Against a background of financial constraints, Lewisham Healthcare and South London NHS Trusts are exploring opportunities to maintain and improve standards. To find the optimum model, we conducted a review of the estate identifying efficiencies, benchmarking and making recommendations to cope with rising demand. Lewisham also asked us to measure the benefits of outsourcing FM services. By talking to staff and shadowing their job roles, we mapped a new specification driven by the ‘best scenario’ outputs. The new contractor has brought investment in new technologies and a commitment to improvement which is streamlining operations and having a positive impact on staff.