice?

Technology as the Enabler

Making shared estates work in practice requires visibility and control. Ad hoc use of space is rarely effective at scale, particularly in complex healthcare environments. Workplace and estate management technologies are increasingly being used to provide real-time insight into how space is used. These systems help ensure that desks, rooms and clinical or non-clinical resources are available when needed, while also generating data that supports longer-term planning.

Importantly, this data allows organisations to test shared working models with confidence, measure what works and adjust strategies over time. In a sector where change must be carefully managed, evidence matters.