Article Summary
The NHS cannot deliver its 10-year plan with outdated buildings and stop-start procurement. FORTIS met with Stephanie Cartwright, Chief Community and Partnerships Officer for Walsall and Wolverhampton and Caroline Walker, Former Interim Chief Executive Officer for NHS Blood and Transplant, to discuss the NHS 10-year plan ambitions and understand why Strategic Estates Delivery Partnerships might be the key to delivering a robust plan.
From Ambition to Delivery: The Challenge of the NHS 10-Year Plan
The NHS 10-year plan sets out an ambitious shift in how care is delivered. As the Prime Minister stated in July 2025, the ambition is to “rewire and future-proof our NHS, so that it puts care on people’s doorsteps, harnesses game-changing tech and prevents illness in the first place.”
The plan sets out three central shifts: moving care from hospitals to communities; transitioning from analogue to digital and shifting focus from treating sickness to preventing it. Together, these changes depend on a significant shift of activity away from acute hospitals and into neighbourhood health centres, enabling people to access more care closer to home. Recent national policy has started to give this shift greater definition at a local level, particularly through the Neighbourhood health framework, which begins to outline how neighbourhood-based models of care are expected to take shape in practice.
However, delivery has not always kept pace with ambition. Many Trusts continue to rely on asking yesterday’s district general hospital to support future models of care. In some cases, business cases assume a “left shift” into community settings that existing buildings, procurement routes and delivery partnerships are not yet equipped to deliver. Executives increasingly describe a delivery gap: the distance between national ambition and local capacity. The question is no longer whether the vision is right, but whether the estate, procurement and partnerships are set up to make it real. A strategic plan needs a system to deliver it consistently, and as Walker points out,
We’ve been trying to move people out of the hospital in the community for two decades (…) It’s all right for a Trust to have a plan, but unless the community and primary care have a plan too, patients have nowhere to go
Why SEDP’s Matter
SEDP’s are emerging as a practical response to this delivery challenge. An SEDP is a structured, long-term partnership between a Trust and a specialist estates delivery partner. It brings together strategy, planning, modelling, design, commercial expertise and delivery under a single, accountable framework. Rather than restarting procurement for every new scheme, Trusts can run a rolling, multi-year estates programme aligned to their clinical strategy.
SEDPs do not replace Trust teams; they strengthen them. They create resilience, fill capability gaps and maintain continuity across political, financial and workforce cycles. It’s the model that keeps estate aligned to the clinical future not the past. Cartwright reflects on the moment the system finds itself in,
This is the strongest national direction for hospital to community shift I’ve seen in my career, but the NHS will need a clear strategy on how we can move from ambition to reality, and a clear communication strategy with our populations in relation to benefits from the shift
SEDP: An Effective Route To Delivery
One of the persistent barriers to delivery is fragmentation. Clinical planning, estates, finance, procurement and the supply chain often operate at different speeds and to different incentives. Walker is clear that clinical engagement is essential, but insufficient on its own,
You can’t plan a hospital without clinical engagement and clinical involvement and clinical sign off (…) Engagement has to mean partnership. Otherwise, you end up with wish lists rather than deliverables
A well-structured SEDP brings everyone around the same conversation. Clinical intent, operational models and physical estate are tested together rather than sequentially. Cost and scope are governed through live benchmarks allowing boards to see, in real time, how decision affect capital cost, programme length and operational efficiency.
Live modelling is critical here. Clinical environments are costed at room level, enabling assumptions about capacity, flows and workforce to be stress-tested early. As Walker says, this avoids the “blank cheque” problem that often emerges when scope is agreed before cost is understood. An SEDP embeds that discipline from day one. It isn’t about turning clinicians into accountants, it’s about showing how estate decisions affect the whole system, not just one speciality. Standardisation plays an important role, but it is intelligent standardisation: repeatable room templates, benchmarked components and proven solutions that shorten programmes and control cost, flexed only where there is a clear clinical benefit.
Finally, design remains central throughout. Buildings are treated as adaptable platforms, capable of absorbing new models of care without constant rebuild. Digital and data infrastructure are embedded from the outset, not retrofitted as an afterthought. Digital can’t be simply wired in. Data capacity, the incoming and outgoing data, data infrastructure across the site needs to be considered.
The Procurement Hurdle and How SEDPs Get Beyond It
Traditional procurement remains a major constraint on pace and value. Long, fragmented processes expose programmes to inflation, market shocks and scope drift. Risk concentrates in individual projects rather than being managed across a programme.
The Midland Metropolitan University Hospital illustrates both the benefits and limitations of the traditional approach. Planned long before the pandemic and delivered after the collapse of Carillion, the system eventually opened a £1 billion, 736-bed modern acute anchor. The new facility brings clear benefits: single rooms, improved infection control and better separation of elective and emergency pathways. However, the experience highlights an important lesson. Even a modernise acute hospital can remain under pressure if the assumed “left shift” of activity into community settings does not happen at pace.
The issue is not ambition, but realism. System-wide modelling, credible community estate plans and protected contingency are essential. Walker describes the consequences of poor cost visibility, “There’s a real push for pace and transparency, but that can actually drive costs up if everyone is working from different assumptions. You end up with a ‘blank cheque’ approach rather than a benchmarked one.”
An SEDP is designed to break this cycle:
- Once procured, the partnership provides a compliant route to commission successive projects without re-running full procurement each time.
- Room standards, benchmark rates and fixed-price packages are agreed upfront, so each new scheme starts from a benchmarked baseline.
- Open-book commercial models are used to illuminate value, not to excuse escalation.
In short, SEDPs move procurement from episodic and reactive to continuous and disciplined, allowing Trusts to protect value and maintain pace across a multi-year estates programme.
Aligning the Three Shifts with Estate Reality
From hospital to community
Community estate is widely acknowledged to be unfit for purpose. “If we’re genuinely serious about neighbourhood hubs and decentralised care, then investment is needed in the community and primary care estate that will make this possible,” says Cartwright. Left-shift assumptions can be difficult to deliver without credible alternatives, “We’ve been talking about left shifting care for a number of years from hospital to community,” Cartwright notes, “But more work is needed with our populations to understand what this looks like. Population expectations continue to pivot towards emergency departments as an appropriate route into care. Part of the left shift includes the shift of the front door from A&E’s front door to the patient’s own front door,” she adds.
SEDPs support this shift by modelling flows across acute and community sites, designing neighbourhood hubs that combine diagnostics, navigation, long-term condition management and same-day care, and aligning disposals and acquisitions so community provision grows as legacy estate is rationalised.
From analogue to digital
Digital-first care requires digital-ready buildings. Connectivity, power and data backbones must be specified from day one. Retrofitting connectivity after the walls go up is, as practitioners keep discovering, an expensive way to rediscover physics.
SEDPs bake digital into the base build:
- Specifying connectivity and data infrastructure as core requirements,
- Designing room sets and adjacencies for hybrid models such as virtual wards, remote monitoring and care navigation centres,
- Using utilisation models that simulate flows at room-hour resolution so digital capacity matches clinical demand.
Without that, “digital first” remains a slogan. With it, digital tools genuinely support earlier diagnosis, better navigation and more efficient acute floors.
Prevention, sustainability and net zero
Prevention and long-term condition management depend on credible spaces in neighbourhoods. Sustainability and net zero must be treated as design constraints as well as opportunities. Eric Fehily, Associate Director of Estates at Essex Partnership University NHS Foundation Trust, puts it starkly: “How do you get to net zero with no money? Of my 140 buildings in Essex, some are over 100 years old. How do I make that net zero?”
SEDPs help Trusts:
- Use real utilisation and energy data to prioritise refurbish, replace or release decisions
- Design modern, efficient hubs that reduce carbon and operating costs
- Embed social value in disposals (for example, affordable housing or biodiversity on released land) and in new developments.
Making the 10-Year Plan a Reality
The success of the NHS 10-year plan will not be measured in speeches or strategy documents, but in places people actually use: neighbourhood hubs, integrated centres that make “one front door” real, flexible acute spaces that can separate elective and emergency flows and digitally enabled estates.
Buildings alone do not deliver care. But the wrong buildings, in the wrong places, with the wrong configuration, actively prevent it.
For Trusts serious about delivery, the task is clear. Start with the model of care, translate it into rooms, routes and rotas, hold the line on scope and cost, build community doors people will actually use and design platforms that can adapt as fast as clinical practice.
SEDPs provide the standing capability, governance and commercial discipline to do this consistently over the decade ahead. They are no longer a nice-to-have. For systems determined to turn ambition into reality, they are essential.
