Beyond capital: From buildings to system influence in NHS infrastructure (PART 2)

In Part 1, we explored why a neighbourhood health centre isn’t automatically a ‘hub’ - and why real impact begins with understanding the flows, connections, and relationships that already exist in a place.

But even the most connected neighbourhood hub is limited by the wider network it sits in. A single building, however well designed, cannot shift health outcomes alone.

Real change happens when neighbourhood hubs are supported by system-level flows: of people, data, services, investment, and policy.

At this level, infrastructure is no longer just physical assets. It becomes connective tissue, linking neighbourhoods, services, and communities. Scaled across a system, it transforms into influence, strategy, coordination, and leadership.

This is where the NHS has a much bigger role to play.

This role is not just in managing estates, but in shaping the infrastructure networks that health depends on.

Because none of this works unless the right people are having the right conversations about healthy infrastructure - at neighbourhood, place, and system levels.

Infrastructure as connective tissue

Neighbourhood flows matter - between GP practices, parks, community spaces, and health hubs.
System flows matter too - across energy networks, transport corridors, ICBs, NHS Trusts, councils, academic institutions, LEPs and more.

To support both, the NHS estate must shift from managing buildings to using its influence more strategically at scale.

Every estates decision shapes the ecosystem.

Every conversation matters.

Local and system levels influence each other constantly.

Consider how system-level flows influence neighbourhood health:

• Transport routes determine access to care, parks, employment, and community spaces.

• Energy networks determine where services can operate efficiently and affect energy costs for households.

• Local planning decisions shape housing quality, social infrastructure, green space and more.

• Housing providers create homes that will last decades - healthy or otherwise.

Health infrastructure is not just physical assets, or even community or green spaces. It is equally the networks those assets support and the flows they enable.

The NHS: Strategic connector, not just provider

Few organisations have the breadth or reach of the NHS.

Its estate spans towns and cities, covering 25 million square metres across England. Its staff reach every demographic. Its decisions shape health, social, environmental, and economic life.

The NHS is more than a provider or commissioner. It is a strategic connector, a convenor, and a system influencer.

But influence only matters if it is used well. It must be intentional, coordinated, strategic, and continuous.

Leaders must:

• Embed neighbourhood connectivity into planning.

• Align investments and estates decisions with long-term health ambitions.

• Consider projects and regeneration programmes through the lens of system-wide health impact, not organisational convenience.

• Collaborate far beyond health - with housing, transport, planning, education, VCSE partners, and community organisations

And this only works if the right people are in the room having the right conversations about health infrastructure.

This is not about the NHS controlling every project - rather, it is about shaping shared goals, seeding long-term potential, and embedding health at the earliest stages of planning, investment, and regeneration.

Connecting the dots without money

The most powerful part? You don’t need capital to start building bridges.

Relationships. Influence. Conversation. Coordination. These are all infrastructure too.

To start, you just need the right people.

Focus on where progress is possible -  common goals, aligned timelines, motivated partners. This approach doesn’t derail, or seek to control, existing projects or programmes of work – it simply shapes them to embed health-led thinking from the earliest stage, amplifying collective impact.

Don’t let over-analysis stall action. Small steps now will compound over time.

This approach is about acknowledging organisational objectives and shared goals, interpreting them in ‘infrastructure language’, and making the small iterations that scale into systemic improvement.

Use the NHS voice strategically to influence partners with shared objectives. Small, consistent conversations can create interventions that embed health at the earliest stage of regeneration, economic investment, and planning - in both public and private sector activity.

New opportunities appear.

Networks form and strengthen.

Flow improves.

And all of it filters down to neighbourhoods.

Scaling influence should then be simple - sharing wins, normalising collaboration, and showing how neighbourhood-level insights connect to system-wide strategies.

Looking forward and measuring impact

Much of this work is relational, but metrics help make progress visible and feel real. Over time, tracking how residents reach health hubs, the affordability and reliability of energy infrastructure, the use of green spaces, and the number of joint initiatives across NHS, councils, housing, and education reveals where connections succeed, and where infrastructure gaps remain.

These measures give data a clear purpose. They make invisible networks visible, guide smarter investment and planning, and help leaders see how local actions ripple across the system.

Ultimately, they reveal a simple truth. Health is everywhere - embedded in the flows, decisions, and relationships that shape our neighbourhoods.

Health is everywhere

The NHS estate, and wider health infrastructure, is so much more than buildings. Every conversation, policy decision, and local connection is part of the network that shapes health outcomes. When influence flows effectively, the infrastructure system adapts, neighbourhoods connect, and people are healthier.

Ten years from now, will neighbourhoods be connected, or isolated?

Will our system be connected, or siloed?

Boards and system leaders have a choice - embed health at the heart of every infrastructure decision, connect neighbourhoods across geographies, and use influence strategically to build networks, or risk leaving health infrastructure as nothing more than a collection of ageing NHS buildings.

The choice isn’t theoretical.

It’s strategic.

It’s systemic.

And it is needed now.