Our estate

When we talk about our 'estate,' we mean all the buildings and land NHS Fife uses.

Managing our estate is a big job. it includes over 80 sites, ranging from large acute hospitals like the Vic, community hospitals like St Andrews Hospital, health centres, clinics, laundry sites, administrative buildings, and more.

Our estates and facilities team ensure that these environments are safe, efficient, and fit for purpose. From maintaining critical infrastructure and ensuring compliance with health and safety standards, to delivering catering, cleaning, laundry and portering services, this team plays a vital role in keeping NHS Fife running smoothly every day.

The challenges our estate currently faces

The biggest challenge is that a significant portion of our buildings are old or ageing.

Two thirds are over 30 years old, and over a third are more than 50 years old.

Older buildings generally come with higher maintenance costs and offer more limited clinical, or staff benefit against modern standards. Much of our spending on our estate goes towards energy costs - heat, light, and power - for facilities that no longer meet modern healthcare needs.

This situation presents a dual challenge: with finances tight and new buildings extremely expensive how do we continue to provide high-quality care in our ageing buildings in a way that’s financially and environmentally sustainable?

Figures for 2023/2024 show that we spent around £100m million on our estates and facilities services.

How we’re evolving our estate to meet these challenges

Rationalisation

We’re reviewing all our sites and buildings to see where we can make smarter choices - this is called estate rationalisation.

That means identifying sites and buildings that are no longer fit for purpose or underused and making decisions to close, sell or repurpose them.

By doing so, we can cut down on utility and maintenance costs and re-invest those savings into other services. For example, while buildings like Hayfield House and Cameron House were previously only around 20% occupied, we were able to provide better facilities by relocating staff to more suitable spaces thanks to smarter space planning and collaboration with local partners like Fife Council and Fife College.

In the first year of our Re-form, Transform, Perform initiative to bridge the gap between our projected spending and our funding, we looked at infrastructure and environmental sustainability. Now, in year two, we are aligning our estate strategy with service redesign.

By working closely with our teams across mental health, hospitals, and GP services, we’re reshaping how and where care is delivered. This means we can often reduce the physical space needed without compromising care - freeing up funds for people and services instead of underutilised or ageing bricks and mortar.

Sustainability at its heart

Environmental sustainability is at the heart of our estate’s strategy.

We’re investing in solar panels, LED lighting, and energy-efficient systems that reduce our carbon footprint while also saving money. Our aim by 2030 is to take this further, incorporating climate risk, nature-based solutions, and community energy generation into our long-term planning.

Data-driven decisions

We’re using data to guide our decisions.

Whether it’s analysing bed occupancy to determine future hospital needs, assessing land use or using our strategic asset management system to identify opportunities for improvement.

By making decisions based on data, not assumptions, we can make changes that are realistic, safe, and grounded in need.

Changing the culture for staff bases

We recognise that buildings are more than bricks and mortar—they’re places where people work and connect. But we also know that change can be difficult.

Many people feel a strong connection to their workspace. But by sharing clear information and engaging with staff, we’re building a better understanding of why these changes matter. We want our buildings to be flexible, welcoming, and supportive of how people actually work and deliver care today - not how they may have worked decades ago.

Looking ahead

We view our estate as being more than just a collection of buildings - it’s a catalyst for change.

By modernising our facilities, embracing sustainability, and aligning our infrastructure with service needs, we’re creating a more resilient, efficient, and patient-focused NHS Fife.