Why the New Hospital Programme matters for the wider built environment

Healthcare doesn’t always get the attention it deserves from the wider property, design and built environment industry. Yet in the UK right now, it may be one of the most important sectors to be watching.

The New Hospital Programme (NHP) is a case in point. It is now a programme of 46 hospital schemes across England, backed by £9.6bn of funding in the current Spending Review period, with investment expected to rise to around £3bn a year, from 2030.

The government describes it as the biggest hospital-building programme in a generation. More importantly, it is an attempt to rethink not just what we build, but how we design, procure and deliver complex public infrastructure. That makes it much bigger than a healthcare story.

Having spent three decades working across Australia and across sectors – from education and workplaces to civic and cultural projects, as well as healthcare – I’ve seen that the most valuable lessons rarely sit neatly within one sector. Healthcare has its own complexities, but many of the fundamentals are universal. And increasingly, the most useful learning is coming from across borders too: from healthcare systems and projects around the world that are tackling similar questions in different ways.

What feels particularly positive in the UK is that the healthcare industry is opening up to this exchange of ideas. There is a growing willingness to share knowledge, challenge established ways of working and bring different parts of the industry together. The scale of the task is significant, but so is the shared purpose.

The values of the NHS (care, access, dignity and service to communities) are deeply understood and widely respected, and there is a strong desire across the industry to turn that shared ambition into something tangible: hospitals and health environments that genuinely serve their communities and, ultimately, help people heal.

Hospitals are obviously specialist buildings. Acute care has extraordinarily complex operational, technical and clinical requirements, while mental health environments require an entirely different understanding of safety, dignity and wellbeing. But beneath that complexity are some very basic principles of good design: understand the people using a building, make it intuitive, allow it to adapt, design for the long term and involve the people who will operate it from the beginning.

The UK has a particularly important opportunity to apply those lessons now. The NHP’s Hospital 2.0 approach is seeking greater standardisation in hospital design and delivery. That can sound like a constraint on architecture, but it needn’t be. The real opportunity is to standardise what should be standardised, freeing time and investment to focus on what is specific to a place, a community and a model of care.

The same principle applies far beyond hospitals. Previous use of RAAC – Reinforced Autoclaved Aerated Concrete – has also forced uncomfortable questions about how we think about the life of public buildings. The problem with RAAC was not simply a material one; it exposed the consequences of thinking about buildings as completed products rather than long-term assets requiring stewardship, maintenance and adaptation.

The government’s new 10-year capital plan recognises the scale of the challenge, including at least £6.75bn over nine years for repairs, unsafe buildings and maintenance, alongside a £2bn programme addressing RAAC.

That should resonate across the built environment. Schools, universities, offices, housing and civic buildings all face the same fundamental question: can we design and deliver buildings that remain useful as circumstances change?

There is another reason to pay attention. Healthcare could become a testing ground for new approaches to infrastructure finance and delivery. The government’s capital plans now include a proposed new model of public-private partnership for neighbourhood health centres, being developed with NISTA – the National Infrastructure and Service Transformation Authority.

The intention is not simply to return to the old private finance initiative (PFI) model, but to learn from it (including its failures) while exploring how private expertise and investment might support public infrastructure where it can demonstrate value for money. That is a significant development for the whole infrastructure market.

And perhaps the most encouraging change is the increasing collaboration around all of this. The NHP is bringing NHS organisations, designers, contractors and industry together around a more programmatic approach. In July this year, 11 long-term partnerships with contractors were announced to deliver the next phase of hospitals, signalling a move towards greater collaboration and certainty across the supply chain.

After years of fragmentation, that feels important. Next up, the architecture and design community.

Hospitals and other healthcare buildings are civic places, they are the cornerstone of our communities and indeed our society. They can be much more than a forbidding island surrounded by a sea of carparks and confusing pedestrian routes. They can help rejuvenate our city centres and blur the edges of what is hospital and what is high street, playground, library and leisure centre.

Healthcare is not a separate world of design with rules that have little relevance elsewhere. It is a highly concentrated version of the challenges every part of our industry increasingly faces: the ageing assets, constrained resources, changing technology, shifting patterns of use, decarbonisation, workforce pressures and the resounding need to deliver better outcomes from every pound invested.

The UK is currently undertaking one of its biggest experiments in how to respond to those challenges. We should be watching closely – not simply because we need better hospitals, but because if we get this right, the lessons could improve how we design and deliver almost everything else.

Picture credit: Tom Roe