Article Summary
NHS estates are under growing pressure to deliver safer, lower cost facilities at greater speed, yet projects still behave like prototypes. In this article, Paul Inch, Director of Strata Consultancy, explores why the current model of reinvention is no longer sustainable and how it leaves schemes exposed to risk, inconsistency and supplier dependency.
Across the NHS, the pressure to deliver more at pace, lower cost and with greater certainty, has never been higher. Yet the way we design and build healthcare facilities remains fundamentally fragmented.
This article draws on insights from Paul Inch, Director at Strata Consultancy, whose perspective reflects a growing industry concern; that too much valuable design intelligence, compliance learning and delivery experience is still being recreated from scratch. In reality, many healthcare buildings share the same operational and regulatory demands. Yet each project continues to behave like a prototype. That approach is no longer sustainable. Not because it always fails as many NHS schemes succeed despite it, but because it relies on reinvention where consistency and assurance are now critical.
Post-Grenfell reform has fundamentally changed the regulatory landscape. The Building Safety Act, golden thread requirements and stricter fire compliance expectations demand a level of traceability and evidence that traditional project-by-project models struggle to provide. Estates teams are now being asked to deliver facilities more quickly, with greater certainty, and within an assurance framework that is far more stringent than in previous decades. That pressure cannot be resolved simply by working harder within the same model. It requires a shift in how healthcare projects are structured from the outset.
A New Model for Healthcare Estates
Modern Methods of Construction (MMC) have become central to NHS delivery. Panelised systems, volumetric modules and hybrid approaches are now widely used. But as Paul Inch highlights, the challenge is not the methods themselves; it is how they are selected and applied. Too often, projects begin with early engagement from a single supplier. While this can bring useful input, it also introduces bias. The scheme can quickly become shaped around what a particular factory can deliver, rather than what the clinical model or estate strategy actually requires, which then, creates risk.
If the system proves inflexible, or if the supplier faces commercial difficulty, projects can become exposed. Recent failures in the modular sector have demonstrated this clearly, with schemes left stranded due to proprietary designs, exclusive test data and system-specific compliance pathways. In these situations, switching supplier is not straightforward. It can require redesign, retesting and delays often at the worst possible time. It is in this context that OSKOP (Open-Source Kit-of-Parts) is gaining attention. Rather than acting as another MMC system, OSKOP introduces a different idea: a platform approach that separates the rules from the suppliers.
Instead of beginning every project from first principles, it provides a coordinated framework – “product book” of validated components, shared interface rules, testes assemblies and delivery methods – that can be applied across multiple projects. The principle is simple: reuse what works, prove everything and keep the system open. Crucially, this approach is not tied to a single manufacturer or factory. Multiple suppliers can operate within the same framework, whether delivering panelised, volumetric or hybrid solutions. For estates teams, that changes the dynamic entirely. Procurement becomes about selecting the right delivery partner for the job and not inheriting a system by default.
Restoring objectivity in early decision-making
A key theme in Paul’s perspective is the importance of independence at the earliest stages of a project. Offsite providers operate within commercial realities. Factory pipelines need to be filled, and early engagement is often driven as much by securing workload as by shaping design.
This is not a criticism; it is simply how the market functions. However, it does mean that project decisions can be influenced by supplier priorities rather than objective suitability. Over time, this can lead to compromises in flexibility, cost, or long-term performance. A platform-first approach reverses this. It starts with defining the performance requirements, compliance pathways and design rules independently, before selecting a supplier. This ensures that decisions are driven by evidence and best fit, rather than by availability or commercial pressure.
Rebuilding confidence through assurance and transparency
If the early stages of a project must be independent, then its assurance framework must be equally so. One of the most significant shifts since Grenfell has been the recognition that trust in construction cannot rely on manufacturer‑led certification or self‑policed quality control. For NHS clients, and especially for estates teams responsible for patient safety and long‑term asset performance, assurance must be traceable, repeatable and transparent. This is where a platform model offers clear value. By defining how assemblies are tested, how interfaces must behave, how data is recorded for the golden thread, and how site and factory inspections are conducted, OSKOP provides an assurance structure that is not dependent on any single business. It brings the familiar rigour of Clerk of Works oversight into the offsite environment, expanding it to cover manufacturing lines, interface connections and installation processes.
This does not replace traditional site supervision; it strengthens it. It ensures that what was tested is exactly what is built, and that compliance is not simply a matter of trust, but of evidence. For NHS estates leaders who must answer to regulators, insurers, clinical stakeholders and the public, that assurance is not an abstract requirement; it is central to operational safety. In recent years, several NHS schemes have experienced the consequences of project designs tied to proprietary systems. When suppliers ran into financial difficulties, the projects they were delivering did not simply face delays; they faced the possibility that no other supplier could legally or technically continue the work. The risk was not the method of construction but the lack of transferability. A platform-first approach mitigates this risk by ensuring that compliance data, interface rules and tested assemblies are not owned by any one party. In doing so, it safeguards both current projects and the long-term adaptability of the estate.
Towards a more resilient future for NHS estates
For the NHS, the implications of this shift are significant. A platform-first approach does not limit choice; it expands it. It focuses on innovation rather than restricting it, and it supports traditional expertise by giving designers, estates teams and contractors a clearer framework within which to operate. By separating the rules from the suppliers, the NHS can retain the benefits of MMC – pace, quality, reduced disruption, improved predictability – without the vulnerabilities that have become increasingly visible across the sector. Procurement becomes about capability rather than dependency, and resilience improves in a market where commercial instability has all too often left clients exposed.
This approach also creates the conditions for genuine organisational learning. When interfaces, assemblies and compliance pathways are shared across projects, each scheme strengthens the next. Knowledge accumulates rather than dissipates, the estate becomes more consistent without becoming inflexible, and the NHS can focus its limited capital and clinical resources on outcomes, rather than reinventing solutions that already exist.
In a system under pressure, this matters. Estates teams are being asked to deliver more, manage more risk and provide more certainty than ever before. Relying on a project-by-project approach no longer aligns with the expectations placed on them, nor with the scale of the challenge ahead. A platform model does not claim to solve every issue in capital delivery, but it does provide a framework capable of supporting the pace, transparency and repeatability the NHS now requires. It creates a more resilient foundation upon which clinical services can grow, adapt and respond to changing demand. As Paul’s perspective highlights, this shift is not about adopting a particular system or championing a new product. It is about restoring objectivity, evidence and independence to the decisions that shape the future of healthcare infrastructure. And if the NHS is to build the capacity it needs safely, sustainably and at scale, then that shift is not just beneficial, it is overdue.
