The 10 Year Plan: Bricks and Clicks – Embrace the tech

In Brief

If you move services online or into the community, you have to reclaim the space or you haven’t saved anything. Estates professionals often ignore the tech – or treat it as competition for scarce capital.  It’s time to embrace it.

• Dispersed care creates friction – Trusts need to ramp up communications, scheduling and workforce tools to stay productive.

• Estates and tech teams must start working together – capital strategy now has to include technology.

• Capital managers need to start treating tech like other assets: plan for it, look at innovative funding structures, and understand the combined estates/tech opportunity.

Why is digital important to bricks and mortar?

Digital Change Means Physical Change – Or It Doesn’t Count

The case for shrinking the hospital footprint is central to the 10 Year Health Plan’s thinking – we covered it in Uneasy lies the head. But if you move services into the community or online, and you don’t take the physical space back, you’ve not really achieved anything. The cost remains.

This is a trap some Trusts are already falling into. You move outpatients online, but the consultant sits in the same clinic room they’ve always used – only now they’re on video calls. That’s not transformation. That’s a shift in medium, not in model.

If virtual care means anything financially, it must translate into a reduced footprint. That could mean consolidation of buildings, subletting, mothballing or demolition. But unless the space is genuinely released, the cost base doesn’t shift. You can’t save bricks with clicks unless the bricks go.

And if you’re replacing bricks with something else – a new facility in the community, a diagnostics hub, a shared access centre – then you need to track the full cost and benefit of that change. We will all thank you for it.  We need data like this to make the case and quantify the impacts for the future.

Dispersed Care Is Harder to Run – That’s the Price of Change

The 10-Year Plan is unambiguous that shifting hospital activity into the community is the right direction. But it introduces friction: scheduling becomes more complex, patient and staff handovers are different, workforce flexibility drops, consultation between colleagues needs to be done differently.  All of those things have to change if we move away from an everyone-in-the-same-place approach.  This is far from a trivial problem and it needs upfront planning and sustained management effort to make such a drastically different model work.

Others smarter than me will have thought about this in more depth and with more expertise but it seems to me that some of the things we are going to need include:

• Smart scheduling that understands the cost of travel time, groups appointments and staff allocation by location and availability, and minimises running back and forth by a stretched workforce.

• Real-time, easy to use communications that reduce downtime and handover risk while promoting collaboration.

• Better rostering tools that enable flexible deployment across locations and modes (in-person, remote, hybrid).  This needs to be aligned to the reality of live clinical services and should help to bake in productivity improvements (including things like ambient voice technology)

This isn’t just about productivity. It’s about keeping clinicians motivated, engaged and connected in a more complex, less centralised environment. Without the right tools, dispersed care quickly starts to feel like chaos.

These aren’t just operational challenges – they’re infrastructure ones. A network of local centres only works if the tech and staffing model are built for it. And that means capital teams need to understand what they’re buying into and help to make it work.

It’s Time for Capital Teams to Get Comfortable With Tech

We’re past the point where “capital” just means bricks and concrete. Technology is infrastructure. And it needs the same disciplines applied:

• Multi-year planning

• Integration with estates strategy

• Proper costing

• Structured procurement

• Mixed capital-revenue financing models

We already do this for estates (or we should be doing so…) and some of those skills can and should be applied to tech. We are starting to do long term costed planning.  We balance capital and revenue costs.  We structure deals to draw intelligently from capital or revenue budgets, mixing RDEL and CDEL, when we can. But tech has often been left in the “revenue project” or “annoying additional draw on capital” box. That’s no longer tenable.

Want remote diagnostics to work at scale? That’s a capital programme. Want to build a scheduling platform that works across 15 community sites? That’s a strategic investment. But most importantly from an estates perspective, do you want your new dispersed community care based model to work?  You better plan for the tech.

This shift demands a new relationship between CIOs, COOs, Estates Directors and DoFs. If tech is going to drive estate change, then it can’t sit in a parallel budget stream with no estate input.  And nor can estates operate without tech input. Planning must be shared, and jointly accountable.  We can help each other.

Conclusion: Capital Thinking for a Post-Hospital Model

We’ve talked a lot in this series about shrinking the hospital footprint and delivering more care in the community. But those changes only land if they affect the estate. That means physically releasing buildings, reducing costs, and tracking change over time.

At the same time, those changes create operational complexity. If we want to run dispersed, digital, localised care models well, then we need the right tech – not just for patients, but for staff.

This is the future. But it only works if capital, estates and digital teams treat it like a system, not a set of parallel projects.

That means capital teams learning how to structure, cost, and plan for technology. It means estates teams engaging with digital colleagues on design and layout. And it means Board-level visibility of how these things connect.

We can save bricks with clicks. But only if we go one step further – and let the clicks help us redesign the whole delivery model, including for estates.