Article Summary
Drawing on the perspective of Matt Etherington, Healthcare Workplace Specialist at Matrix Booking, this article explores how the shift towards neighbourhood healthcare could help the NHS make more effective use of its existing estate. As services become increasingly distributed across hospitals, community facilities and shared public-sector environments, Matt argues that greater visibility of how space is used will be essential to reducing duplication, relieving pressure on acute sites and creating an estate capable of adapting to changing local needs.
For NHS leaders, the shift towards neighbourhood healthcare raises a fundamental estate question: how can organisations create the capacity needed for new models of care without continually adding to an already costly and complex footprint?
The NHS 10-Year plan places neighbourhood health services at the centre of future care delivery, creating renewed focus on how estate can support care closer to home while making best use of limited resources.
The answer will not lie in new development alone. Across the NHS, hospitals, community facilities, primary care premises and wider public-sector buildings are often planned and managed separately, even where they serve the same populations. At the same time, acute sites remain under sustained pressure, capital is constrained and organisations are being asked to accommodate expanding services, changing workforce models and greater demand within environments that are not always used as effectively as they could be.
As more care moves closer to home, this creates an opportunity to reconsider the estate as a connected system rather than a collection of individual buildings. Neighbourhood health centres, community diagnostic facilities and integrated local services could help relieve pressure on acute hospitals, reduce unnecessary duplication and make better use of existing assets. However, those benefits will only be realised if organisations understand where capacity exists, how it is being used and whether it is genuinely suitable for the services local populations require.
Drawing on his experience supporting organisations to manage increasingly shared and distributed environments, Matt Etherington, Healthcare Workplace Specialist at Matrix Booking, argues that neighbourhood healthcare should be understood not only as a service transformation programme, but as an estate strategy. As Matt explains,
The solution is often making better use of the space that already exists rather than adding more space
The opportunity is therefore not simply to relocate activity from hospitals into community settings. It is to create a more deliberate relationship between services, people and place, ensuring that the estate is aligned with how care is changing and flexible enough to respond as local needs evolve.
Rethinking the role of healthcare estate
For decades, much of the healthcare estate has been organised around hospitals and other dedicated clinical facilities. While these environments remain essential for the delivery of acute and specialist services, the way care is delivered is becoming increasingly distributed.
Integrated Care Systems, neighbourhood health centre, community diagnostic centres and virtual wards, all reflect a broader shift away from care being concentrated within individual organisations. Increasingly, services are being planned around populations, pathways and places rather than the boundaries of a single provider.
This has significant implications for the estate. Healthcare organisations, local authorities and community services have often developed, funded and managed their assets independently. While this reflects traditional organisational boundaries, it can also result in duplicated facilities, fragmented service delivery and limited opportunities to share space and infrastructure.
Neighbourhood healthcare offers an opportunity to rethink that model. By bringing health, social care and wider community services together within shared local environments, organisations can create more integrated pathways around patients while making more effective use of public-sector assets.
For Matt, the significance of this shift extends beyond patient access or service integration. It also creates an opportunity to reconsider how estate is planned and utilised. As he explains,
Much of the discussion around neighbourhood healthcare has focused on access and patient outcomes, which are clearly important. But it also presents a significant opportunity to think differently about how healthcare space is used and shared across organisations
However, a connected model of care cannot be created through co-location alone. Placing several services within the same building does not automatically create integration if each continues to operate through separate spaces, systems and priorities. As Matt notes, neighbourhood environments should support “collaboration rather than simple co-location”.
For senior leaders, the implication is clear. As services become more integrated, estate strategies must move beyond individual buildings and organisational ownership. The physical environment must be planned and managed as part of a coordinated local system of care.
The visibility gap
The ambition to create a more connected estate is difficult to realise without a clear understanding of how existing space is being used.
Many organisations still rely on periodic audits, manual reporting, spreadsheets or disconnected local systems to assess utilisation. These methods can provide a snapshot of activity, but they often struggle to capture how demand changes across different days, times, services and buildings.
As a result, capacity can remain hidden. Rooms may appear fully occupied because they are booked, while sitting empty in practice. Administrative areas may be heavily used on certain days and largely vacant on others. Community facilities may have suitable space available that remains invisible to teams elsewhere in the system.
This can create an apparent contradiction, where estate pressures can exist at the same time. Some teams report that they cannot find appropriate space, while usable rooms elsewhere remain empty or inaccessible. One organisation considers expanding its footprint while another within the same local system holds underused capacity. These are not necessarily failures of individual teams. They are often symptoms of fragmented estate information and organisational boundaries that make it difficult to see, access or coordinate space across a wider system.
In shared buildings, the problem can become even more visible. Different organisations may operate separate booking processes, access arrangements and administrative systems, despite working within the same environment. Staff can arrive expecting to use the same room, while other suitable spaces remain vacant. As Matt explains, these are not isolated operational issues, but part of “the everyday reality of running a multi-tenanted building without the right infrastructure in place.”
He compares the challenge to operating a major transport system without reliable visibility,
Managing a modern healthcare estate without accurate utilisation data is like running an airport without knowing which gates are available. Space may exist, but without visibility it becomes much harder to allocate resources effectively, avoid bottlenecks and plan for future demand
At a small scale, these issues may appear administrative. At system level, however, they affect productivity, staff experience, service capacity and the quality of estate decisions.
For senior leaders, this matters because estate decisions made without reliable utilisation insight are more likely to be based on assumptions. Before organisations invest in additional capacity, consolidate services or reconfigure existing environments, they need a clearer view of where demand exists and whether the estate is already capable of meeting it.
Turning utilisation insight into better decisions
Greater visibility is only valuable if it leads to better decisions. Utilisation data can help organisations understand where demand is concentrated, where bookings do not reflect actual use and where space could be adapted, shared or allocated differently. It can also provide a stronger evidence base for deciding whether additional investment is genuinely required.
However, utilisation cannot be judged through occupancy figures alone. A clinical room used for only part of the week may still be essential because of the service it supports, the equipment it contains or the need to retain capacity for urgent demand. Equally, an empty room is not necessarily suitable for another purpose.
Healthcare environments are shaped by clinical, operational and regulatory requirements. Infection prevention, accessibility, confidentiality, safeguarding, equipment and service adjacencies all influence whether space can be used differently.
The purpose of utilisation data is therefore not to identify the maximum number of people who can be placed within a building. It is to help leaders understand whether the estate is supporting care effectively and where changes could create greater value. As Matt explains,
The value of this visibility extends far beyond identifying empty desks or unused rooms
Used well, this insight can reveal where administrative space could be adapted, where functions could be consolidated and where a shared environment could support a broader range of services. Equally, it may confirm that existing capacity is genuinely constrained and that additional investment is justified.
This gives leaders a more reliable basis for prioritising adaptation, reconfiguration and capital expenditure. Rather than treating utilisation as a simple measure of efficiency, organisations can use it to align space more closely with operational demand and future models of care. The real value lies not in the data itself, but in the confidence it creates around what should change, where investment should be directed and which parts of the estate are capable of supporting more.
Shared estate requires shared governance
Better information alone will not create a more connected estate. Shared environments bring together organisations with different priorities, accountabilities and ways of working. Even where suitable space exists, uncertainty can remain over who is entitled to use it, how access is managed, how costs are shared and who is responsible when demand conflicts.
Without clear governance, local teams may revert to informal processes or protect space for their own use because they have little confidence that it will be available when needed. This can reproduce organisational silos within a nominally integrated building.
For neighbourhood healthcare to work effectively, partners need agreed principles for how space is allocated, booked, managed and reviewed. They also need clarity about which areas must remain dedicated, which can be shared and how decisions will be made as services and demand change. This is not simply an operational issue. It requires leadership across organisational boundaries. Senior leaders must create the conditions for services to share space with confidence, knowing that access will be fair, responsibilities will be clear and local arrangements can adapt without becoming trapped in lengthy negotiation.
There is also a cultural challenge. Organisations may need to move away from equating ownership with guaranteed access to capacity and towards a model based on visibility, coordination and shared responsibility. In some cases, a well-managed shared resource may provide greater practical availability than a dedicated space that is only partly used.
The success of a shared estate therefore depends on more than systems and processes. It depends on trust, transparency and a willingness to plan around collective need rather than organisational ownership.
Making the existing estate work smarter
Neighbourhood healthcare offers the NHS an opportunity to make better use of the estate it already has, but that opportunity will not be realised through relocation alone.
Organisations need to understand where capacity exists, whether it is suitable for different services and how it can be shared across organisational boundaries. They also need governance arrangements that allow the estate to adapt as demand, pathways and workforce models change.
This does not mean that every estate challenge can be solved through optimisation. Some buildings will require significant investment, others may no longer be fit for purpose and new capacity will still be needed in parts of the system.
The priority is to distinguish clearly between genuine estate constraints and capacity that is underused, poorly coordinated or difficult to access. As Matt explains,
This is not about reducing space for the sake of it. It’s about ensuring environments reflect how healthcare is delivered today and remain flexible enough to adapt as needs change
For senior leaders, the task is therefore not simply to manage buildings more efficiently. It is to ensure that estate decisions support the wider model of care, direct investment towards the areas of greatest need and create environments capable of delivering long-term value.
As neighbourhood healthcare continues to evolve, the challenge is no longer simply expanding capacity but understanding how existing assets can support more integrated, community-based models of care. Those organisations that develop the visibility, governance and flexibility to manage estate across whole systems rather than individual buildings will be better placed to respond to changing demand, maximise the value of public assets and deliver sustainable long-term improvements in care.
The future of the NHS estate will not be defined only by how much new space is created. It will also depend on how intelligently existing space is understood, connected and used.
