Pioneering the "third way" for NHS estates: a practical path from recovery to reinvention

As the NHS embarks on its ambitious 10-year plan, the challenge is clear: deliver elective recovery, modernise ageing infrastructure, and prepare for the future of care – all while meeting the urgent needs of today. Waiting lists remain high, workforce pressures are mounting, and estate constraints continue to limit what frontline teams can achieve.

The latest set of critical statistics from the Royal College of Surgeons Surgical Workforce Census, reinforces what surgeons are experiencing: limited theatre access, unfit spaces, and infrastructure constraints are directly affecting patient care, workforce wellbeing, and productivity.

53% of surgical consultants identified theatre access as a major challenge, driven by lack of theatre space (73%), availability of theatre staff (59%), and bed availability (47%).

Strategic programmes like the New Hospital Programme are essential, but their timelines stretch years into the future. The question is: how do we bridge the gap between today’s reality and tomorrow’s vision?

The answer may lie in reimagining the NHS estate—not as a static backdrop, but as an active enabler of productivity, resilience, and recovery. For decades, the conversation has been framed as a binary choice: temporary solutions that deliver speed but compromise quality, or traditional builds that offer permanence but lack agility. It’s time to move beyond that.

Introducing the third way: a new approach to healthcare infrastructure

The Third Way combines the best of both worlds: the clinical standards and longevity of permanent construction with the speed, flexibility, and adaptability traditionally associated with temporary facilities. This is not about compromise – it’s about creating a new category of estate solution that meets immediate needs while supporting long-term objectives.

As an NHS Professor of surgery commented when visiting a Darwin Group On-Demand® operating theatre: “When I walked into the [On-Demand] theatre, it felt like coming home. It felt perfect. To a surgeon, a theatre is a place you know and love – where you may spend the vast majority of your working life. To walk into a room that is person-ready is such a delight.”

At Darwin Group, we call this approach On-Demand: permanent-grade facilities delivered at pace, designed to feel indistinguishable from traditional hospital facilities, and built to adapt as care models evolve. These environments provide clinicians and patients with spaces that uphold safety, dignity, and operational excellence – whether they are needed for months or years.

Why On-Demand matters now

• Accelerates elective recovery by unlocking theatre capacity and reducing cancellations caused by estate constraints.
• Supports workforce wellbeing through high-quality, intuitive environments that enhance focus and retention.
• Protects investment by avoiding underutilised assets and reducing reliance on outdated temporary facilities.
• Future-proofs care delivery by enabling estates to evolve alongside technology, demographics, and clinical practice.

This approach aligns with the NHS’s strategic direction: embracing modern methods of construction and improving productivity, while anticipating the shift towards delivering care closer to communities.

A call to think differently

The NHS’s vision for the next decade is bold – and rightly so. But achieving it requires more than traditional thinking. It demands solutions that blend permanence with agility, speed with quality, and immediate responsiveness with long-term value. On-Demand facilities offer exactly that: a way to relieve today’s pressures while building an estate strategy that is fit for the future.

As one NHS leader observed during a tour of Darwin Group’s latest On-Demand facility: "It’s extraordinary. You have completely reimagined how to build a hospital."

The pressures on NHS estates are significant, but so is the opportunity to innovate. The Third Way is that opportunity – a pioneering approach that supports the NHS in delivering its objectives now and for decades to come.