Beyond buildings: how joined-up NHS facility planning delivers healthier places

Informed NHS facility planning isn’t about spending more – it’s about working differently. When capital programmes and local assets are brought into a single, transparent view, partners can shape places that enable health by design, says Mott MacDonald project director for health buildings Kerry Harding.

Budgets could stretch further, buildings could work harder and people would feel the difference in their everyday lives if health and care infrastructure were planned as one system. Neighbourhood health delivery plans support this shift by providing a practical way for partners to coordinate investment and focus on outcomes that matter to communities.

Across any local system, there is no shortage of ambition. Acute, primary care and local authorities all hold their own capital pipelines – each valuable individually but often developed in isolation. That is where value leaks out and opportunities to create wider public benefit are missed.

A more effective approach is planning infrastructure for wellbeing, openly and collaboratively. Real transformation can’t be delivered by a single organisation while others look on from the sidelines. It needs a clear process and a shared commitment that runs from the first conversation through to delivery. Neighbourhood health delivery plans offer this structure. They translate integrated planning principles into something recognisable and grounded, the streets people walk, the buildings they use, and the services they rely on.

One pipeline

Neighbourhood health delivery plans map investment onto real places, showing how health infrastructure, housing, transport, green space and community assets interconnect to form the foundations of healthier neighbourhoods.

A single pipeline for health-related infrastructure at system, place and neighbourhood level creates transparency, exposes opportunities to maximise value for money and makes investment more coherent. Where funding is secured, it helps partners articulate the benefits; where funding is not, it clarifies what is needed and why, enabling informed conversations and avoiding duplication.

Seeing the full picture changes the questions asked. Instead of “what do I need to build?”, the focus becomes, “what problem are we solving, what does the community need and what already exists that can meet this need”. This unlocks more accessible choices and highlights where small adjustments can bring services closer to people.

A coherent local picture

Neighbourhood health delivery plans form the practical layer between strategy and action. They take the principles of integrated planning and apply them at a scale people recognise in their town, community or their local services.

These plans are not abstract: they map capital programmes onto real streets and buildings, showing how health, housing, transport and public spaces connect. They act as stepping stones, using existing strategies and primary care network plans as anchors.

Whether delivering therapy sessions in a leisure centre, co-locating office space or improving a cycling route, every decision sits within a coherent local picture. Partner buy‑in becomes easier because they can see how their project contributes to a shared neighbourhood outcome rather than a distant system goal.

The plans also set clear priorities, timelines and dependencies. They highlight where Section 106 funding can support improvements, where community assets can strengthen social prescribing, and where seemingly small changes can unlock large health benefits. The plans make the combined pipeline tangible and give communities a meaningful voice.

Smarter moves

Leisure centres illustrate how neighbourhood level planning can make existing assets work harder. Many outpatient activities do not require clinical rooms, they simply need a familiar, consistent and accessible space. Using leisure centres for these activities reduces pressure on hospital estates and places care closer to everyday life.

Transport and development planning benefit in the same way. When new housing delivers safer crossings or cycle routes, the conversation should include how these assets can support access to GP practices, community services and town centres. Embedding health considerations into Local Development Plans ensures each new development contributes to shared wellbeing goals.

Often, the most powerful changes are modest. Improving lighting on a poorly used footpath may seem small, but it can immediately unlock more active travel – ten minutes of walking a day is a meaningful health gain for someone who previously felt unable to do so.

Planning with purpose does not require more funding. It requires coordination, clarity and a shared approach to using what already exists and making decisions as a single, joined up system.

The long view: planning for today and for the next generation

Some benefits of neighbourhood level planning be visible quickly; others may take years or even decades to fully emerge. The challenge is to maintain long term vision while delivering early wins that build momentum.

Purposeful, coordinated planning helps systems escape the cycle of patch repairs on ageing buildings. Instead of short term fixes that drain budgets, investment can be directed towards interventions that endure and support communities over generations.

Money is not the only measure

One of the most transformative steps an area can take is to publish a combined place-based pipeline. When acute, primary care and local authority projects sit together, new options emerge – from repurposing buildings to making simple colocation decisions that unlock wider benefits.

Financial value matters, but it is not the sole measure of success. Sometimes the more beneficial return is confidence, access or inclusion. These gains must be recognised and captured, not lost between spreadsheets.

Planning with purpose does not require more funding. It requires coordination, clarity and a shared approach to using what already exists and making decisions as a single, joined up system. When that happens, the benefits are measurable and lasting – creating places that support health by design, not by exception.