How can we stop HBNs from falling behind

The alignment of standard room sizes with Health Building Notes (HBNs)00-03 and 11-01 signals a clear intention to ground the neighbourhood health agenda within established design principles from the outset. However, the fact that the industry will require more clarity on which version of the HBN the SoA refers to calls into question the current HBN process.

HBNs exist to provide best practice guidance on the design and planning of new healthcare buildings. The recent SoA states that all standard room sizes are aligned with ‘updated HBN 00-03 and HBN 11-01’. The most recent, publicly available editions of HBN 00-03: Clinical and clinical support spaces and HBN 11-01: Facilities for primary and community care services were published in 2013. Since then, healthcare delivery models, digital integration, infection prevention priorities, and expectations around community-based care have evolved considerably, particularly with the emergence of NHCs as a central policy concept. If elements of the new SoA are informed by unpublished updates or interim revisions, there may be value in making that development process more visible so that designers, trusts, and local authorities can fully understand and engage with the basis for the guidance. Clarity on whether an updated HBN is forthcoming, and on what timescale would be genuinely helpful to the sector.

There is also a broader design challenge worth considering. NHCs are likely to be delivered within existing NHS estate or through the reimagining of high street and community buildings. This raises an important question about the role of HBNs in supporting a more adaptive model of healthcare design. HBNs will need to evolve if they are to truly support the reuse and adaptation of existing buildings, a priority that sits squarely within current estates optimisation and net zero commitments. Guidance that can flex between new-build standards and performance-based criteria for existing buildings would be a meaningful development.

This reflects a broader challenge with the HBN system. Revising national healthcare guidance is necessarily complex, requiring meaningful clinical engagement, technical sign-off across multiple bodies, and the need for robust evidence all take time. However, the pace of revision makes it difficult for guidance to keep up with rapidly evolving service models and estate strategies.

There are useful international examples that may offer ideas for future development. The Australasian Health Facility Guidelines, overseen by the Australasian Health Infrastructure Alliance, operate through a more iterative and transparent model. The system encourages stakeholders, including clinicians, architects, engineers, and healthcare planners to feedback on published guidelines through an online process, with updates issued incrementally rather than through infrequent wholesale revisions. This creates a body of guidance that can respond more dynamically to emerging evidence, operational learning, and changing models of care.

A similar approach could complement the existing HBN framework in England. More modular updating of room requirements or functional content, alongside a structured feedback mechanism for practitioners and clinicians, could help ensure that guidance evolves in closer step with project experience and policy development while retaining the rigour and governance that national standards require.

NHCs represent a significant opportunity within English health estate policy. As the programme develops, there is equally an opportunity to consider how the supporting guidance might evolve alongside it ensuring that future healthcare design standards remain both robust and responsive to change.