A Guide to Healthcare Planning

Plan with Clinical Demands in Mind

Effective planning starts with understanding broad clinical demand trends and comparing these with local data. At the same time, plans need to actively engage neighbouring organisations and sectors to assess capacity, delivery, and system-wide pressures.

Create Models of Care

Once a clear evidence base is established, organisations should explore new models of care. These may be drawn from national guidance, best-practice providers across the country, or international exemplars. Adopting a new pathway can fundamentally reshape the demand and capacity profile, so modelling, scenario planning and evaluating the wider implications, workforce, running costs, and the physical estate, become essential.

Any proposed service changes must be triangulated with partners, neighbouring organisations, and commissioners to ensure clarity, alignment and system-wide understanding of the impacts.

Gary Doherty is the former Director of Strategy at Lancashire Teaching Hospitals NHS Foundation Trust. He first joined the NHS via the management training scheme and has worked in operational jobs in small and large acute hospitals across England and Wales.

“There are so many variables and moving parts – a healthcare organisation in a local economy is mind-blowing in its complexity, and therefore it shouldn’t surprise us that what looks like the right plan in one place doesn’t work in another. No matter what variables you’ve considered when putting your plan together, you must accept that there will be something that you either haven’t thought of or haven’t computed in the right way.”

Matthew Ward joined the NHS 20 years ago and has held various Director roles spanning Provider operations, Primary Care Trust commissioning and as Chief Operating Officer of a local clinical commissioning group. He is NHS England’s National Strategy Lead, which covers the breadth of the national estates portfolio.

“Strategy, planning and development can be seen as a bit wishy-washy and secondary to some harder-hitting things. But that’s completely wrong. Getting it right is difficult, but when you do, it puts everything in the correct place. Engaging people and working collaboratively all comes off developing and having a clear strategy.”

How to Plan Healthcare: The Process

An NHS Joint Forward Plan (JFP) is a five-year operational plan created by an NHS Integrated Care Board (ICB) and its partner trusts to detail how they will deliver services and meet the health needs of their local population. These plans align with the broader Integrated Care Strategy (ICS) and outline how organisations will work together to improve health, tackle inequalities, and manage resources. They are required by national guidance and updated annually.

Read Paul Fenton’s interview and discover how he and his team formulated a comprehensive estates infrastructure strategy for NHS England 

Types of Healthcare Planning

Development Control Plan (DCP)

This is where a Development Control Plan (DCP) fits. A DCP provides a structured, long-term (5 to 15 years) strategic roadmap for how an NHS Trust’s estate should evolve as clinical models, technologies and population needs change. It goes beyond buildings: a DCP sets out the sequencing, risks, dependencies and investment required to deliver a future-ready estate, allowing digital, workforce and clinical models to be deployed safely and effectively.

A DCP aligns service needs, digital requirements and population pressures with physical infrastructure, ensuring buildings and sites remain adaptable, compliant and fit for purpose.

To understand how DCPs are being delivered in practice, we spoke with two NHS Trust leaders: Neil McElduff, Director of Estates and Facilities Management at Medway NHS Foundation Trust, and Jamie Deas, Director of Strategy and Integration at University Hospitals Coventry and Warwickshire NHS Trust (UHCW). At the time of interview, both Trusts were tackling major estate challenges and emphasised that a DCP is not just a technical estates exercise, but the physical expression of clinical strategy, demand forecasts and system-wide planning.

Neil highlighted that the biggest benefit of a DCP is clarity: it creates a shared, evidence-based view of what the estate must deliver over the next decade and why. It allows the Trust to sequence investment sensibly rather than reactively, manage risk across ageing infrastructure and ensure capital spending is directly tied to clinical priorities.

Jamie stressed that developing a DCP starts “with the questions, not the answers”. Trusts must understand how their population will change, which care will move out of hospital, what will remain specialist and acute, and how digital and workforce factors reshape demand. Without this alignment, he argues, organisations risk “locking today’s problems in for another generation”.

Both Trusts identify four essentials for any successful healthcare masterplan:

• Start with clinical need, not buildings
• Stress-test multiple future scenarios
• Align early with primary care, community services, mental health, local authorities and the ICB
• Translate strategy into space through a robust Schedule of Accommodation (see below)

They also outline the key questions Boards and ICBs should ask during any master planning process, including:

• What demand are we planning for, and how might it change?
• Which services genuinely need to stay acute?
• What are the estate safety risks?
• What digital investment is required?
• How do we ensure affordability across capital, workforce and revenue?

Finally, both leaders emphasise that stakeholder buy-in is the real differentiator. A DCP cannot be created “by estates, for estates”. Clinicians, executives, partners and commissioners must be involved early and consistently, with clear narratives that explain why decisions are being made and how they support long-term system priorities.

Why Do You Need a Schedule of Accommodation?

Once an organisation has clarity about future demand and the models of care they intend to implement, it is essential to build a macro Schedule of Accommodation. This provides an analytical understanding of the estate required to deliver those models of care. A gap analysis between the current estate and the predicted Schedule of Accommodation then informs the DCP, shaping what the future healthcare estate should look like.

A Living, Breathing Strategic Estate Delivery Process

This process should remain dynamic. regularly revisited as new models of care emerge, real-estate conditions shift, or external pressures change. It’s not a one-off exercise but a dedicated, ongoing Strategic Estate Delivery Process: a living plan that is continually updated, refreshed and adjusted.

What a DCP Covers

• Where the organisation is now, and where it needs to be
• Which estate options exist, and the risks/challenges associated with them
• The investment required, sequencing, dependencies and timing
• How clinical models, digital capability and workforce design shape the estate

A DCP sits within broader healthcare planning.

It is trust-facing (focused on the internal estate), whereas wider system planning looks at how healthcare infrastructure interacts with new housing, community growth and local development frameworks.

Community healthcare planning, meanwhile, ensures that local authorities and NHS bodies work together to assess how new developments, especially housing, will impact healthcare demand. This can involve Local Plans, Supplementary Planning Documents (SPDs), Community Infrastructure Levy (CIL) contributions, Section 106 agreements, and health-in-all-policies approaches.

Read https://health-spaces.com/blog/2024/05/05/nhs-masterplanning-dcps/

Quality and Safety

Maintaining a focus on quality of care, patient safety and clinical effectiveness, supported by robust clinical governance frameworks and risk management, is a critical part of healthcare planning. Quality and safety in healthcare planning means designing services that consistently deliver safe, effective care in the areas where harm is currently most likely, and right now that includes maternity and neonatal care, mental health, and care in ageing or poorly maintained estates.

National inspections have found widespread safety concerns in maternity services from culture to staffing, and fetal monitoring, and maternity remains a formal priority in national planning guidance. CQC’s recent State of Care reports also highlight ongoing risks on mental health wards, where cramped, outdated environments and workforce shortfalls can compromise both dignity and safety. Against this backdrop, the NHS Patient Safety Strategy is now credited with saving lives and money each year, but also underlines the need for a stronger safety culture and safer systems, not just more policies.

Robust clinical governance and risk management means that “ward to board” there are clear lines of accountability, regular review of quality and safety data (incidents, complaints, mortality, serious incidents, staffing red flags), and a strong learning culture rather than blame.

Tools that support evidence-based decision making include the NICE guidelines, which integrate shared decision making (SDM) principles directly into its guidelines and have published specific guidance to embed SDM as a core standard of clinical practice.

National benchmarking programmes such as GIRFT and the Model Health System show, service by service, where outcomes, lengths of stay, readmissions, and costs diverge from peers, and quantify the opportunity if gaps were closed.

That intelligence should then feed into structured risk registers and serious incident frameworks (now PSIRF), so the highest-impact quality and safety risks are logged, owned, and acted on rather than buried in reports.

Teams test specific improvements in practice, for example, a new sepsis pathway or theatre start-time protocol, track whether changes are genuinely improving outcomes or reliability over time, and decide whether to adopt, adapt or abandon. In combination, these tools create a visible, data-driven loop from “we have a problem here” to “we’ve tested fixes and can prove what works.”

In modern healthcare planning, quality and safety are crucial to test decision-making around workforce, estates, digital and financial.

What Tools and Methodologies Are Best For Healthcare Planning?

Lean, Six Sigma, and Root Cause Analysis (RCA) are established process and quality-improvement methodologies used across both commercial and public organisations like the NHS to redesign workflows, remove inefficiency, and drive consistent, high-quality outcomes. Standard frameworks NHS organisations rely on when redesigning pathways or improving productivity include PDSA cycles, clinical audit, and SPC charts support iterative testing, making it clear what actually works rather than what feels right. Demand and capacity modelling helps planners move beyond guesswork to predictable, testable models of how services behave under different pressures.

Queuing theory is a mathematical framework used to analyse wait times, bottlenecks, and flow in systems where demand fluctuates. Little’s Law, one of its core principles, links three variables: how many patients are in the system, how long they stay, and how fast they arrive. It underpins bed modelling, clinic flow analysis, and theatre throughput planning. These models are essential for setting safe staffing levels, planning theatre lists, sizing assessment areas, or understanding what happens when demand exceeds supply. Increasingly, systems are also using digital twins and advanced analytics to forecast peaks and test scenarios before making capital or workforce decisions.

As with all healthcare planning, none of these tools work without clinical engagement. The most effective plans involve clinicians from the earliest stages shaping assumptions, validating model outputs, pressure-testing risks, and ensuring that the clinical model, workforce model, estate design and digital infrastructure all align. When clinicians co-design solutions, plans are safer, more deliverable, and far more likely to stick in practice.