Last week’s announcement of the £750 million Estates Safety Fund by the UK Government represents another high-profile attempt to address the mounting safety and infrastructure risks across the NHS estate. But while welcome in intent, this funding, much like many of its predecessors, is ultimately a reactive measure, failing to deliver the kind of transformational, long-term change that our healthcare system desperately needs.
In a previous campaign, where we explored the NHS estates in full from the perspectives of capital investment, new models of infrastructure, the provision of estates and facilities services, and the role of integrated care boards, systems, and Health and Care Partnerships, we explored the need for a new paradigm for estates strategies, one that prioritises population health, local need, and a “left shift” from acute to community-based care. Viewed through this lens, the Estates Safety Fund feels misaligned with the direction of travel. Here’s why:
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Necessary, But Not Future Focused
The £750 million allocation is being positioned as an investment in safety, a critical and commendable priority. However, this funding is largely designated for like for like refurbishment or urgent maintenance across the acute estate. While this may reduce immediate risk, it does little to reimagine how, and where, care is delivered. There is no scope within this envelope for capital projects that support new models of care or community-based provision. In short, the funding does not support the NHS’s “left shift” agenda, and we are once again missing an opportunity to invest in hospitals that are truly fit for the future.
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A Drop in the Ocean for Acute, a Tidal Wave for Community
On average, each Trust stands to receive approximately £4.3 million. In the context of acute hospital estate, where major refurbishment projects routinely exceed tens and hundreds of millions, this is marginal. But the same amount, if invested strategically into out of hospital settings, such as diagnostic hubs, health centres, or community outpatient centres, could have a meaningful impact on capacity, access, patient outcomes, and, most importantly, the alleviate the current pressures within the acute setting. It begs the question: should we be defaulting to acute estate repair, or thinking more creatively about where the greatest return on investment lies?
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Just Over 5 Percent of the Problem
The current NHS estate backlog sits at an eye watering £13.8 billion. This single year fund accounts for just over 5% of that figure. While it will no doubt alleviate immediate pressure in specific settings, it barely dents the scale of the challenge. Moreover, targeting piecemeal fixes to complex, systemic problems almost always leads to inefficiency. Without an overarching estates masterplan rooted in system wide priorities, investments risk being misaligned, or short lived.
Figure 1: Overview of NHS Estates Backlog by Region and how this correlates to Estates Safety Fund Allocation
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Uneven Distribution Undermines Levelling Up
An analysis of the fund’s allocation shows a heavy bias toward London based Trusts, with the North West receiving comparatively less support. Given the government’s longstanding commitment to “levelling up,” even if under a new guise, this distribution feels at odds with national equity goals. It risks perpetuating regional disparities in health infrastructure, access, and outcomes. If population health truly matters, capital investment should be weighted accordingly.
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One Year Settlements Undermine Long Term Planning
This is a one-year fund. And therein lies a central flaw. Estates strategies require a long-term horizon, years of planning, engagement, design, and construction. The constant cycle of short-term capital allocations makes it almost impossible for NHS Trusts or ICBs to plan proactively or coherently. If we want to support transformation, we must provide the financial certainty that allows for it. In short, multi-year settlements, integrated into ICS capital plans, aligned with service transformation priorities.
Conclusion
This article was written before the announcement of £370m capital to support urgent care recovery and there is no question that unsafe estate must be addressed. But without a concurrent investment in modernising care delivery models, and rebalancing where care is delivered, these interventions remain tactical, not strategic.
“Now more than ever, we need to think beyond bricks and mortar. We need a capital strategy that looks ten years ahead, not one. One that links investment to outcomes, not just to repairs. One that supports population health, not just the acute sector.”
