Henry Higgins is a Conservative councillor for Hillingdon and founder of Blackridge Planning Insight.

Drive past almost any large hospital in Britain and you’ll see it: a car park nobody uses at weekends, a fenced-off strip of grass, or concrete, or a demolished ward site that has been sat empty for a decade.

NHS England’s own figures show 153 hectares of declared surplus land across the NHS estate, plus another 235 hectares identified as potentially surplus on top. Call it 388 hectares, roughly 540 football pitches of publicly owned land, doing nothing, while the nurses working fifty yards away can’t afford to live anywhere near their own hospital.

This is exactly the kind of problem a centre-right party should be leading on: an asset management problem, on territory that’s supposed to be ours.

We should build key worker housing on spare NHS land, because the NHS already loses more money to the housing crisis than it would ever spend solving it.

Replacing a single trained nurse costs the NHS up to £12,000, NHS Shared Business Services estimates, once you count training and lost productivity. An agency nurse, covering the gap while that recruitment happens, can cost around £100,000 a year, several times a substantive salary. NHS England’s own latest figures put the national vacancy rate at 6.5 per cent (nearly 100,000 full-time-equivalent posts), down from over 121,000 a few years ago. That’s real progress, and it’s worth protecting as the workforce grows.

A May 2023 University of Huddersfield study of South Central Ambulance Service and Berkshire Healthcare NHS Trust staff, commissioned by the Buckinghamshire, Oxfordshire and Berkshire West and Frimley NHS integrated care systems, found that of those who had considered leaving their job in the past year, 61 per cent cited housing and living costs as a reason, and nearly six in ten said their salary simply doesn’t cover housing costs at all. For a Band 2 worker renting alone and running a car, housing, energy and transport combined can eat more than 75 per cent of take-home pay. Housing isn’t sitting alongside the staffing crisis. For a large number of NHS staff, lack of housing is what causes the staffing crisis.

It is far better to keep the land and build housing for NHS staff on it than to sell it for a one-off payment.

If the NHS were to sell the surplus land outright, the current default, NHS England’s own figures put the likely receipt at £717 million, though the same data shows actually disposing of the land would cost an estimated £1.36 billion before that receipt materialises. That’s a single cheque, spent once, land gone for good.

If NHS trusts were to keep the land and build key worker housing instead, the maths changes shape. Strip out access roads and retained clinical space, and there’s a realistic 220 hectares of net developable land within that surplus estate, at the density already proven at Finchley Memorial Hospital, where 130 homes now have consent on surplus land reserved for NHS staff, that’s in the region of 7,700 to 8,800 homes, worth roughly £60 to £83 million a year in rent. The real prize is the vacancies this closes.

Put a number on it: a one-point improvement in retention across the NHS’s 1.6 million-strong workforce means roughly 16,000 fewer staff leaving and needing replacement each year, worth roughly £192 million a year at that £12,000 replacement-cost estimate alone, before counting a single pound of agency cover at up to £100,000 a head. That dwarfs anything the land itself could earn in rent.

None of it works without one unglamorous fix: trusts need to keep what they earn. NHS capital and revenue budgets are currently held separately and centrally constrained under the Capital Departmental Expenditure Limit, and money raised locally doesn’t automatically stay with the trust that generated it. This is an important gap the 2017 Naylor Review flagged nearly a decade ago without it being fixed. If the NHS tried to build the homes without fixing the funding rule this time, the money it earned would be paid over to central government and lost to the health service, and you’d have built a great asset that Whitehall quietly absorbs elsewhere, just as it did last time.

This isn’t hypothetical, and it isn’t just a British idea. Finchley Memorial has consent for 130 staff homes as one of five sites, alongside Croydon University Hospital, Kingston, Sydenham Green in Lewisham and Erith Road in Bexley.

In a live One Public Estate “Homes for NHS Staff” pilot, each backed with £70,000 in feasibility funding. St Ann’s Hospital in Haringey redeveloped 18 acres into a scheme of 934 homes, 22 of which are reserved for a decade, at London Living Rent, for the local mental health trust’s staff.

New South Wales has proven the model at the sharpest end of the problem, rural areas where housing scarcity is the real barrier to recruiting a hospital’s staff. Its Key Worker Accommodation Programme has spent $23 million on on-site housing for health staff across the Murrumbidgee region alone. This is just part of a wider $200.1 million statewide boost to rural health worker accommodation.

Canada and the United States tell the same story. Directly opposite Vancouver General Hospital, a 507-unit healthcare workforce housing scheme is going up with a nomination agreement giving hospital staff priority access.

In Campbell River, British Columbia, a regional government body just opened 20 units of health-professional housing next to the hospital it serves.

Florida’s state housing agency now offers key workers, nurses and paramedics among them, up to $35,000 in down payment assistance through its Hometown Heroes programme.

Britain doesn’t need to invent any of this. It needs to stop treating pilot schemes as the ceiling and start treating proven models as the template.

Every one of these schemes proves the model. None has been allowed to become the default. The real opportunity is that nobody has scaled it yet. We should be good at exactly this: rolling out a proven idea everywhere it applies. A model that already works has no business staying a pilot.

Every trust holding surplus land should be required to bring forward a set proportion for staff housing before any of it is sold to the highest bidder for something else.

Design it once, properly, to a standard, repeatable key worker housing template. This is the same instinct already applied to hospital buildings through the NHS’s Hospital 2.0 programme, so every trust can deploy it without refighting the planning argument from scratch each time. And let trusts keep the rental income, so this becomes a permanent, self-funding asset the NHS controls for good. A receipt, by contrast, can only ever be cashed once.

This is an idea that belongs comfortably in the centre-right tradition. It asks taxpayers for nothing extra, and it needs no new land or new bureaucracy, only trusts using what they already own properly, rewarding thrift over waste and putting staff ahead of slogans. Mrs. Thatcher understood that the best asset is often the one already sitting idle on your own balance sheet, and Britain has 540 football pitches of it, waiting to be built on.