1 British Journal of Healthcare Management | 2022 | https://doi.org/10.12968/bjhc.2022.0042 EDITORIAL © 2022 MA Healthcare Ltd It has long been recognised that many high-income countries, including the UK, have ageing populations. Because older people typically require more frequent access to medical services than younger people, it is no surprise that, as the proportion of older people has increased, demand for healthcare has grown (NHS Providers, 2018). For cynics, it is also no surprise that this increase in demand, although predicted, has not been met with an equivalent increase in supply of healthcare services. Capacity has become a signifcant problem for healthcare services, with at least 22 new hospitals with 800 beds each needed to meet demand by 2027 as a result of the ageing population and the increasing number of people living with long-term conditions (Naylor, 2017). It seems likely that this ageing population trend will continue for the foreseeable future. When demand outstrips supply, one would usually expect to see an increase in price, which has inevitably been the case for countries that rely on private healthcare provision. However, in the NHS, which is free at the point of delivery, such price adjustment is not an option. Instead, other forms of service ‘rationing’, such as growing waiting lists (Ward, 2021), have come into play. This disparity between supply and demand in healthcare existed before March 2020, but was seriously exacerbated by the outbreak of the COVID-19 pandemic. As was the case during other epidemics and pandemics in history, this rapidly-spreading virus caused a surge in demand for medical services. Despite three lockdowns, national and international authorities have (unsurprisingly) found it diffcult to bring the pandemic under control. With the pandemic compounding a long-term need for increased capacity in healthcare, the importance of innovative thinking has never been greater. Indeed, the pandemic has arguably highlighted a lack of long-term, sustainable planning and funding for the NHS, particularly in terms of staffng, equipment and estates. Making NHS estates work In the author’s area of north London, the community has been served by the Chase Farm Hospital, Enfeld, since before the NHS was founded in 1948. However, until the Highlands Wing was built in 1995, the hospital was largely a collection of Victorian buildings, which had become run-down, unattractive and diffcult to maintain. In 2014, Chase Farm Hospital became a constituent of the Royal Free London NHS Foundation Trust which, in a review, discovered a signifcant backlog of patients waiting for elective treatment. Of these patients, the review found that one may have experienced ‘serious harm’, while 39 patients had potentially experienced ‘moderate harm’ as a result of the backlog (Barnes, 2015). This, along with other issues, led to a redevelopment scheme for the site, which was fnanced partly by government (who contributed around £82 million) and partly from the proceeds of selling ‘surplus’ land at the site. Most of the existing buildings were demolished and replaced by a large single building, housing almost all of the department that had previously been in the Victorian buildings or temporary modular units. The redevelopment project began in 2014 and, remarkably, was completed 4 years later in July 2018 (Royal Free London NHS Foundation Trust, 2018). Although building a new hospital can be an option to improve NHS estates and increase capacity, this is usually very time-consuming and may not always be feasible, particularly in areas that lack space. NHS leaders and estates managers have thus looked for ways to increase capacity and allow them to deliver healthcare in line the modern demand for fexible, integrated and convenient care. This has included setting up ‘satellite’ clinics (Tantum and Hill, 2017), using mobile facilities for certain services (such as chemotherapy) (Booth et al, 2021) and, as described in the recent British Journal of Healthcare Management supplement, using modern methods of construction to build modular facilities (Clough, 2021a). How to cite this article: Cohen IK. Making space in the NHS. British Journal of Healthcare Management. 2022. https://doi. org/10.12968/bjhc.2022.0042 Making space in the NHS Ivan K Cohen Author details can be found at the end of this article Correspondence to: Ivan K Cohen; coheni@richmond.ac.uk