‘FUTURE-PROOFING’ HEALTHCARE FACILITY DESIGN


Aligning the health system with tomorrow’s world


With the NHS having celebrated its 75th anniversary earlier this year, Graham Harris, Principal, and Neil Evans, Associate Principal, at Arcadis, look back at some of the major changes in healthcare provision and buildings over the period, and forward to some of the key steps – including increasing digitalisation and ‘embedding healthcare deeper into the fabric of communities’ – that they believe will help ensure a resilient service, able to cope with changing demographics and demands, in the future.


The ground-breaking NHS marked an incredible 75 years of service on 5 July this year. It has long been a source of tremendous pride for the UK, and – as the world’s first free-at-the-point-of-use healthcare service available to all citizens – set a new standard and blueprint followed by other nations for their own health services. In the three quarters of a century since, the transformation of healthcare – and how we think of healthcare facilities – has been vast. This has gone hand in hand with how we design and build healthcare buildings, which has evolved accordingly to meet changes in the macro landscape, impacting priorities and needs. Architecture and design practitioners have started considering in greater detail than ever before the impact these buildings and facilities have on the staff, patients, and visitors, who use them. They are finding more creative ways to mirror these considerations when updating and maintaining buildings to ensure that they are modern, climate-friendly, energy- efficient, digitally connected, appealing, comforting, and better embedded into their local communities. Crucially, this sets them up for longevity and agility to best serve the principles behind the NHS. The Government has a two-pronged priority – to prevent illness, while simultaneously strengthening public health. We have learned some hard lessons from the COVID-19 pandemic, which put the NHS under enormous strain, and served to highlight where improvements are needed to make our health system fit for purpose in a new era. How can good design complement these efforts and shape the future of our NHS? When it was launched in 1948, the NHS


faced a very particular set of pressures, including a much smaller budget and fewer nurses and doctors, as well as a post-war baby boom to contend with. Back then, the country was acclimatising after the Second World War, rationing was still in force for certain products, and the focus was very much on socio-economic


An aerial view of London’s new Pears Maudsley Centre for Children and Young People.


recovery. There were different kinds of healthcare issues and requirements and, just as advancements in the medical field have seen significant leaps forward over the last 75 years, the way we live has also shifted substantially. Figures from the Office for National


Statistics (ONS) show that people are living an average of 13 years longer today than when the NHS was established. ONS data also reveals that infant mortality has reduced significantly. In 1948 there were 34.5 infant deaths per 1,000 live births, compared with 3.7 in recent years. Amazing breakthroughs in medicine, including new vaccinations coming into effect that have wiped out polio, for instance, have been a real boon for public health.


A contrasting workforce picture According to NHS Digital, a year after the inception of the NHS, there were just over 68,000 nurses in NHS hospitals in England and Wales, and 11,735 doctors and consultants. An extremely contrasting picture to 2022, with 350,600 nurses and 132,900 doctors, with a total NHS workforce of 1.3 million. However, we face multiple new challenges today. Health and social care services are under pressure


and struggling with a multi-billion-pound funding shortfall, affected by economic uncertainty resulting from energy price hikes, inflation, and rising interest rates, the massive hit from the coronavirus, and other factors. Life expectancy dipped for the first time in 40 years during the pandemic, and many are still being treated for longer-term complications arising from the virus. Despite the surge in healthcare


employees over time, patient numbers have grown too, translating into ongoing, acute staff shortages. It is estimated that, unless appropriate industry and policy interventions are made, by 2030/1 the NHS will have a gap of approximately 140,600 nurses. As demand for services continues to exceed available resources, waiting lists reached another record high, jumping to a backlog of almost 7.5 million by May this year. Additionally, as awareness around the


climate crisis has increased, the NHS committed to achieving Net Zero by 2040 with the goal of becoming the first ever Net Zero carbon national health system. The NHS contributes 4% of the nation’s carbon emissions and is, among other things, seeking to slash the environmental footprint associated with its buildings


November 2023 Health Estate Journal 49


Courtesy of Arcadis


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