Article Summary
As healthcare estates face growing pressure from ageing infrastructure and limited capital, this FORTIS article explores how digital platforms are reshaping the way hospitals are managed and future-proofed. Drawing on insights from Brett Smith, Head of Digital & Software at Siemens, it examines how connected systems, AI and real-time data are helping estates teams move from reactive management to more resilient, insight-led environments.
A System Under Pressure
Healthcare estates are facing unprecedented challenges. Ageing buildings, rising demand, tightening capital controls, energy volatility and an expanding maintenance backlog have created a system that is increasingly difficult to sustain through traditional approaches alone. The NHS maintenance backlog now stands at nearly ÂŁ16 billion, with ÂŁ3.5 billion of that classified as high-risk repairs – a figure that reflects not just deferred investment, but structural strain. As Matthew Taylor, Chief Executive of the NHS Confederation warns, “The continued rise in the NHS maintenance backlog bill is deeply worrying but unfortunately not surprising given the health service has been starved of capital investment for more than a decade.”
For many Trusts, the challenge is no longer simply how to repair buildings, but how to ensure the estate can actively support safe, efficient, and resilient care delivery in the years ahead. In this context, digital transformation is no longer a future ambition or a technical upgrade. It is becoming a fundamental estates strategy and a defining feature of what many now describe as the smart hospital.
We spoke to Brett Smith, Head of Digital & Software at Siemens to explore how digital platforms are changing the way healthcare estates are understood, managed and future proofed.
The Changing Role of Facilities Management
Historically, facilities management focused on compliance and cost control and while these remain essential, the demands on healthcare estates have grown exponentially. Modern hospitals are complex systems of systems: clinical pathways depend on environmental performance, safety systems, energy infrastructure, and operational workflows functioning in unison.
Yet many estates still operate with fragmented data, disconnected systems and limited real-time visibility. Energy, security, fire safety, comfort and maintenance are often managed through separate platforms, contracts and teams. When something goes wrong, the response is reactive by necessity. As Brett Smith, Head of Digital & Software at Siemens, puts it,
Healthcare environments are busy and critical spaces Beyond energy, you’ve got security, compliance and patient comfort to manage, all while dealing with a maintenance backlog that’s growing in the wrong direction
This fragmentation makes it difficult to prioritise investment, anticipate failure, or understand how one decision affects another. In an era where estates must deliver net-zero targets, improve patient experience and stretch limited capital further, this lack of joined-up insight is becoming a major constraint.
Digital Platforms are Changing the Conversation
What’s changing isn’t just the technology, it’s the mindset. Estates leaders increasingly recognise that managing individual assets in isolation is no longer enough. The estate must be understood as a connected system, where decisions in one area inevitably affect outcomes elsewhere. That shift is as much about perspective as it is about technology. “The biggest message is that it’s not just about energy,” says a Siemens colleague. “It’s energy, security and the whole user experience – how the estate works for the people using it.”
Digital platforms such as Building X are emerging as a response to this challenge. Acting as a digital backbone, it unifies previously disconnected systems – energy, operations, fire, security & comfort – into a single, intelligent ecosystem. This shift transforms facilities management from reactive oversight into proactive, insight-driven decision-making, enabling greater sustainability, resilience and environment that genuinely support patient well-being. The real value lies not in the interface, but in the insight it unlocks. When estates teams can see performance across an entire portfolio in real time, patterns become visible. Issues that once emerged only after failure can be anticipated. Investment decisions can be guided by evidence rather than assumption.
AI as a Practical Estates Tool
Artificial intelligence is often discussed in abstract terms, but in the context of healthcare estates, its value is pragmatic. AI enables platforms like Building X to move beyond static monitoring, analysing trends across large volumes of data to identify anomalies, inefficiencies and emerging risks. In practice, this might mean detecting equipment behaving abnormally before it fails, identifying energy use that signals inefficiency, or flagging comfort conditions drifting outside acceptable ranges in sensitive clinical spaces. These insights allow estates teams to intervene earlier, reduce disruption and focus resources where they matter most.
Importantly, this is not about removing human expertise, but about augmenting it. AI supports better judgement by surfacing information that would otherwise remain hidden in disconnected systems. As Smith notes,
The narrative is shifting in a much more positive direction toward a digital future. I heard real interest in digital platforms and digital twins. Trusts are asking how AI can optimise operations and improve patient environments
Cybersecurity as part of estates resilience
As healthcare estates become more connected, cybersecurity has become a fundamental part of estates resilience. Building systems now sit alongside clinical and operational networks, meaning that resilience is no longer purely physical. This reframes cybersecurity as more than an IT concern and an estates issue, a safety issue and a governance issue. Secure, well-designed platforms are essential to ensure that increased connectivity does not introduce new vulnerabilities.
The conversation with Siemens highlighted that digital transformation in healthcare estates must be approached holistically. Connectivity, intelligence, and security are interdependent, and progress in one area cannot come at the expense of another.
Measurable Impact
The impact of digital platforms is most clearly seen in day-to-day operations. One example discussed was the use of Building X Operations Manager to provide remote visibility across an estate. Facilities managers can connect to building management systems without being onsite, allowing them to see how systems are performing in real time. This visibility enables earlier detection of issues such as equipment faults, rising energy consumption, or comfort conditions drifting out of range. By intervening sooner, teams can prevent escalation, reduce unplanned downtime and maintain stable environments for patients and staff.
While these improvements may appear operational, their implications are wider. Reduced energy waste releases capital for clinical services. Predictive maintenance extends asset life. Reliable environments support staff wellbeing and patient recovery. The value lies not in any single feature, but in the cumulative effect of better-informed decision-making.
Starting small and thinking long-term
One of the recurring themes in the discussion was the importance of scale. The size and complexity of NHS estates can make change feel overwhelming. “However, the most effective approaches tend to start with clear outcomes rather than attempting to transform everything at once.
Smith describes this as a “crawl, walk, run” mindset: define the problem you are trying to solve, whether reducing backlog risk, cutting energy use, or improving visibility and then focus on high-value, achievable steps. Early wins build confidence and capability, creating momentum for broader transformation over time. This mindset aligns closely with the realities of NHS estates, where capital, capacity and operational pressure demand pragmatism rather than grand gestures.
Towards Estates That Actively Support Care
At recent industry events, Smith observed a clear shift:
For the first time, I heard real interest in digital platforms and digital twins. Trusts are asking how AI can optimise operations and improve patient environments
This future cannot be achieved by technology alone. Success depends on collaboration between estates teams, clinical leaders and technology partners. Digital initiatives must be grounded in reality, aligned with organisational goals and delivered in stages for measurable impact. Looking ahead, the conversation points toward a shift in how healthcare estates are perceived. Rather than passive infrastructure, buildings are increasingly seen as active contributors to care delivery – environments that adapt, anticipate and support clinical activity.
Digital platforms like Building X provide a framework for this transition. As AI, connected systems and digital twins mature, the opportunity is to move from reactive management to estates that quietly and intelligently support safety, comfort, efficiency and resilience. What is clear is that the pressures facing healthcare estates are structural, not temporary. Addressing them requires new ways of thinking, grounded in collaboration between estates, digital and clinical teams. The transformation starts with bold decisions today: using insight to turn data into action and buildings into partners in care. It’s not just about fixing infrastructure – it’s about creating intelligent environments that actively support care delivery.
