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Changes to the National Health System are a bit like swimwear - what they reveal is interesting, but what they conceal is vital. We are now four months into major structural reorganisations of the institutions that manage the delivery and location of healthcare: we have seen the abolition of Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs); to be replaced by GP-led commissioners, the National Commissioning board, and crucially NHS Property Services Ltd to manage the former PCT and SHA properties.

NHS Property Services is undertaking an extensive review and audit of current facilities to ensure consistency across the country with regards to the costs of maintenance, services, and leases. On the surface, these changes have revealed a degree of inconsistency in the management of the buildings required for service delivery across the healthcare sector.

However, the changes also conceal one very important opportunity: it allows NHS organisations to undertake a once-in-a-generation review of their clinical service delivery and their estate, ensuring that ‘form’ does really follow clinical ‘function’. This is a simple concept, but one which has proven difficult for the NHS to deliver successfully in the past.

NHS Property Services was established in April 2013 to manage the estate transferred from the now defunct PCTs and SHAs. The transferred estate consists of over 3,700 assets (25% of which are GP surgeries), making it one of the largest property portfolios in Europe. The aim of the organisation was to add commercial discipline and entrepreneurship to the management of NHS assets while retaining firm public sector values. This, in theory, would produce genuinely sustainable and fit-for-purpose solutions to the NHS estate, something which has proved challenging in the past. Any receipts from the rationalisation and disposal of property no longer deemed useful to the NHS, would be ploughed back into the service to fund modernisation and improvement of the retained NHS estate.

NHS Property Services has the opportunity to look beyond what is obvious within its remit and develop one of the most innovative property portfolios in Europe

For NHS Property Services Ltd to actually deliver this aim, will not be as easy as it appears.

Firstly, NHS Property Services has inherited a range of very disparate assets, with few in the condition required by NHS standards; it has been estimated that the total backlog maintenance required across the whole healthcare system is more than £4bn, a significant proportion of which falls under the auspices of NHS Property Services.

Secondly, it is rare that any surplus assets can be sold or rationalised as they often form part of a wider operational estate or have restrictive covenants attached to the land’s use. As such, the rationalisation and disposal of assets takes time and investment to realise, which are luxuries not afforded to the NHS given the efficiency challenges and the aggressive cost-reduction timetables.

Thirdly, changes to clinical models of care and clinical pathways, increased integration of translational research into everyday clinical practice, and changes in medical technology, all present major problems to delivering flexible and future-proofed estate, particularly in the reconfiguration of existing clinical buildings. All too often, the delivery of modern models of care are restricted by the inflexibility of the existing estate to such a degree that the ‘form’, if not dictating ‘function’, puts very serious constraints on delivery.

The NHS changes have revealed reform of the estate to be a truly Sisyphean task. However, NHS Property Services should grasp the opportunity to develop new ways of utilising the NHS estate and improving the delivery of healthcare services. There is a huge opportunity for the organisation to lead innovative ways of working by integrating elements of primary and secondary care; assist in breaking down the barriers between health and social care that have historically been a true restriction on efficient patient care; improve the access to local authority services and housing; and work with the private sector to share best practice.

The NHS faces challenging but exciting times. NHS Property Services has the opportunity to look beyond what is obvious within its remit and develop one of the most innovative property portfolios in Europe, where ‘form’ and ‘function’ are greater than the sum of their parts.

Dr Matthew Williams-Gray is an associate director at Mace and head of strategic healthcare consultancy services