TRAINING AND DEVELOPMENT Best practice This ‘healthcare-retrofit lens’ would
see workstream emphasis shift as a project progresses. At Stages 0-1, teams would build a stronger understanding of the asset and site-wide infrastructure, ensuring clinical strategy is better informed. At Stage 2, this knowledge would shape feasible options, reveal wider dependencies and define the true extent of the project boundary. Stages 3-4 would focus on testing assumptions and addressing unresolved risks before construction starts. From Stage 5 onwards, discoveries would be managed through controlled change, with lessons learned informing future estate planning. Carbon, resilience, and whole-life value also need early attention to inform wider strategies and costs – and procurement strategy matters too: influencing when surveys, specialists, enabling-works, and contractors can be brought into the conversation to help reduce uncertainty. By identifying the right workstreams and evaluating risk early, teams can make timely and robust decisions, even when contractor engagement comes later.
The core proposition Front-load knowledge, not just design
Healthcare retrofit needs to front-load knowledge and decision making; more design does not necessarily mean more certainty.
This means strengthening the early RIBA stages with a clearer understanding of the building and wider estate; taking a risk-based approach to surveys and investigations; assessing confidence in available records; and considering clinical continuity and operational constraints early.
Retrofit is often treated as a single response to an immediate need, not always considering how the project fits the estate’s longer-term requirements. Reviewing enhanced Stage 0-1 information alongside a Development Control Plan or
Estate Strategy can help teams consider asset condition, adjacencies, infrastructure capacity and future clinical needs together - before deciding where and how to intervene. This shifts the question from ‘How do we fit this into this building?’ to ‘Is this the right location and intervention for the estate’s future?’. A central NGHN proposal is to create
a focused-resource suite: An Existing Building Brief that can be applied at Stage 1 will establish an agreed account of the asset, its operational dependencies, known constraints and unresolved questions. An accompanying Information-confidence Matrix would distinguish verified conditions, surveyed observations, record-based information, and assumptions. A Risk-based Investigation Plan would identify what needs to be established, when access is possible, and what is defined by the findings. Lessons from completed projects should
always feed-back, helping teams identify the right questions, investigations, and risks for future projects. The aim is to make uncertainty visible early, support better-informed decisions and reduce the likelihood that critical dependencies are
discovered only after developed design or construction is under way.
Our next steps From shared experience to a practical resource
The next step will be to test the principles of the healthcare retrofit overlay with the wider sector. We will compare insights with experience from current and completed projects, identifying where information, decisions, and specialist input are needed earlier.
Our aim is that we produce an
integrated, best-practice resource that strengthens Stage 0 estate assessment and guides establishing the ‘Existing Building Brief’, ‘Information-confidence Matrix’, and ‘Risk-based Investigation Plan’. The resource would:
• Support informed decisions about clinical continuity and responses to
• Embed stage-by-stage healthcare gateway reviews.
reactive clinical projects.
• Facilitate the controlled management of discoveries.
feeding Stage 7 evaluation back into future estate planning.
Healthcare retrofit needs to front- load knowledge and decision making; more design does not necessarily mean more certainty
We want to create a tool that benefits the full project team, not just designers, including clients, consultant, estates teams, and facilities teams. By working together, we can deliver more reliable, knowledge-rich, and future-ready retrofit projects.
November 2026 Health Estate Journal 17
• Improve Estate teams’ understanding of their assets.
• Support operational and clinical readiness beyond practical completion,
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