In December 2024, Darwin Group submitted its response to the NHS 10-Year Health Plan consultation with a clear message: the future of healthcare delivery depends on agile, adaptable, and patient-centred estates.

Now, six months on – and with the plan’s release imminent – our recommendations feel more relevant and urgent than ever.

The challenge we raised

We highlighted a critical issue: many facilities are no longer fit for purpose.

Decades of underinvestment have left the NHS’s estates and infrastructure outdated, inflexible, and unable to support modern models of care. At the same time, the cost and severity of the maintenance backlog across NHS buildings continues to rise. This limits their ability to:

• Adapt to changing population needs
• Integrate new technologies
• Expand access to key services like diagnostics, mental health support, and urgent care

We suggested that without a radical rethink of estate strategy, the NHS would struggle to shift care from hospitals to communities – a central ambition of the 10-Year Health Plan.

What’s changed since then?

The evidence has only strengthened our case.

In June 2025, the Government’s Spending Review 2025 confirmed a record £30 billion capital investment over five years to modernise NHS infrastructure, with £5 billion specifically earmarked for critical repairs and safety upgrades.

This includes funding for new hospitals, primary care facilities, and digital infrastructure, reflecting a growing recognition that traditional construction timelines and rigid estates are no longer viable for a modern, responsive health service.

The Spending Review also committed to:

• A £4 billion increase in annual capital budgets for the Department of Health and Social Care by 2029–30
• The ‘largest ever’ NHS capital budget, representing a 20% real-terms increase over the review period
• A strategic shift toward multi-year capital settlements, enabling long-term planning and better value for money.

These developments reinforce the need for efficient, flexible and sustainable infrastructure across the NHS, which can act as a core enabler for the shift from hospital to communities. Leveraging innovative solutions, such as modular infrastructure, can be an integral part of this shift.

Why adaptable facilities matter now more than ever

Modular buildings are not just a stopgap – they can be a strategic enabler of the NHS ’s transformation reform. As the demand for more localised, responsive, and sustainable healthcare grows, modular infrastructure offers unmatched advantages:

• Speed: With much of the fit-out completed offsite, facilities can become operational in weeks or months, not years – ideal for responding to urgent needs, seasonal pressures, or estate failures.
• Flexibility: Designed for easy reconfiguration or relocation, modular buildings can adapt to shifting population needs, clinical models, or integrated care strategies.
• Affordability: Hire models like Darwin Group On-Demand® allow trusts to spread costs over time, reducing capital pressure and supporting agile estate planning.
• Sustainability: With reduced construction waste, lower transport impact, and energy-efficient design, modular supports the NHS Net Zero ambition from day one.

Looking ahead: What we hope to see in the 10-Year Health Plan

As the NHS finalises its 10-Year Health Plan, we hope to see:

• A national framework for modular (off-site fit-out) deployment: Hireable modular infrastructure should be embedded as a strategic pillar of the NHS estate strategy, enabling rapid, scalable, and evolving care closer to home.
• Support for integrated community care: ICSs must be equipped with the tools and guidance to deliver joined-up services in modern, adaptable facilities that meet local needs.

This is not just about buildings, it’s about creating a system that works for patients, staff, and communities. The next decade will demand infrastructure that can evolve with the NHS. Modular solutions are not a temporary fix; they are the foundation for a more resilient and responsive health and care service.

Darwin Group stands ready to partner with NHS Trusts, ICSs, and local authorities to deliver the infrastructure needed for a more agile and patient-centred health system.