With significant changes unfolding within the NHS, the NLA Expert Panel on Healthcare has embarked on this year's cycle by addressing these pivotal challenges head-on. The most recent change is the dissolution of NHS England and takeover by DHSC over the next two years. This change was presaged by the departure of Amanda Pritchard, CEO; Julian Kelly, CFO; and Dame Emily Lawson, COO. The arrival of Sir Jim Mackey as interim CEO of NHSE together with the new Chair Dr Penny Dash, heralds the start of a new era. Coupled with this is the forthcoming formation of NISTA (National Infrastructure and Service Transformation Authority) on 1 April, a combination of the NIC (National Infrastructure Commission) and the IPA (Infrastructure Projects Authority). In addition, we look forward to the publication of the 10-year long-term plan anticipated for July ahead of recess.

Discussion progressed to the key challenges that the NHS faces this year. These include NHS Trusts driving towards meeting a 4 per cent cost improvement programme target with an increased focus on productivity in back office/administrative and clinical processes as well as productivity savings in areas such as operational costs. Focus could be on, for example, decarbonisation, which could reduce the amount of energy use, intense clinical space, and/or installing alternative energy sources to drive down running costs.

Other key challenges included asset management and an increase of not only backlog but also high-risk backlog, which could turn estates risks into clinical risks if not remediated.

Advancing one of the NHS’s three shifts, “moving care from hospital to community”, this is likely to present some workforce challenges. However, with the advent of increased digital capability, there may be the possibility to provide strong clinical oversight of certain procedures in areas such as diagnostics virtually. This would support the third shift of “making better use of technology” by moving from analogue to digital.

With the new administration, the panel explored whether there might be a return to private investment as well as the possibility of exceeding CDEL limits for high-performing Trusts. There was strong consensus that if this were to be the case, then any healthcare facility would need to demonstrate a long-life, loose-fit approach to an adaptable estate to accommodate future models of care. We understand that this thinking is already being championed within the New Hospital Programme and, from a multi-agency perspective, fits into the adaptive reuse agenda. New models of care are likely to see more collaboration between healthcare and life sciences. Advancing areas such as precision medicine should also have an impact on increasing prevention of more acute illnesses and comorbidities leading to a longer, healthier life expectancy, which supports the third shift from cure to prevention, or “focussing on preventing sickness, not just treating it”.

On the subject of prevention, the panel discussed topics ranging from unlocking bed blocking not only with increased care beds but also by increasing step-down facilities, possibly through private investment. The concept of prevention could be extended to safeguarding clinical retention and recruitment into the NHS aided by key worker housing. The panel committed to sharing a spectrum of case studies of privately funded facilities, whether that be in health or life sciences. On the subject of adaptive reuse, the panel shared case studies, particularly those that support the creation of a ready reckoner for an NHS Trust to make an initial viability assessment easily of the conversion of another asset type into a healthcare facility.

Focus turned to increasing healthier life expectancy through a multi-agency approach to behavioural change and encouraging the city’s population in the areas of highest deprivation to want to spend time in leisure spaces. This needs to involve not only the NHS but also Directors of Public Health in Local Authorities and Voluntary, Community and Social Enterprise (VCSE).

We learnt that the GLA is currently developing a Local Nature Recovery Strategy that will create a comprehensive spatial habitat map across the capital. Similarly, the All London Green Grid has undertaken a similar mapping exercise. To increase the usage of such a map, which potentially plots all the green and blue routes, we reflected on our thinking to date in previous panel cycles and how we can encourage Londoners to access this. Ideas included curating spaces with activities at Local Authority or Integrated Care Board (ICB) level, understanding the safety rating of a space, access to public conveniences, and environmental conditions such as air quality. Equally, it was deemed to be important to utilise an existing highly-utilised digital platform such as Google or City Mapper that could overlay this level of data.

To explore this initiative further, under the NLA pillar of Thinking Beyond Boundaries,the plan is for the NLA to host a symposium on Health Creating Cities this autumn that would involve a cross-panel approach to key discussion points. This fits in well with the roadmap to developing research on this subject in 2026 and aligns with the GLA’s consultation in March 2026 on “Towards a New London Plan”, into which the panel plans to input.

In the previous NLA cycle, we agreed to build a self-evaluating complexity assessment prototype for NHS Trusts to categorise the complexity of a project, matching the skills within a project team that are required for its successful delivery. Discussion continued on addressing, within the tool, not only technical skills gaps but also governance gaps, i.e., ensuring that the most appropriate resource is in a decision-making position. It was also tabled that perhaps a useful approach might be to embed the principles of the tool within NHS frameworks, i.e., the framework provider could pose the relevant technical questions to the recruiting NHS client before calling off the necessary resource.