TRAINING AND DEVELOPMENT NGHN
RETROFITTING THE RIBA PLAN OF WORK FOR HEALTHCARE
Chloe Madge, Senior Associate and Architect at Stride Treglown, and Kai Xin Tan, Associate and Architect at Fleet Architects, explain how the RIBA Plan of Work can better support the collaborative, evidence-based decision-making needed for healthcare retrofit projects.
Through monthly Working Group sessions, the NextGen Healthcare Network (NGHN) has brought together expert insight and peer discussion to explore how healthcare retrofit projects can better manage risk and uncertainty.
Members’ experiences reveal recurring challenges: incomplete building information, discoveries made too late, and pressure to commit to designs before critical assumptions can be tested. Together, these discussions point to a need for a clearer plan of action to support better-resolved, lower-risk projects.
Conventional application under pressure
Retrofitting an occupied hospital brings risks that extend beyond the site; clinical services may be disrupted, infrastructure resilience affected, and defects exposed in neighbouring departments. The challenge is often not the timeline itself,
but the assumptions underpinning it. A project brief should be grounded in an established clinical need; equally, site selection should be informed by accurately documented existing conditions. This information reduces uncertainty and makes project outcomes more predictable. Historical records may be incomplete and project boundaries rarely align with routes of ventilation, power, drainage or fire systems. Hospitals remain operational so intrusive investigations often need planning around clinical activity. In practice, procurement timelines can be disjointed, delaying specialist input until after important decisions have already been made. A ward refurbishment, for example, may uncover unexpected fire-compartmentation defects, leading to unplanned shutdowns, extra costs, and delayed occupation; the full extent of these consequences is often understood far too late.
A healthcare take on the RIBA Plan of Work
The NGHN ‘Best Practice’ Working Group are developing proposals for a healthcare retrofit overlay to the RIBA Plan of Work, informed by continued working group consultation with its 600-plus members. The RIBA Plan of Work provides a widely understood framework and common project language. The healthcare retrofit challenge is not meeting the stages themselves, but how they are applied when existing conditions, clinical operations, estate infrastructure, and delivery constraints are all closely connected. A healthcare retrofit overlay could interpret RIBA Stages more explicitly; helping clients, estates teams, clinicians, designers, consultants, and contractors work together more effectively.
Workstreams
What should a healthcare retrofit overlay address?
The overlay would retain RIBA stages whilst adding mechanisms which facilitate: stage-specific questions, evidence requirements, risk and assumption registers, controlled feedback loops, and operational acceptance criteria. These mechanisms would align to
continuous workstreams which run across the Plan of Work, helping teams identify what matters at each stage and what needs to be understood before key decisions are made. Provisional workstreams include:
• Existing building & wider estate.
• Clinical & operational continuity & safety.
• Carbon, resilience, & whole-life value. • Compliance & assurance. • Procurement & delivery.
16 Health Estate Journal November 2026
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