Part 3: Heads of Estates
Heads of Estates and Facilities Management play a critical role in the NHS. They bridge the gap between engineering detail and operational delivery, ensuring hospitals remain compliant, safe, and efficient. Their work covers statutory maintenance, PFI contract management, and supporting the Director of Estates and Facilities with technical oversight.Following last week’s look at Directors of EFM, this week turns to the next leadership tier: Heads of Estates. From my research, two distinct personas emerge, both highly competent, both committed, yet shaped by very different experiences and approaches to knowledge sharing.
He brings a measured, methodical, and internally focused approach to leadership. His advice captures his mindset: “Familiarise yourself with the system and its capabilities, and focus on HTM areas where you are knowledgeable.”
Richard’s knowledge-sharing behaviour revolves around regulations, HTMs, and benchmarking from sources such as the Model Hospital. He attends AP refresher courses and technical seminars but finds little time for wider networking. He is frustrated by the lack of board-level representation for EFM and the historically competitive culture between Trusts that limits collaboration.
Natalie began her career as an engineering apprentice in the NHS, working her way up through operational roles before becoming Head of Estates. She combines technical expertise with an HND in Management and Leadership and brings a hands-on, people-first approach to the job.
Her advice reflects that balance: “Build strong working relationships with NHS stakeholders and clinical teams to ensure minimal disruption to other departments.”
Natalie uses HTMs for guidance but also engages actively with professional bodies such as IHEEM and HefmA, attends CPD events, and keeps close contact with suppliers and manufacturers. She’s pragmatic about barriers too, acknowledging that busy schedules, silo working, and the limits of virtual meetings can make collaboration harder. Yet she remains convinced that in-person networking and structured training programmes are key to breaking those silos.
The contrasts between Richard and Natalie reveal two equally valuable but distinct leadership styles within the same role.
Background and Expertise: Both come from engineering, but Richard entered the NHS later in his career after time in the wider public sector, while Natalie has grown within it since apprenticeship. Richard’s expertise is deeply technical and systems-focused; Natalie combines technical competence with relational and leadership skills.
Knowledge Sharing: Richard prefers structured, codified sources such as HTMs and the Model Hospital, whereas Natalie thrives on peer exchange and professional body engagement.
Barriers: Richard feels limited by culture and hierarchy, too few opportunities, too little board visibility. Natalie feels the pinch of time pressure and siloed teams but finds partial remedies in external networking.
Future Focus: Richard calls for large hospitals to share expertise through a Collaboration Hub and for a quarterly ICS-wide forum. Natalie imagines a more interactive, in-person model led by NHSE and industry associations to facilitate real-time knowledge exchange.
Despite these differences, Richard and Natalie share the same foundation. Both are deeply committed to compliance, safety, and continuous improvement. Both see time, culture, and communication barriers as ongoing challenges. Both value their teams and recognise that collaboration is essential to maintaining a safe, resilient estate.
Understanding what really drives Heads of Estates helps us design INNEX around their needs. They are often responsible for interpreting a vast range of guidelines across multiple disciplines, many of which fall outside their formal training. Our platform gives them the ability to search, compare, and understand requirements across areas like electrical safety, water, fire, waste, and medical gases, all in one place.
And the data backs it up. From usage across our deployments, Heads of Estates are among the most active users on INNEX, asking the widest variety of questions across all disciplines. They are the bridge between policy and practice, and the insight from this research helps us build tools that truly fit how they think, learn, and lead.
The Head of Estates role is where operational expertise meets leadership responsibility. These are the people ensuring every switch, pipe, and plant room aligns with national standards. Yet they often do so without the structured networks or recognition available to clinical leaders.
Understanding personas like Richard and Natalie helps identify what different types of leaders need. Some thrive with codified systems and stable processes; others need dialogue and connection. For the NHS to build resilient estates, it must support both – through shared learning, cross-Trust collaboration, and platforms that make expertise visible.
That’s exactly what we’re focusing on through INNEX’s Collaboration Forum, bringing together technical leaders like Richard and networkers like Natalie to share real-world experience, resources, and innovations across the NHS and beyond. If you are interested in joining the forum, sign up to the waiting list here.
Want to dig into the details? Read the full thesis here.