THE HEALTHCARE ESTATE Spire Yale Wrexham repurposed business park buildings.
healthcare and retail. There seems to be a real opportunity to bring healthcare services closer to people while providing a shot in the arm to the vitality of our community centres. Healthcare has the potential to act as a new ‘anchor’. Policy to support such an approach has been around since 1996 (Town Centres and Retail Developments (PPG6), 1996, Department of the Environment), and more recent support has come from industry organisations such as the NHS Confederation in its 2020 report, Health on the High Street, and by Professor Sir Mike Richards, in his 2020 report commissioned by the NHS on diagnostics capacity in England, Diagnostics: Recovery and Renewal.
Health on the High Street summarises
discussions from the NHS, local government, community businesses, and a range of invited experts, which highlight the role health can play in supporting economic and social recovery, and, in particular, reimagining our relationship with the high street. In his report, Professor Sir Mike Richards recommends a new
diagnostic model where more facilities are created in free-standing locations, away from main hospital sites, including on the high street, and in retail locations.
A ‘force to bring people together’ On the ground, people are worried that the decline of their high streets, commercial centres, and shopping centres, will have a profound social impact, as these places are the social glue that keeps communities together. But if retail destinations can combine experiences with essential services like healthcare, in a time when ideas of a 15-minute city are taking shape, then a new generation of places can still act as a strong force to bring people together.
Another reason why we are focusing
on reuse in healthcare is the scale of the work that must be done on the existing NHS estate. At the end of 2020/21 the backlog maintenance bill stood at £9.2 bn (NHS Digital). This includes a substantial share of problems (classed as ‘significant’ or ‘high risk’) that require urgent action to avoid harm to both staff and patients.
Second
Entrance / Wait Surgical Inpatient Outpatient Minor Ops
First
Diagnostics / Imaging Ophthalmic Theatres Endoscopy
Ground
Genomic Medicine FM / BoH Plant
Vacant / Future Expansion Basement
Vertical Circulation (stair and lift) Primary Service Riser
Plans of a community hospital made from a repurposed shopping centre with the addition of a lightwell at the core of the building.
100 Health Estate Journal October 2023
The New Hospital Programme (NHP) understandably attracts a lot of attention, but even if all 40 hospitals in the NHP are delivered, it would represent under 10% of the overall NHS estate. Waiting lists are never far from the front pages, and it’s clear that the NHP alone is not the solution to our healthcare issues. Re-use and repair of existing buildings must play a major role in grappling with the critical issues of condition, configuration, and capacity, of healthcare facilities, responding to the continuing shift to decentralise services, and decarbonising the NHS – and it can do so quickly. In 2020 the NHS launched the
Community Diagnostic Centre programme to develop 160 centres across England, and this has acted as a key driver in the move to repurposing buildings on the high street, albeit for one particular kind of healthcare. So, the shift has started, and a range of over 100 facilities have been completed to date, including repurposed facilities. The detail below on how to repurpose buildings for healthcare is hopefully not just of interest to Estates Departments planning their own capital projects, but also to teams looking to take a lease of an existing building from a private developer. Both routes will involve unlocking the potential of existing buildings to save cost, accelerate delivery and – with lease options – look to build in greater financial flexibility.
A typology-specific approach Most of the non-specialist buildings we are repurposing currently are either retail or offices, with both typologies presenting different challenges and opportunities. The buildings we are working with have not been designed with models of care in mind, and often lack flexibility, as they pre-date the ‘long life, loose fit’ approach now widely used in architecture. Some buildings will readily adapt to outpatient consulting, diagnostic, and minor treatment services, but do not have the basic structural, planning, or servicing capacity for a surgical, imaging, or inpatient facility. So, we first assess a building’s suitability around the requirements of each typology and the particular healthcare service model being considered.
Out of the two typologies, we have
found that generally offices are the most challenging to convert to healthcare. This is mainly due to the limited existing staircase provision for means of escape, restrictions in the dimensions of the structural frame, and – often in older masonry buildings – a fenestration pattern of regular ‘punched’ openings. The frame can present a number
of issues: floor-to-underside-of-floor heights can limit the space available to route essential electrical and mechanical
Adrian Lambert
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