Article Summary
Drawing from Bethan George's NHS transformation experience and her more recent role as Director of Population Health Management at Optum, this article considers how linked whole-population data could give NHS organisations a stronger basis for estate and capital decisions. Bethan argues that a better understanding of different population groups, their outcomes and experiences of care, and how they use care services could help systems determine what kinds of spaces they need, where those spaces should be and how best to use existing assets.
Capital and workforce decisions are critical to preparing the NHS for the future. Yet how often do organisations start by asking what their local population is likely to need over the coming years before deciding what to build, refurbish or retain?
Demographics and outcomes data can indicate likely future needs. Activity data can show where services are under pressure today. Estates data tells us what buildings an organisation owns, how they are being used and what condition they are in. These data sets, used in isolation, provide limited clues about whether assets are in the right places or designed for the right services. Bringing them together and linking them wherever possible at person level provides a clearer picture of how estates might need to adapt to support improvements in care delivery.
The next step is to use that insight to inform decisions about the future estate. Linked population health and estates data, alongside local thinking about future care delivery models, must now begin to influence estates planning. Leaders should look beyond current delivery models and activity to test what infrastructure, technology, collaboration and neighbourhood delivery models will require.
Done properly, NHS organisations could make estate and capital decisions based not only on the infrastructure of today, but on a clearer view of the services and spaces their populations may need tomorrow.
NHS England describes how systems using joined-up data, population segmentation and risk stratification to do population health management (PHM) can better understand the needs of different groups and the wider determinants of health. PHM connects information across health and care services, creating a clearer understanding of population needs and enabling the development of innovative care models for specific groups that improve care delivery and outcomes.
That wider view of population need has implications for where and how care is delivered. PHM supports the development of neighbourhood care by helping systems understand how activity outside the hospital is beginning to affect secondary care and what spaces may be needed to scale it over time. As care increasingly extends beyond traditional hospital settings, that shift also raises questions about how the existing estate can be used differently. FORTIS has examined this relationship with Matt Etherington, considering how neighbourhood healthcare can help the NHS make better use of its existing estate. The data can broaden thinking about the spaces available through local authorities and the voluntary sector, including whether they could be adapted to support care delivery.
As these opportunities emerge, linked data and intelligence need to inform service redesign, workforce planning and estates strategy in a more integrated way. After all, shifting care left depends on organisations working together to reimagine estates collectively and align them with future care delivery models and the growing role of digital care delivery.
How population need changes NHS estate decisions
Estate and capital planning naturally draws heavily on the evidence available within individual organisations. The risk is that it can anchor planning around the way services and assets are organised, rather than around the needs of the population.
High hospital activity today may point towards a need for additional capacity. Linked population data can show what is driving that activity and whether the current model of care is producing the best outcomes and experiences for those using services. Population health projections can take the analysis further, helping leaders explore how different care models could shape future demand and the way services are organised as population needs change.
At person level, linking these sources shifts the conversation from accommodating current activity within individual organisations to planning how care can be delivered collectively and improve outcomes.
What population segmentation could mean for estates
Segmenting a whole population to create smaller, mutually exclusive groups of people with similar care needs allows systems to break down the challenges of improving care outcomes and experiences into more manageable areas of focus. This matters because people with more complex care needs require greater continuity and better co-ordination of care. They are likely to benefit from regular face-to-face and easily accessible contact with a co-located care team. Groups with less complex needs will have different requirements. For example, care models for people with long-term conditions may involve group consultations, which call for flexible shared space and easy access to diagnostics. Digital care delivery, supported self-care and remote monitoring solutions for some population groups may completely change estates requirements, potentially needing spaces for call centre teams and/or for care staff providing remote care from their own homes.
Understanding these needs at population level gives estates planning a more practical basis for moving from demand to service model. Rather than relying on a single, siloed and generalised measure of demand, planning can follow a sequence: define the population segment, identify the model(s) of care required, and then specify the location, configuration and adaptability of the supporting space.
The same segmentation approach can then help estates and capital leaders explore the pressures facing the system, revealing which groups use services repeatedly, where unmet need is accumulating and where earlier intervention might impact future utilisation.
A shared language for planning across the system
Collective estates planning will require a significant cultural shift for systems accustomed to organisations planning around their own services, capacity and operational pressures. For estates teams, this means constantly balancing what existing infrastructure can support against its condition, cost and the practicalities of change. Linked whole population data can provide a common basis for considering those different factors together, allowing partners to focus discussions on population needs.
Of course, this does not remove competing priorities. Care providers will always have to bring different and sometimes competing operational concerns to the table. Proposals can, however, be considered against the same understanding of population segments, care pathways and projected patterns of need and with shared accountability for the outcomes, shifting the conversation from competing organisational requirements to one about which combination of services and infrastructure will best support the population as a whole.
Left shift also cannot simply mean relocating existing services into different buildings. It requires systems to understand which populations could benefit from earlier intervention, which pathways of care could be delivered differently and collectively and what those changes would mean for the estate.
Bringing population, clinical, operational and estates perspectives together early in estates planning therefore becomes important. Population insight can help identify where need sits and how it may change; clinical and operational teams can translate that into appropriate models of care; and estates teams can work with care providers to determine what locations, spaces and infrastructure could realistically support care delivered this way.
Using population need to inform capital investment decisions
Using population insight to guide estate decisions becomes more valuable when capital is constrained, as NHS organisations continually face difficult choices about where to invest, which assets should be adapted, where additional capacity is genuinely required and whether some buildings still have a strategic role.
Population health data cannot make those decisions for a system, but it can help leaders test assumptions about future care delivery and the impact of different care models. That assessment is crucial when projected demand appears to point towards more acute capacity. Projected growth in frailty, respiratory illness or complex long-term conditions may appear to justify acute expansion if historical activity is simply carried forward. But if the same population analysis shows opportunities for earlier intervention, local diagnostics or different forms of multidisciplinary support, the infrastructure response may look very different.
This does not necessarily mean building less. It means investing with a clearer understanding of what capacity is genuinely required, what form it should take, how existing assets can support it and what else might be needed.
The same thinking can be applied to how existing assets are evaluated. Population insight can add a different perspective to estate-categorisation frameworks, including core, flex and tail approaches. These frameworks allow organisations to assess the strategic role of their assets and consider where investment, adaptation or disposal may be appropriate. Cross-referencing those decisions with a more refined understanding of population need can help determine whether an asset’s current role reflects its future value to the wider system.
A building that appears less important when judged primarily on current activity, for example, may become strategically valuable if its location supports greater community provision. Equally, an asset considered central today may need to be reassessed if the services it houses are likely to be delivered differently in future.
The opportunity, therefore, is not to add another dataset to the capital planning process, but to use population insight to make better choices between competing estate options. Before committing to build, refurbish, retain or dispose of an asset, leaders need to understand whether the pressure they are responding to represents an enduring need for physical capacity, unmet need elsewhere in the system or activity that could be managed differently.
That shifts the capital conversation from how much estate care providers need to a more fundamental question: what estate will future models of care actually require?
