MJ Medical

The role of design in realising opportunities for the NHS Estate


Against a backdrop of budgetary pressures, on-going quality of care scandals and seismic shifts in commissioning structures, the state of the NHS estate is again coming to the fore in public debate. A recent report by Nigel Edwards, a Senior Fellow at the Kings Fund, makes the point that much of the NHS estate is underutilised and not-fit-for purpose. He argues convincingly that a reconsideration of approach could result in significant opportunities for improvements in both care and value for money.

The long needed refurbishment and renewal of the NHS estate at all levels was facilitated in the 1990’s through an increase in budgetary allocation, as well as the introduction of procurement models that opened up access to new sources of market finance and ‘off balance sheet’ investment. The macroeconomic events of 2008 and the subsequent budgetary elision, along with a growing clamour regarding the apparent lack of value for money privately financed concessionary contracts provided, led to a relatively abrupt drop in the levels of capital investment.

Levels of investment in the NHS estate are likely to face constraints for the foreseeable future. The focus for the deployment of scarce investment should therefore be on maximising the use and usefulness of the resulting facilities. Too many of the development projects undertaken over the last 20 years have prioritised initial capital expenditure considerations over lifetime utilisation and efficiency. In addition, models of care are all too often being design around the buildings in which they are delivered rather than the other way round

As Edwards’ report highlights, the break-neck speed of clinical best-practise and technology development means that much of the resulting design has become sub-optimal in terms of functionally. This means some of the newest parts of the NHS Estate are not fit for purpose or underutilised, thereby wasting significant amounts of resource and investment.

Flexible and responsive spaces are essential in ensuring that efficiency and delivery of cutting edge clinical care are achievable throughout a building’s lifespan. Realising these qualities in a healthcare facility’s design requires a robust approach to estate strategy development, a commitment to gathering evidence based solutions from ‘real-world’ and research sources around the world, knowledge of the direction of travel in terms of future clinical practise and technology, and an innovative and open-mined approach to translating these into a design that supports the associated models of care.

Well-designed healthcare facilities enable the delivery of an optimum quality and quantity of care, and as such exist as the primary financial asset to a healthcare provider. Poorly designed facilities inhibit the achievement of excellence and act as a financial drain. A focus on evidence-based design in the re-configuration or development of healthcare facilities can realise significant financial and quality of care returns. Herein lies the opportunity for the NHS estate.

Nathaniel Hobbs

Director – MJ Medical