Article Summary
This article examines how buildings, space and infrastructure will shape the delivery of the NHS 10-Year Plan, and why the shift to community-based care, digital services and prevention depends on an estate aligned with modern models of care.
What is the NHS 10-Year Plan?
In simple terms, the NHS 10-Year Plan sets out how England’s health system will move care closer to home, use digital tools more effectively and shift from reactive treatment to prevention and early intervention.
Published by the UK Government in July 2025 as Fit for the Future, the plan lays out a long-term vision for a system that’s easier to access, more resilient and less reliant on overcrowded hospitals. Delivering that vision means three big shifts: expanding community-based care, embedding digital as standard and putting prevention at the centre – all while managing workforce pressures and tight public finances.
A key part of the strategy is the physical estate. The plan proposes up to 300 new Neighbourhood Health Centres (NHCs) – integrated, one‑stop hubs that bring together health, social care and voluntary services under one roof. These centres are expected to offer extended opening hours and serve as the main point of access for community-based care.
The plan also ties estate development directly to new contracting and funding arrangements for Primary Care Networks (PCNs) and Integrated Care Boards (ICBs). In short, the Government assumes that new models of care will only work if the right buildings, in the right places, are ready to support them. And that’s where the challenge really begins.
Why NHS Buildings and Estates Matter to the 10-Year Plan
You cannot deliver community-led, digital-first, prevention-focused care without an estate that is aligned with current and future models of care. The NHS estate is not simply a backdrop to reform; it is a critical enabler that directly shapes what can be delivered, at what pace and at what scale. For example:
- Virtual wards and remote monitoring depend on robust digital infrastructure and connectivity.
- Shifting care closer to home requires community buildings that are accessible, appropriately sized and located where populations actually live and age.
- Modern clinical pathways demand environments that support multidisciplinary working, efficient patient flow and flexible use of space.
When clinicians are spread across unsuitable buildings, when patient journeys are fragmented by physical layouts, or when digital ambitions are constrained by outdated infrastructure, the estate becomes a barrier rather than an enabler. This is why many senior NHS leaders now refer to a growing delivery gap – the gap between what national strategy promises and what the current estate can realistically support. Strategies can evolve quickly. Buildings cannot. And if the estate does not keep pace, transformation stalls.
The 3 Big Shifts Explained: Community, Digital, Prevention
The NHS 10-year plan is built around three major shifts, which, as highlighted by the NHS Confederation, “should reduce demand on hospitals and NHS staff, reduce waiting times and save taxpayers’ money, delivering high-quality healthcare without taking up an ever-growing share of national wealth”.
The plan envisages fewer hospital-centric pathways and greater reliance on neighbourhood health centres, diagnostic hubs and same-day community services. And for there to be less reliance on big acute hospitals and the A&E as the only “front door” to healthcare. But this shift only works if the community estate is ready – with sufficient capacity, modern diagnostics and spaces designed for integrated teams.
Video consultations, remote monitoring, AI‑supported triage and shared digital records aren’t “the future” anymore, they’re what people now expect as standard. But digital progress still depends on the basics. If buildings don’t have the right wiring, connectivity, clinical layouts or room to adapt, even the smartest technology can only go so far. In other words, digital innovation hits a hard limit when the physical estate can’t keep up.
Prevention requires space for early diagnosis, rehabilitation, lifestyle support and long-term condition management. It requires environments that support continuity of care rather than episodic intervention. You cannot redesign care pathways on paper if the estate cannot support them in practice.
The Problem: Outdates Estates and Delayed Delivery
No practical guide would be complete without addressing the scale of the challenge. A large part of the NHS estate is ageing, inflexible and expensive to run. Many community buildings are 50 to 100 years old. Others are too small for modern diagnostics, too fragmented for multidisciplinary teams, or simply no longer in the right places to meet local needs. On top of that, there are well‑known delivery hurdles:
- Long, complicated procurement processes
- Projects sitting in approval cycles for years
- Budgets rising during periods of inactivity
- Clinical strategies changing direction mid-project
- Weak connections between workforce, service and estate planning
This is where delays happen, costs drift and the “delivery gap” widens. It’s no surprise what happens next. Service models are approved on the assumption that care will shift into the community, but the buildings required to deliver that shift are not ready. If the estate does not evolve, the system cannot deliver the transformation required.
The Solution: Better Planning and Stronger Partnerships
The good news is that the NHS is not starting from scratch. Across Trusts and systems, there is growing recognition that delivering the NHS 10-Year Plan at scale requires a different approach. One built on:
- Long-term, system-wide planning
- Closer alignment between clinical, estates, digital and financial strategies
- Clear governance and faster decision-making
- Consistent benchmarking and cost control
- Partnership models that provide continuity and capability
Strategic estates partnerships offer a way to move beyond stop-start delivery by creating a single, consistent approach to planning and implementation. Done well, they enable Trusts to bring clinicians, estates teams, digital leaders and finance together around shared data and long-term objectives – reducing risk, accelerating delivery and improving value for money. Ultimately, the success of the NHS 10-Year Plan depends on whether Trusts can modernise their estate at pace and at scale. Stronger partnerships and smarter planning are the only way to close the delivery gap between ambition and reality.
